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00:02Surgeons they can change your life forever as they tread the line between life and death we got a bed
00:11What's it really like to hold someone's life in your hands it's miracles and disasters nothing in between
00:19And how do you balance the needs of others with the needs of your family
00:30Love you mom. Bye now. We go behind the mask to find out just what it takes
00:36To live life as a surgeon
00:42It all went really well professor Omar is number one
01:0159 year old in the birdie is one of london's top heart surgeons
01:06Morning
01:07You're set
01:08He specializes in keyhole heart surgery and was the first person in the uk to perform a quadruple heart bypass
01:15through keyhole
01:18I think I've pretty much seen
01:19Everything there is to see in cardiac surgery. I
01:23Don't see surprises anymore after treating nearly 5,000 patients and working for the NHS
01:30For 35 years. He's now set up his own clinic
01:34You got my patient here mr. This is 101 mr. Smith. Yeah, I'm going to be 60
01:39This year and I don't know where that numbers come from
01:43You know, we all think we look 25. It's only we look in the mirror that we think well not
01:48quite 25
01:49But I do feel this sense of time now. It's a sense of urgency
01:54To get so much more done in such a short period of time. So
01:57Actually, I'm busy than I've ever been today
02:03This afternoon 70 year old mike has come to see inda after being diagnosed with severe heart failure
02:10He's come for his final consultation with his wife sue and daughter sarah
02:15Hello. Oh, hello. Are you set? Yeah, not a bad one through michael. Thank you
02:21Mike didn't realize that his shortness of breath and ankle swelling was down to his heart
02:25So he didn't visit a doctor for a few years
02:29So when michael first came to see me when your dad first came to see me
02:32I mean you said to me that you just thought your feet were getting bigger because you were getting older.
02:36Oh, yes
02:37Yes, and I was losing the energy because I was getting older the worst symptom
02:41I've had all the way through this has been this cough
02:43Yeah, because the cough of course
02:45It's been the thing that stopped me sleeping easily
02:49Every time I lay down in a proper bed and and so I've been sleeping on a chair for the
02:54last six months
02:56Mike is such a bright man and yet he put ankle swelling down to getting older
03:01Had he recognized that as being a problem we may have picked his problem much earlier
03:06The delay in diagnosis has meant that mike's heart has severely deteriorated
03:13He now needs open heart surgery to repair or replace three out of his four heart valves
03:19Two valves will need to be repaired and one replaced as well as a double bypass to help blood flow
03:26around two blocked arteries
03:29There's a risk that Michael could die from this operation
03:33It's about 10 percent
03:35But you could perhaps look at it the other way around and say well
03:38There's a 90 chance that I'm not going to die from this operation and it's a matter of perspective
03:43But if we don't do anything
03:46Then what is certain is that this will get worse and you get sicker and sicker
03:51But I've got some of the best people in that room with me tomorrow
03:56Mike recognized the seriousness of his heart condition
04:00I think he also recognized that without treatment
04:03He wasn't going to do very well in a very short period of time
04:08Mike's operation carries risks
04:10But if inda doesn't operate on mike soon, he won't have long to live
04:15You're one of the best people in the world to do this so though i'm not looking forward to tomorrow
04:20I have placed my life in your homes. We'll look after you i'll see you bright and early
04:25Good the sooner it comes and it's over the better
04:29Thanks again good to see you it's really good to see you thank you so much
04:36Mike retired two years ago and lives in hertfordshire
04:39But he used to be an engineer a practical one needs a garage
04:44This is my domain
04:46It's quite a good man cave
04:49There's a huge huge amount of memories this mini was one that my mother had and
04:55We bought it with a defective engine and my father and I took it to bits and we replaced all
05:00the bits
05:01And it was a lovely engine when it was finished. So I think that's the sort of job
05:06I hope mr birdie does on my heart
05:09So it's very with the heart being a pump. It's a very similar thing to a four-stroke engine
05:15So yeah, I hope he can do just as good a job as we did on the mini
