- 1 hour ago
Category
📺
TVTranscript
00:03Surgeons they can change your life forever as they tread the line between life and death we got a bed
00:12What's it really like to hold someone's life in your hands it's miracles and disasters nothing in
00:18between let's get this bugger out and how do you balance the needs of others with the needs of your
00:24family in sweet home you take care and have a good sleep I will do love you mom bye now
00:32we go behind
00:33the mask to find out just what it takes still a minute by bus to live life as a surgeon
00:42bit of a
00:42rollercoaster right yeah it all went really well professor all my race number one
01:0259 year old in the birdie is one of London's top heart surgeons morning you're set he specializes
01:10in keyhole heart surgery and was the first person in the UK to perform a quadruple heart bypass through
01:16keyhole I think I've pretty much seen everything there is to see in cardiac surgery I don't see
01:25surprises anymore after treating nearly 5,000 patients and working for the NHS for 35 years
01:31he's now set up his own clinic you've got my patient here mr. Smith I'm going to be 60 this
01:40year and I
01:42don't know where that number's come from you know we all think we look 25 it's when we look in
01:47the
01:47mirror that we think we're not quite 25 but I do feel this sense of time now it's a sense
01:53of urgency
01:54to get so much more done in such a short period of time so actually I'm busier than I've ever
02:00been today
02:04this afternoon 70 year old Mike has come to see Inder after being diagnosed with severe heart failure
02:11he's come for his final consultation with his wife Sue and daughter Sarah hello oh hello are you set
02:18yeah thank you Mike didn't realize that his shortness of breath and ankle swelling was down to his heart
02:26so he didn't visit a doctor for a few years so when Michael first came to see me when your
02:32dad first
02:32came to see me I mean you said to me that you just thought your feet were getting bigger because
02:36you
02:36were getting older oh yes yes and I was losing the energy because I was getting older the worst
02:41symptom I've had all the way through this has been this cough yeah because the cough of course has
02:47been the thing that stopped me sleeping easily every time I lay down in a proper bed and and so
02:52I've
02:53been sleeping on a chair for the last six months Mike is such a bright man and yet he put
03:00ankle swelling
03:01down to getting older had he recognized that as being a problem we may have picked his problem much
03:06earlier the delay in diagnosis has meant that Mike's heart has severely deteriorated he now needs open
03:15heart surgery to repair or replace three out of his four heart valves two valves will need to be repaired
03:22and one replaced as well as a double bypass to help blood flow around two blocked arteries there's a
03:30risk that Michael could die from this operation it's about 10% but you could perhaps look at it the
03:37other
03:38way around and say well there's a 90% chance that I'm not going to die from this operation and
03:42it's a
03:42matter of perspective but if we don't do anything then what is certain is that this will get worse and
03:49you
03:50get sicker and sicker but I've got some of the best people in that room with me tomorrow Mike
03:57recognized the seriousness of his heart condition I I think he also recognized that without treatment
04:03he wasn't going to do very well in a very short period of time Mike's operation carries risks but if
04:11Inder doesn't operate on Mike soon he won't have long to live you're one of the best people in the
04:17world
04:17to do this so though I'm not looking forward to tomorrow I have placed my life in your homes
04:23we'll look after you I'll see you bright and early good sooner it comes and it's over the best
04:29thanks again good to see you certainly good to see you thank you so much
04:37Mike retired two years ago and lives in Hertfordshire but he used to be an engineer
04:41a practical man needs a garage this is my domain it's quite a good man cave there's a huge huge
04:51amount of memories this mini was one that my mother had and we bought it with a defective engine and
04:58my
04:58father and I took it to bits and we replaced all the bits and it was a lovely engine when
05:03it was finished
05:03so I think that's the sort of job I hope mr birdie does on my heart so it's very serious
05:10with the heart
05:12being a pump it's a very similar thing to a four-stroke engine so yeah I hope he can do
05:17just as good a job as we
05:18did on the mini Mike has five children and has been married to sue for 30 years he's scared he
05:28doesn't he
05:28doesn't admit it but I think he is scared I think anybody would be and I say to him I'm
05:35very selfish
05:36you know it's not just about you Mike I'm scared I'm scared too in a different way
05:51it's just before 7 a.m. at Cromwell Hospital and the day of Mike's heart surgery
06:01on a day that I'm operating I exist in a completely different world I'll wake up early I'll have a