05:20Mike has five children and has been married to sue for 30 years
05:26He's scared
05:27Yeah, he doesn't he doesn't admit it, but I think he is scared
05:31I think anybody would be
05:33And I say to him i'm very selfish, you know, it's not just about you mike
05:38I'm scared i'm scared too
05:41In a different way
05:50It's just before 7am at cromwell hospital and the day of mike's heart surgery
05:55Hello
05:56Good morning
05:57I've got a procedure of mr birdie today
06:01On a day that i'm operating i exist in a completely different world
06:06I'll wake up early i'll have a good breakfast because i need to keep my mind clear
06:09And then i won't have anything after six in the morning until after the service completed and focus specifically on
06:15that one individual that i'm going to operate on
06:19Just trying to get the right size
06:22You can't always get them
06:26You know you need to operate in style don't you
06:32Hello mr bird
06:33Hello mr bird
06:34Good morning
06:34It's good to see you
06:35Yeah it's good to see you yeah
06:37You all okay
06:38Hello yes good time
06:39Did you sleep well
06:40Not very
06:41One hour and 80 minutes
06:43We've got the a team with us today
06:45I've put on here the reasons we're doing it symptoms and live longer
06:50Yeah
06:50That's the key here
06:51Yeah
06:51Yeah
06:52It is not you signing yourself over to me it's my responsibility to you
06:55Once you're happy i just need you to sign print and date this form at the back
07:00Yep
07:01We're going to wait until the end of the surgery to decide how well things have gone
07:05How well you're behaving to decide whether we wake you up this evening
07:09Yes
07:09That earns rights
07:10Okay
07:11Any questions on this stage
07:14No i don't think so
07:16Then at the end of the surgery i'll send me another message and then i will meet with you
07:19On the intensive care unit or call you if you're not in the vicinity
07:23Oh i'm not going anywhere
07:25Thank you mr birdie
07:27It's good luck
07:28Yeah thanks
07:38I just don't want you to have to go through this
07:45I'm being silly now
07:50I'm going to be crying
07:53Don't i can't cope when you cry that really gets me going because it's all about me of course
07:59Yeah
08:00Would you do some nice shopping for your dad
08:02Go and get some new jumper
08:03Get me a new jumper
08:05Check there's no holes in the sleeve
08:06We'll get you a chocolate orange for when you feel better
08:12Oh i can't wait to see you later
08:17So what you see here is the mitral valve and this great big red flame represents a jet of blood
08:24inside the heart
08:26Now when that valve closes closes closes closes nothing should leak
08:32That represents the blood flowing in the wrong direction
08:36There's a huge leak there
08:40Love you too
08:41Yeah i'll be telling you the posting well
08:47You're going to be fine
08:49You're going to be fine
08:50You're going to be fine
08:50You're going to be fine
08:50All right
08:51Come in
08:51Say something
08:55Right
08:55Thank 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
09:04He's already extremely unwell
09:06He's in heart failure every time his heart beats
09:09The leaking valves are just leaking blood the wrong way
09:14To fix mike's three leaking heart valves the surgical team will temporarily stop his heart
09:21First inda will repair the mitral and tricuspid valves
09:26These valves act like small doors that keep blood flowing in the right direction
09:31Because they're leaking blood is flowing backwards
09:35Inda will sew a strong support ring around each valve to help them close properly and stop the leak
09:42The aortic valve is too damaged to repair so it will be replaced with a new valve made from cow
09:48tissue to control blood flow out of the heart
09:54Once everything is complete mike's heart will be started again
10:00The biggest concern for me is after we finish the procedure is his heart going to
10:05Come off the heart one machine
10:07I'm about to send susan a message his wife susan so far so good about to start
10:18Her next message from me will be at the end of the procedure
10:23Mike surgery is so complicated inda has brought to the table
10:27Some of the best surgeons in the country
10:31Antanas has very expertly opened the breast bones and we see the heart in its full glory
10:38Together they have 60 years of experience in heart surgery
10:43Thanks boss
10:46Inda needs to stop mike's heart so we'll put him on a heart lung machine that will circulate blood around
10:51mike's body
10:52And will breathe for him
10:54Good so that's working nicely
10:57With mike now connected to the heart lung machine inda can stop his heart
11:02Now we're going to take that clamp off and go on to the heart lung machine happy everybody on to
11:08bypass them piece
11:11As we do that the heart starts to decompress
11:16So the machine is now doing the work of the heart and the lungs the heart is no longer beating
11:22okay good
11:23With mike's heart stopped and fully supported by the heart lung machine inda needs to work as quickly as possible
11:29on the three faulty valves
11:32And the key for any heart surgeon is to balance perfection with efficiency because the longer on the heart lung
11:38machine
11:40The harder it is going to be for michael to recover from the surgery
11:45First inda needs to repair the mitral valve
11:48He 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
11:57in
12:01He attaches strings to the cloth valve ring and also into mike's mitral valve
12:07so the ring can be carefully slid and secured into the correct position
12:12it's delicate work
12:14and we're going to slide this ring into the heart
12:17a bit of concentration going on here
12:23perfect
12:24and there's the mitral valve looking much more like a proper mitral valve now now we've reshaped it and so
12:29hopefully the leaflets are going to meet again and seal
12:34yeah that works nicely
12:37next inda needs to do the same for mike's leaking tricuspid valve
12:41and now what we see here is the tricuspid valve and you see how big that annulus is look how
12:46much it stretches when it's so large that the leaflets this just can't meet
12:51these critical things are the difference between michael's health and ill health we're going to stitch
12:58something around here
13:03and there we are there it is in place the trickiest moment here i think is going to be at
13:08the end
13:08will this heart work only only time's going to tell that so now we're replacing the aortic valve
13:16finally inda 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
13:42it's going to take a lot of pressure this aorta in the end so we have to stitch it very
13:46carefully
13:47i've got to make sure each of these stitches don't leave a hole big enough for blood to leak through
13:53with two valves successfully repaired and one successfully replaced mike's aorta his main
13:59blood vessel will now be transporting a lot more blood than it's been used to in the last few months
14:05inda needs to make sure it's fully sealed perfect happy good with the first part of the operation a
14:15success inda is ready for the critical moment in the operation to see if mike's heart will be strong
14:21enough to work on its own without the support of the heart lung machine this clamp has been stopping
14:27the heart from getting any blood i'm taking that clamp off now and resuming normal blood flow
14:35so the heart is now gently beginning to beat we're going to come off the heart lung machine now
14:40so shane over to you so gradually the heart's taking over the circulation
14:47after being on the heart lung machine for three and a half hours mike's heart is starting to beat
14:52on its own some bleeding going on here but almost straight away inda notices some sudden bleeding
15:01where's that coming coming from the aorta i guess you'll have to go back on to bypass we've got some
15:07bleeding going on get your pacing sorted out go back on mike's heart has to be put immediately back
15:12on the heart lung machine so the inda and the team can find the cause of the bleed
15:21don't tell me the earl just has blown it sudden bleeding empty out
15:28something's gone here something's just blown pump off the drain please we may have to stop the heart
15:36simon yeah i need your flow right down empty out i need to have a i need to see what's
15:41happening here
15:41is it this this here
15:45the bleed doesn't seem to be coming from the repaired valves but from the main part of the heart
15:51the team need to have the blood drained from the heart so they can see where the bleed is coming
15:55from
15:57something has just blown yeah it looks like it's ruptured there yeah
16:00yeah why don't we just put a finger on that stop the heart look at it properly look it's gone
16:04on here
16:05as well mike's chest is rapidly filling with blood but inda can't clearly see where the blood is coming
16:11from okay clamp is on if inda doesn't find the cause of the bleeding it could be fatal clearly got
16:20a
16:33problem here
16:33i just watched it it just blew just bang
16:37heart surgeon inda has been operating on 70 year old mike for four hours
16:42he successfully repaired and replaced his three leaking heart valves but just at the critical moment