06:08good breakfast because I need to keep my mind clear and then I won't have anything after 6 in
06:11the morning until after the service completed I'm focused specifically on that one individual
06:16that I'm going to operate on just trying to get the right size you can't always get them
06:27you know you need to operate in style
06:43we've got the a team with us today I've put on here the reasons we're doing it symptoms and live
06:50longer yeah it's the key here yeah yeah it is not you signing yourself over to me it's my responsibility
06:55to you once you're happy I just need you to sign print and date this form at the back yep
07:01we're
07:02going to wait until the end of the surgery to decide how well things have gone how are you behaving
07:07to
07:07decide whether we wake you up this evening yes that's right okay any questions at this stage
07:15no I don't think so then at the end of the survey I'll send me another message and then I
07:19will meet
07:19with you on the intensive care unit I'll call you if you're not in the vicinity oh I'm not going
07:25anywhere thank you mr birdie yeah thanks I just don't want you to have to go through this
07:53so I can't go when you do cry that really gets me going because it's all about me of course
07:58yeah
08:00what is the nice shopping for you dad go get some new jump
08:17so what you see here is the mitral valve and this great big red flame represents a jet of blood
08:25inside the heart now when that valve closes closes closes closes nothing should leak
08:32that represents the blood flowing in the wrong direction there's a huge leak there
08:55right thank you
08:59so the biggest risk for Mike here is going to be that we have to do such a lot to
09:04Mike's heart
09:05he's already extremely unwell he's in heart failure every time his heart beats the leaking valves are
09:11just leaking blood the wrong way to fix Mike's three leaking heart valves the surgical team will
09:19temporarily stop his heart first Inder will repair the mitral and tricuspid valves these valves act like
09:27small doors that keep blood flowing in the right direction because they're leaking blood is flowing
09:34backwards Inder will sew a strong support ring around each valve to help them close properly and stop the
09:41leak the aortic valve is too damaged to repair so it will be replaced with a new valve made from
09:49cow
09:49tissue to control blood flow out of the heart once everything is complete Mike's heart will be started
09:58again the biggest concern for me is after we finish the procedure is his heart going to come off the
10:06heart
10:07one machine I'm about to send Susan a message his wife Susan so far so good about to start
10:19her next message from me will be at the end of the procedure
10:24Mike surgery is so complicated Inder has brought to the table some of the best surgeons in the country
10:32Antonas has very expertly opened the breast bones and we see the heart in its full glory together they
10:39have 60 years of experience in heart surgery thanks boss Indonesia stopped Mike's heart so we'll put
10:49him on a heart lung machine that will circulate blood around Mike's body and we'll breathe for him
10:55good so that's working nicely with Mike now connected to the heart lung machine Inder can stop his heart now
11:03we're going to take that clamp off and go on to the heart lung machine happy everybody on to bypass
11:09them
11:09peace as we do that the heart starts to decompress so the machine is now doing the work of the
11:19heart and
11:19the lungs the heart is no longer beating okay good with Mike's heart stopped and fully supported by
11:26the heart lung machine Inder needs to work as quickly as possible on the three faulty valves and the
11:33key for any heart surgeon is to balance perfection with efficiency because the longer on the heart lung
11:39machine the harder it is going to be for Michael to recover from the surgery first Inder needs to repair
11:47the mitral valve he will need to reinforce Mike's misshapen valve by sewing in a cloth shaped ring
11:54now we've got to orientate this the correct way so we're going to be very precise about how this goes
11:58in he attaches strings to the cloth valve ring and also into Mike's mitral valve so the ring can be
12:09carefully slid and secured into the correct position it's delicate work and we're going to slide this
12:16ring into the heart a bit of concentration going on here yeah perfect and there's the mitral valve
12:26looking much more like a proper mitral valve now now we've reshaped it and so hopefully the leaflets
12:31are going to meet again and seal yeah that works nicely next Inder needs to do the same for Mike's
12:40leaking
12:40tricuspid valve and now what we see here is the tricuspid valve and you see how big the annulus is
12:47look
12:47as much it stretches when it's so large that the leaflets this just can't meet these critical things
12:53or the difference between Michael's health and ill health and we're going to stitch something around
13:00here and there we are there it is in place the trickiest moment here I think is going to be
13:08at the
13:09end will this heart work only only time is going to tell that so now we're replacing the aortic valve
13:17finally Inder is replacing Mike's aortic valve with a valve that is made from cow tissue okay sutures
13:23please the cow tissue is very similar to human tissue and is highly durable the aortic valve's been
13:29removed and we're going to parachute the valve into here so the aortic valve's in place doing the job it's
13:36meant to do beautiful all three valves have been repaired or replaced so we're closing the aorta now
13:43it's going to take a lot of pressure this aorta in the end so we have to stitch it very
13:47carefully I've
13:48got to make sure each of these stitches don't leave a hole big enough for blood to leak through with
13:54two
13:54valves successfully repaired and one successfully replaced Mike's aorta his main blood vessel will now
14:01be transporting a lot more blood than it's been used to in the last few months in the needs to
14:07make
14:07sure it's fully sealed perfect happy good with the first part of the operation a success Inder is ready
14:17for the critical moment in the operation to see if Mike's heart will be strong enough to work on its
14:22own without the support of the heart lung machine this clamp has been stopping the heart from getting
14:29any blood I'm taking that clamp off now and resuming normal blood flow so the heart is now gently beginning
14:37to be we're going to come off the heart lung machine now associate over to you so gradually the
14:44hearts taking over the circulation after being on the heart lung machine for three and a half hours Mike's
14:52heart is starting to beat on its own some bleeding going on here but almost straight away Inder notices
14:58some sudden bleeding what exactly coming from the aorta I guess you'll have to go back on to bypass we
15:08got some bleeding going on get your pacing sorted out go back on Mike's heart has to be put
15:12immediately back on the heart lung machine so that Inder and the team can find the cause of the bleed
15:22don't tell me to you it's just blown it sudden bleeding empty out
15:29something's gone here something's just blows pump off the drain please we may have to stop the heart
15:37Simon yeah I need your flow right down empty out I need to have I need to see what's happening
15:42here
15:42is it this this here the bleed doesn't seem to be coming from the repaired valves but from the main
15:50part of the heart the team need to have the blood drain from the heart so they can see where
15:55the bleed is coming from
15:57something is just below yeah it looks like it's ruptured there yeah why don't we just put a finger on
16:03that stop the hole and look at it properly look it's gone here as well
16:06Mike's chest is rapidly filling with blood but Inder can't clearly see where the blood is coming
16:11from okay clamp is on if Inder doesn't find the cause of the bleeding it could be fatal
16:20it's really got a problem here
16:33it just ruptured it just blew just bang
16:37heart surgeon Inder has been operating on 70 year old Mike for four hours
16:43he successfully repaired and replaced his three leaking heart valves but just at the critical moment
16:50as Inder tested to see if Mike's heart could beat on its own
16:54it started to bleed
16:59this is a glue that we're using here to try and reinforce the tissues
17:04the glue should seal and strengthen Mike's tissue
17:07put some blood in the heart please
17:12now he needs to see if the bleeding has stopped so he refills the heart with blood
17:18running well
17:20and takes him off the heart lung machine for the second time
17:23your clamp is now off
17:25Mike's heart is beating again but it has an irregular rhythm
17:30I think we're going to have to shock this
17:31okay we're going to shock the heart
17:34okay
17:37Inder uses the defibrillator to try and shock Mike's heart back to a normal rhythm
17:49I was about 26 when we met
17:53so I was quite young Mike's 12 years older than I am
17:56we worked VT and in my eyes he was very important
18:01we had a job where we had to go around the country in the car
18:05and I remember the first time we went out
18:07it's oh my god what am I going to talk to him I don't know him
18:10I'm not going to have any conversation to talk to him I think we had like a six hour round
18:13trip
18:14and the time just flew by we just got on really well
18:17and just over the months we went on more and more trips and then we found more and more trips
18:23to go on to
18:23together
18:25so I'm very lucky to have found him
18:28and had 30 years of happy marriage with him
18:35come all right now
18:37come all right now
18:42back up
18:47looks better yeah
18:49I think it looks a lot better doesn't it
18:52Inder has successfully shocked Mike's heart
18:54and it's now beating normally
18:57it's gone again
18:59something is not right here
19:01but Mike's heart is still bleeding
19:03I thought we fixed him
19:05these suits should have fixed it
19:06we've really got a problem here