16:49as inda tested to see if mike's heart could beat on its own it started to bleed
16:57require glue please this is a glue that we're using here to try and reinforce the tissues
17:03the glue should seal and strengthen mike's tissue put some blood in the heart please
17:11now he needs to see if the bleeding has stopped so he refills the heart with blood
17:17running well and takes him off the heart lung machine for the second time okay your clamp is now
17:24off mike's heart is beating again but it has an irregular rhythm i think we're going to have to shock
17:30this okay we're going to shock the heart okay inda uses the defibrillator to try and shock mike's
17:39heart back to a normal rhythm
17:48i was about 26 when we met so i was quite young mike's 12 years older than i am
17:56we worked vt and in my eyes he was very important we had a job where we had to go
18:02around the country in
18:03the car and i remember the first time we went out it's oh my god what am i going to
18:08talk to him i
18:08don't know him i'm not going to have any conversation to talk to him i think we had like a
18:12six hour round
18:12trip and the time just flew by we just got on really well and just over the months we we
18:19went on
18:20more and more trips and then we found more and more trips to go on to together so very lucky
18:26to have
18:26found him and had 30 years of happy marriage with him
18:34flow right down
18:41back up
18:47looks better yeah i think it looks a lot better doesn't it
18:50hmm inda has successfully shocked mike's heart and it's now beating normally
18:57it's gone again something is not right here
19:01but mike's heart is still bleeding i thought we fixed it these sutures should have fixed it
19:06we've really got a problem here you'll have to go back on to bypass we've got a big problem
19:17it's still leaking a bit i hate to stop the start again be careful i think we're going to have
19:24to
19:25arrest the heart again it's too bad the blood is too much give me a cross clamp please we're going
19:30to have to stop the heart again
19:34the glue and stitching in the heart isn't working
19:38inda and his team can't clearly see the cause of the bleed
19:42inda decides his only option is to stop mike's heart again
19:48there there it is there there what's that there
19:54can you give me a polysucker there there's a hole there's a hole there
20:01inda can see a hole in the aorta the main part of the heart that takes blood to the rest
20:06of the
20:07body i 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 but to stop the heart and open the aorta
20:23yeah we're gonna have to look from the inside which is gonna be a nightmare
20:27the hole is in an area of the aorta that they can't reach inda and his team decide their only
20:34and last
20:34option is to open up the aorta to reach and fix the hole something that could be fatal
20:42well there's something very very bad going on here it's a tear isn't it see it's in the section
20:49looks nasty
20:52it's never been here before
20:58because mike's heart hasn't been working properly for years his aorta has become drastically weakened
21:06now the valves have been repaired the blood is flowing at the correct pressure again
21:10but his weakened aorta isn't strong enough to cope with the pressure
21:15every time his heart is taken off the heart lung machine the inner layer is tearing
21:21aorta's dissected around the back so we try to repair on the inside rather than do anything too
21:25complicated and now we're just closing this aorta up inda and his team can't reach around the back
21:32so they sew and attempt to repair the aorta from the inside seriously if this doesn't work we
21:39are going to be in really big trouble
21:45with the repair complete inda and his team refill the heart with blood to test if it's worked
21:52ecg is nicely recovered
21:56so we're now gradually just beginning to take the various pipes out of the heart
22:00and we're going to try and come off the heart lung machine once more
22:05okay we're going to come off gently aim for a systolic about 65 70 to start with
22:11we're going to hope that it doesn't tear again because if it does we really are
22:17on a hiding to nothing i think
22:20mike's heart is taken off the heart lung machine for the third time
22:25if his aorta tears again they might not be able to repair it
22:36looks better yeah yeah yeah we're good
22:42the repair appears to be holding the heart's working well we fixed it from the inside and
22:50hopefully it will be okay it was really unfortunate what we just suffered but anyway it's good having