19:08you'll have to go back on to bypass
19:10we've got a big problem
19:15off and drain please
19:18still reeking a bit
19:19I hate to stop the start again
19:23be careful
19:24I think we're going to have to arrest the heart again
19:26it's too bad the blood is too much
19:28give me a cross plant please
19:30we're going to have to stop the heart again
19:35the glue and stitching in the heart isn't working
19:38Inder and his team can't clearly see the cause of the bleed
19:43Inder decides his only option is to stop Mike's heart again
19:49there, there it is
19:51there, there
19:52what's that there
19:54can you give me a pour in this up
19:56there
19:57there's a hole
19:58there's a hole
20:02Inder can see a hole in the aorta
20:04the main part of the heart that takes blood to the rest of the body
20:08I think we have to stop it and open the aorta
20:12we've got a big problem there
20:17we've got no other choice
20:19but to stop the heart and open the aorta
20:23yeah, we're going to have to look from the inside
20:25which is going to be a nightmare
20:28the hole is in an area of the aorta that they can't reach
20:32Inder and his team decide their only and last option
20:35is to open up the aorta to reach and fix the hole
20:40something that could be fatal
20:43there's something very, very bad going on here
20:59because Mike's heart hasn't been working properly for years
21:02his aorta has become drastically weakened
21:06now the valves have been repaired
21:08the blood is flowing at the correct pressure again
21:10but his weakened aorta
21:12isn't strong enough to cope with the pressure
21:16every time his heart is taken off the heart-lung machine
21:18the inner layer is tearing
21:22the aorta's dissected around the back
21:23so we try to repair it on the inside
21:24rather than do anything too complicated
21:27and now we're just closing this aorta up
21:30Inder and his team can't reach around the back
21:32so they sew and attempt to repair the aorta from the inside
21:38seriously, if this doesn't work
21:39we are going to be in really big trouble
21:45with the repair complete
21:47Inder and his team refill the heart with blood
21:50to test if it's worked
21:52ECG is nicely recovering
21:57so we're now gradually just beginning to take
21:59the various pipes out of the heart
22:01and we're going to try and come off the heart-lung machine once more
22:05okay, we're going to come off gently
22:07aim for a systolic about 65-70 to start with
22:12we want to hope that it doesn't tear again
22:15because if it does, we really are
22:17on a hiding to nothing, I think
22:21Mike's heart is taken off the heart-lung machine
22:23for the third time
22:26if his aorta tears again
22:27they might not be able to repair it
22:37looks better, yeah?
22:38yeah
22:39yeah, we're good
22:43the repair appears to be holding
22:46the heart's working well
22:48we've fixed it from the inside
22:50and hopefully it will be okay
22:55it was really unfortunate what we've just suffered
22:57but anyway, it's good having so many eyes and ears here
23:01after six hours in the operating room
23:04Inder and his team have successfully managed to stop the bleeding
23:09well done guys
23:11well done
23:12now it's down to nature
23:14it's down to how nature needs to now help us
23:18help Mike
23:28the bleed might have stopped
23:30but opening up the aorta was a high-risk move
23:33and Inder doesn't know how Mike's heart will recover
23:36his condition is critical
23:40now it's just a case of very, very gently
23:42like the most delicate egg
23:48on your kitchen top
23:49just making sure it doesn't roll onto the floor
23:53yeah, just keeping it up
23:54delicate, delicate, delicate
23:55so no rushing this guy now
23:58so I need to speak to the family
24:00and let them know
24:01we're okay
24:02but we're extremely worried
24:07alright, so
24:09let me sit down
24:10so you're sensible
24:11the operation's taken longer than we anticipated
24:13when we came off the heart law machine
24:16his heart was working really well
24:17and then suddenly there was some bleeding
24:20and we really couldn't understand where it was coming from
24:24and in the end
24:25we had to restock the heart
24:27and open the aorta pie
24:30and we could see what had happened
24:31was the aorta where we had opened it
24:34and it had tore back on itself
24:37we've repaired that
24:39and I wouldn't pretend to say that we're out of trouble
24:41this is plan B, not plan A
24:44and my experience with this is
24:46we've just got to be patient
24:48I've actually never seen this happen before
24:51the best way for me to describe it
24:52is there's three situations
24:54plan A, everything's gone to plan
24:56I'm really happy
24:57plan B, we've had a difficulty
24:59but I think we've got it under control
25:01but he's not out of the woods right now
25:03and C, where I'm really, really worried
25:05and I'm not sure I can get him out of this
25:06I think he's in B
25:08these are things that are in my mind
25:10as possible scenarios at this stage
25:13as part of managing a difficult situation
25:16okay?