22:59so many eyes and ears here after six hours in the operating room inda and his team have successfully
23:05managed to stop the bleeding hold on guys hold on now it's down to nature it's down to how nature
23:16needs to now help us help mike
23:28the bleed might have stopped but opening up the aorta was a high risk move and inda doesn't know how
23:34mike's heart will recover his condition is critical now i wish just a case of very very gently like
23:42um like you like the most delicate egg on your kitchen top just making sure it doesn't roll onto
23:51the floor you know just keeping it up delicate delicate delicate so no rushing this guy now
23:57so i'll need to speak to the family and let them know we're okay but we're extremely worried
24:06all right so um let me sit down so you're sensitive the operation has taken longer than we'd anticipated
24:13when we came off the heart long machines his heart was working really well and then suddenly there was
24:18some bleeding and we really couldn't understand where it was coming from and in the end we had to
24:26restock the heart and open the aorta pi and we could see what had happened was
24:32the aorta where we had opened it and it had tore back on itself we've repaired that and i wouldn't
24:39pretend to say that we're out of trouble this is plan b not plan a and my experience with this
24:46is we've
24:46just got to be patient i've actually never seen this happen before the best way for me to describe
24:52it is there's three situations plan a everything's going to plan i'm really happy plan b we've had a
24:58difficulty but i think we've got it under control but he's not on boards right now and c is where
25:03i'm really really worried and i'm not sure i can get him out of this i think he's in in
25:07b these are
25:08things that are in my mind as possible scenarios at this stage as part of managing a difficult situation
25:15okay okay so long ago you know that he's going to be okay is that a difficult question okay i
25:24don't
25:24like the answer to that but if he has a stable night and we come in tomorrow and we're in
25:29a situation
25:30where we feel he's been so stable that we can wake him up from the ventilator that's going to be
25:34important
25:34at some point and then of course the next hurdle we don't really know that his brain
25:39and his faculties are working until he wakes
25:45mike is now being closely monitored all his family can do is wait
25:58mike experienced further complications with bleeding later in the evening
26:02and required further treatment he is now recovering in intensive care
26:11you just run through things in your mind you replay this you replay that it's the now not knowing how
26:16things are going to go so i'm going to go and see my family this weekend but i'm going to
26:20be completely
26:21distracted with it and that's that's the hard part of being a heart surgeon the hard part of being a
26:29doctor or anyone in the medical profession because we all feel it all of my colleagues will feel it
26:34and the truth of the matter is we've done everything we can
26:38i'm confident we've made the right assessment and
26:42i think time will tell now
26:53it's seven days since inda performed major open heart surgery on mike to repair three faulty heart
27:00valves and bypass two blocked arteries scans have shown that he doesn't have brain damage
27:06and he's recovering in intensive care
27:08happy birthday
27:11happy birthday
27:17happy birthday
27:19have i got to blow it inda is turning 60 and has come to nottingham his hometown
27:24for a few hours to be with his family i just wanted to say thank you so much for my
27:29birthday
27:30obviously this is a special number and this has meant so much to me to see you all today i'd
27:36love
27:36to stay but i can't i have to go back to london because i've got a patient that needs me
27:40you
27:41understand that you've understood that for years and i thank you very very much thank you
27:48i feel old actually to be honest with you 60 years it's a milestone birthday
27:55he's celebrating with his parents his wife his five grandchildren and three sons really proud of my
28:03dad it's always going to be a sacrifice to be made for and to be successful in your career be
28:08a
28:08father of three boys you'd expect this to be sacrificed of course i think he's done a great
28:13job really and actually sometimes maybe we haven't realized where maybe he's been under significant
28:18stress with you know patients or things that are upcoming and but still able to kind of be calm and
28:25collected let's say