25:17So, so long could you know that he's going to be okay?
25:22Is that a difficult question?
25:24It's a difficult question
25:24I don't know the answer to that
25:25but if he has a stable night
25:27and we come in tomorrow
25:29and we're in a situation where we feel
25:31he's been so stable
25:32that we can wake him up from the ventilator
25:34that's going to be important
25:35and then of course the next hurdle
25:37we don't really know
25:39that his brain and his faculties are working
25:41until he wakes
25:46Mike is now being closely monitored
25:49all his family can do
25:50is wait
25:58Mike experienced further complications
26:00with bleeding later in the evening
26:02and required further treatment
26:06he is now recovering in intensive care
26:11you just run through things in your mind
26:13you replay this
26:14you replay that
26:15it's the now not knowing how things are going to go
26:18so I've got to go and see my family this weekend
26:20but I'm going to be completely distracted with it
26:25that's the hard part of being a heart surgeon
26:28the hard part of being a doctor
26:29or anyone in the medical profession
26:32because we all feel it
26:33all of my colleagues will feel it
26:35and the truth of the matter is
26:36we've done everything we can
26:38I'm confident we've made the right assessment
26:40and every time will tell now
26:54it's seven days since Inder performed major open heart surgery on Mike
26:58to repair three faulty heart valves
27:01and bypass two blocked arteries
27:04scans have shown that he doesn't have brain damage
27:06and he's recovering in intensive care
27:11happy birthday to you
27:13have I got to blow it
27:22Inder is turning 60
27:23and has come to Nottingham
27:24his hometown
27:25for a few hours to be with his family
27:28I just wanted to say thank you so much for my birthday
27:30obviously this is a special number
27:33and this has meant so much to me
27:35to see you all today
27:36I'd love to stay but I can't
27:37I have to go back to London
27:39because I've got a patient that needs me
27:41you understand that
27:42you've understood that for years
27:43and I thank you very very much
27:46thank you
27:49I feel old actually to be honest with you
27:5260 years
27:53it's a milestone birthday
27:55he's celebrating with his parents
27:57his wife
27:59his five grandchildren
28:01and three sons
28:03really proud of my dad
28:04it's always going to be a sacrifice to be made
28:06for being successful in your career
28:08be a father of three boys
28:10you'd expect there to be sacrifice of course
28:13I think he's done a great job really
28:15and actually sometimes maybe we haven't realized where maybe he's been under significant stress
28:19with you know patients or
28:20things that are upcoming
28:22and but still able to kind of
28:24be calm and collected let's say
28:30a lot of people think that heart surgery is a really thick skin
28:34we're not actually we're just human beings
28:36and we just feel the same emotions that everyone does
28:38anxiety
28:40insecurity
28:41fear
28:42nervousness
28:43we feel all of those
28:44but somehow we bury them
28:46and I think that's not always a good thing for us
28:49you can't help
28:50but think about how it affects you in your private life as well
28:54I've seen death in my career
28:57all the time
28:58and it's a good thing and a bad thing in a way
29:00because it allows me to always make sure
29:03that I make the most of every moment with every member of my family
29:07because I realize how fragile our life is
29:1959 year old Sarah has come to see Inder with her husband Ashley
29:26after a cut on her finger wouldn't heal
29:28she saw her GP who listened to her chest and picked up a heart murmur
29:35over the last two years
29:37I've had niggles
29:39hello
29:40hello
29:40I put it down to just everyday normal
29:44nice to meet you
29:44nice to meet you
29:45getting older
29:46me too sorry
29:47please come on
29:48lifestyle
29:50three months ago
29:51I ended up going to my GP
29:53with what I thought was the onset of sepsis
29:55because
29:56I'd had a really bad infection
29:58and my heart was palpitating
30:01a doctor picked up a heart murmur
30:03and in investigating that heart murmur
30:05they've picked up the fact that you have at least moderate
30:07possibly severe
30:09mitral valve leakage
30:12tests revealed one of Sarah's heart valves isn't closing properly
30:15so blood is leaking into her heart
30:20the other thing we've noticed
30:21is that the rest of your body is very healthy
30:23if we deal with it early
30:25we can also think about doing procedures
30:27other than just opening the breastbone
30:29to repair this heart valve
30:30call this keyhole mitral valve repair
30:34whatever
30:36you
30:37think needs to be done
30:38is the right thing to be done
30:41let's have a little listen to your heart
30:45because Sarah's faulty mitral valve
30:47has been picked up early
30:48and she's otherwise fit and healthy
30:50she's a good candidate for keyhole heart surgery
30:53very good
30:53you've got a rip roaring murmur there
30:56have I?
30:56yeah
30:57good luck to me
30:58just in the weeks
30:59see you next week
31:03there are two doors of the mitral valve
31:05anterior door
31:06posterior door
31:07and it's the back door that's flipping the wrong way
31:10and letting blood leak backwards
31:11into the smaller chambers of the heart
31:13and then back into the lungs
31:15we've got one chance to get this right
31:17and the good thing about all of that
31:18is we can do it through the keyhole procedure
31:21and that means that we'll be able to get a very good outcome
31:24and a very swift recovery
31:35Sarah lives in North Oxfordshire
31:37with her husband Ashley
31:38and 13 year old daughter Lily
31:42I'm obviously a slightly older mum
31:44I'd like to hope
31:46that I'm a good mum
31:48and I put everything in place for her
31:50that she needs
31:51and will need later on in life
31:55do you want butter Ashley?
31:57yes please darling
32:01Sarah obviously cares about me incredibly
32:05but you know Lily's 13
32:08and she needs a mother basically
32:11and you know what happens if it all goes wrong
32:17we've sat down and we've talked about some of those issues
32:21not issues we really want to talk about
32:23because we want to look at the positives
32:25but yeah you know there is a contingency
32:28that we hope doesn't get used
32:33Lily is
32:42it's the only thing that sets me off
32:44I mention Lily's name
32:45that's it I'm gone
32:51there's no right or wrong way
32:52to sit a child down and say
32:54your mum's going into hospital next week
33:02it's 6.45 in the morning
33:03and the day of Sarah's heart surgery
33:08hello how are you?
33:09I'm good thanks
33:11the team are all here
33:12top team
33:13we're going to do an operation
33:14called keyhole mitral valve repair
33:16this is the one operation
33:18that I do as a heart surgeon
33:19that's going to put you back
33:20on a normal life curve
33:21if I can repair your heart valve
33:22and that's the intention today
33:31I'm hoping that I'm going to
33:34beat all the levels for recovery
33:36and I'm going to be home at the weekend
33:39but let's see
33:46thinking about the surgery
33:48I'm absolutely terrified
33:55my mum was ill when I was little
33:56when I was 13
33:57in fact she passed away
33:58when I was 13
34:00Lily's age
34:04I think should everything go well
34:07good morning
34:08welcome in
34:08we look back
34:11and we just live for every moment
34:14and it won't be manana
34:17it'll be let's do it now
34:18and make the most of life
34:19you might feel something warm in your hand
34:22as we hear these lines
34:25Sarah's the right candidate
34:26for minimally invasive surgery
34:28because she's fit
34:29we've made the diagnosis early
34:32she's got a heart condition
34:33that is amenable
34:34to minimally invasive surgery
34:35stings as it goes in
34:37okay
34:37but then it should just go numb
34:39yeah
34:42to access Sarah's heart
34:44Inder will make a 3cm keyhole incision
34:47between her ribs
34:50using a telescope
34:51and long instruments
34:52he will sew a new cord
34:54into Sarah's mitral valve
34:55to stop the valve leaflet
34:57turning the wrong way
34:59the leaflets
35:00are just like doors
35:01that open and close
35:02to let blood in and out of the heart
35:05he will then sew in a prosthetic band
35:07around the edge of her valve
35:08to reshape and support it
35:11this will stop blood
35:12leaking into her left atrium
35:16I'm expecting Sarah
35:17to be back to normal activities
35:19within a week or two
35:20after a keyhole mitral valve repair
35:24it's an absolute game changer
35:26for patients
35:26to be honest
35:27right
35:27let's go
35:30Sarah has been anaesthetized
35:31and her blood pressure
35:32is being monitored
35:34today
35:34instead of making
35:35a cut through the breastbone here
35:37we're going to make
35:38a small cut
35:38through the side
35:41Inder is accessing
35:42Sarah's heart
35:43by making an incision
35:44between her ribs
35:45this means there will be
35:47less risk of bleeding
35:48and a faster recovery
35:49compared to open heart surgery
35:52so we've made a space
35:53between two of the ribs
35:55and we're going to start
35:56setting Sarah up
35:57for the heart-lung machine
35:59the heart-lung machine
36:00will circulate Sarah's blood
36:02and breathe for her
36:03while Inder stops her heart
36:06okay
36:07everything's connected now
36:08you happy to go on bypass?
36:10happy to go on bypass
36:11good line pressure?
36:12so far so good
36:14yeah that's fine
36:15full flow
36:16okay
36:16lungs off then boss
36:18okay
36:18so now we're on the heart-lung machine
36:20in order to stop this heart
36:22we have to stop blood to the heart
36:24so we're going to put a clamp across here
36:25so the clamp
36:27is now stopping blood
36:28getting to the heart
36:29now you see the heart's beginning
36:30to dissociate and stop
36:35with Sarah's heart stopped
36:37and supported by the heart-lung machine
36:39Inder can make his first keyhole incision
36:41into Sarah's heart
36:43it's going to be a small chamber
36:44this isn't it
36:48gently pass this
36:50very long blade into the chest
36:54okay we're going to open the chamber
36:55of the heart now
36:56Inder is cutting through the main part
36:59of Sarah's heart
37:00and drains her blood
37:02he now needs to repair
37:04Sarah's faulty valve
37:05without damaging
37:06the surrounding blood vessels
37:08thanks boss
37:21at Cromwell Hospital in London
37:23heart surgeon Inder
37:25is an hour into operating
37:26on 59-year-old Sarah
37:30he's made the first cut
37:31into her heart
37:32and needs to repair
37:33a faulty valve
37:34through a keyhole incision
37:40yeah keep doing what you're doing
37:42very carefully
37:43open this here
37:46there's the nitrile valve
37:48and it's full glory
37:50wonderful view
37:53with the glasses on
37:55I'm going to get depth perception
37:58the long thin camera
38:00that Inder has put through
38:01the small incision
38:02gives him a magnified view
38:04of Sarah's heart
38:05on a monitor
38:05and his glasses
38:07make his vision 3D
38:12Sarah's an incredible woman
38:14we've been together now
38:16for just nigh on 23 years
38:18we tried for a child
38:21quite early on
38:23nothing happened
38:23and then surprise surprise
38:25quite a few years later
38:26Lily came along
38:28we had two cats
38:30which were great
38:31but having Lily
38:32coming along
38:33that made the family
38:34hopefully
38:35everything will go well
38:37and we can then
38:38sort of move forward
38:43oh yeah beautiful
38:46so this is the area
38:47of the leaflet
38:47that we think is abnormal
38:48and here
38:50there it is
38:51see it's ruptured
38:56so here's the new string
38:57that we're going to use
38:59it's very slippery
39:00but it's very very strong
39:02and it was going to behave
39:03exactly like
39:06Sarah's
39:06faulty cord
39:08and what we're going to try
39:09and do
39:10is get this needle
39:11into position
39:20to repair Sarah's ruptured valve
39:22first Inder needs to sew
39:24a Gore-Tex cord
39:25into the valve leaflet
39:26to stop it turning
39:28the wrong way
39:31he's using an instrument
39:33that is 30 centimetres long
39:35it would be the equivalent
39:36of sewing with chopsticks
39:39so we've got
39:40see nice and strong
39:41and we're going to put this
39:42into the edge
39:43of that leaflet
39:45next
39:46Inder is using
39:47extra long needle holders
39:49and forceps
39:50to sew a prosthetic band
39:51around Sarah's heart valve
39:53to reshape
39:54and reinforce it
39:56so it looks so big
39:58in the side
39:58but it's so small
39:59in real life
40:00good
40:01okay
40:01so now we'll just
40:02tile these strings
40:06so we're turning
40:07the mitral valve
40:09so that the leaflets
40:11can meet properly
40:14so we've secured
40:15the cord
40:17we've put in
40:17the new band
40:19and now it's the final test
40:21with the cord sewn in
40:22and the valve shape reinforced
40:24Inder inserts a saline solution
40:26to test if the valve
40:28is still leaking
40:30oh
40:31I think I'm happy
40:33so you see
40:34the heart is now
40:35at the moment
40:35full of air
40:36so we're going to
40:37close the chambers
40:37and the next thing to do
40:38is to actually
40:39what we call
40:40de-air the heart
40:41get rid of all the air
40:42so that no air
40:43can go into the brain
40:45so that's the next challenge
40:46that we've got
40:48fill the heart for me please
40:49fill in the heart
40:54and now
40:55the heart will
40:56start
40:56to beat
40:58magic stick
40:59just gently stroke
41:01the heart
41:01sometimes
41:02can help it along
41:04there you are
41:04beginning to
41:08her blood tests are good
41:09we'll try and come off
41:10the heart-lung machine
41:11so that her heart
41:11will then actually
41:12start doing some work
41:14with the valve repaired
41:16Inder is ready to see
41:17how Sarah's heart
41:18will beat
41:18and how her lungs
41:20will breathe
41:20without the support
41:21of the heart-lung machine
41:23beginning to beat now
41:26so the lung is now
41:27that's good
41:28the lung is now up
41:29so
41:31Sarah's lungs
41:32are ventilating
41:33her heart is beating
41:34yeah
41:35okay
41:36okay
41:36we're going to come off
41:36the heart-lung machine now
41:37so gradually
41:40we're going to
41:40reduce the amount of blood
41:42that drains down
41:42these pipes
41:43and so
41:44eventually none will
41:45and so the heart's
41:46then got to do everything
41:49Sarah's heart
41:50is now off
41:50the heart-lung machine
41:51and is beating on its own
41:54and I've got nice white swabs
41:55and so I'm convinced
41:57we don't have any
41:57complication here
41:58with bleeding
41:59so we're going to
42:00take the pipes out
42:04okay
42:06good
42:07thanks everybody
42:08great job
42:10ready
42:10steady
42:14so we've got a good result
42:16she's asleep right now
42:18we'll leave her like that
42:19for a couple of hours
42:20once we're happy
42:21all is good
42:21we'll wake her up
42:22and that's the final thing
42:23to make sure neurologically
42:24she's completely intact
42:25in other words
42:26that her brain
42:26is working perfectly
42:31it's a bumpy road
42:32it's not straightforward
42:33it's major
42:35surgery at the end of the day
42:36you can't pretend
42:37that it isn't
42:39if she wakes up
42:40she's out of the woods
42:42Sarah will spend the night
42:43in intensive care
42:44where she can be
42:45closely monitored
42:53when Inder is not in surgery
42:55or clinic
42:55he spends his time
42:57teaching medical students
42:58in the NHS
43:00today he's in Nottingham
43:01training the next generation
43:03of heart surgeons
43:04teaching students
43:06how to tie knots
43:06with needle holders
43:07that are used in keyhole
43:09heart surgery
43:10you're putting that needle
43:11through a tissue
43:12and you want to just turn it
43:13that little bit more
43:14you can do it in your hand
43:14go home and watch
43:15Coronation Street
43:16whatever TV you like
43:17sit and do that
43:18every day
43:19it'll become natural
43:20yeah
43:23I used to stitch
43:24on an orange
43:25every evening
43:26for an hour or two a day
43:28every single evening
43:29I would just do it
43:30so when I was in theatre
43:31it just felt natural
43:34it feels great
43:34to pass this on
43:35to younger generations
43:37I've got no plans
43:38to retire
43:38anytime soon
43:40I think that I'll be
43:41doing something
43:42when I'm 80
43:42what it is I'll be doing
43:43when I'm 80
43:44if I live that long
43:44I don't know yet
43:45but there'll always
43:46be something
43:49being a doctor
43:50is an identity
43:51and I think when people
43:53lose their identities
43:54that's when they
43:55lose themselves
43:58being a surgeon
43:59it's who I am
44:00it's who I was
44:01always meant to be
44:03and who I always
44:04will be
44:08you
44:17you
44:18you
44:18you
44:18you
44:18you
Comments