28:29a lot of people think that heart surgeons are really thick skin
28:33we're not actually we're just human beings and we just feel the same emotions that everyone does
28:38anxiety insecurity fear nervousness we feel all of those but somehow we bury them and i think that's
28:46not always a good thing for us you can't help but think about how it affects you in your private
28:51life as
28:52well i've seen death in my career all the time and it's a good thing and a bad thing in
28:59a way because
29:00it allows me to always make sure that i make the most of every moment with every member of my
29:05family
29:06because i realized how fragile life is
29:1959 year old sarah has come to see inda with her husband ashley
29:25after a cut on her finger wouldn't heal she saw her gp who listened to her chest and picked up
29:31a heart
29:34murmur
29:34over the last two years i've had niggles hello hello i put it down to just everyday normal nice
29:44to meet you getting older
29:48lifestyle three months ago i ended up going to my gp with what i thought was the onset of sepsis
29:55because um i'd had a really bad infection and my heart was palpitating a doctor picked up a heart
30:02murmur and in investigating that heart murmur they've picked up the fact that you have at least
30:06moderate possibly severe mitral valve leakage
30:11tests revealed one of sarah's heart valves isn't closing properly so blood is leaking into her heart
30:19the other thing we've noticed is that the rest of your body is very healthy if we deal with it
30:23early we can also think about doing procedures other than just opening the breastbone to repair this
30:29heart valve call this keyhole mitral valve repair whatever you think needs to be done is the right thing
30:39to be done let's have a little listen to your heart because sarah's faulty mitral valve has been picked up
30:47early and she's otherwise fit and healthy she's a good candidate for keyhole heart surgery very good
30:53you've got a you've got a rip roaring murmur there have i yeah good messi nick just in your mix
30:59see you next week
31:03there are two doors of the mitral valve anterior door posterior door and it's the back door that's
31:08flipping the wrong way and letting blood leak backwards into the smaller chambers of the heart and then back into
31:13the lungs
31:15we've got one chance to get this right and the good thing about all of that is we can do
31:18it through
31:18the keyhole procedure and that means that we'll be able to get a very good outcome and a very swift
31:24recovery
31:35Sarah lives in north oxfordshire with her husband ashley and 13 year old daughter lily
31:41i'm obviously a slightly older mum i'd like to hope that i'm a good mum and i put everything in
31:49place for
31:49her that she needs and will need later on in life do you want butter ashley oh yes please darling
32:01sarah obviously cares about me incredibly but you know lily's 13 and she needs a mother basically
32:11and you know what happens if it all goes wrong we've sat down and we've talked about some of those
32:20issues
32:21not issues we really want to talk about because we want to look at the positives
32:25but yeah that you know there is a contingency that we hope doesn't get used lily is
32:41it's the only thing that sets me off i mention lily's name that's it i'm gone
32:50there's no right or wrong way to sit a child down and say your mum's going into hospital next week
33:01it's 6 45 in the morning and the day of sarah's heart surgery
33:07hello how are you i'm good thanks yeah the team are all here top team we're going to do an
33:13operation
33:13called keyhole mitral valve repair this is the one operation that i do as a heart surgeon that's going
33:19to put you back on a normal life curve if i can repair your heart valve and that's the intention
33:23today yeah
33:24what do you see you soon see you shortly okay thank you
33:31i'm hoping that i'm going to beat all the levels for recovery
33:37and i'm going to be home at the weekend but let's see
33:45thinking about the surgery i'm absolutely terrified
33:54my mum was ill when i was little when i was 13. in fact she passed away when i was
33:5813. lily's age
34:03i think should everything go well
34:09we look back and we'll just live for every moment and uh it won't be manana it'll be let's do
34:17it now
34:17and make the most of life you might feel something warm in your hand as we uh clear these lines
34:24sarah's the right candidate for minimally invasive surgery because she's fit we've made the diagnosis
34:31early she's got a heart condition that is amenable to minimally invasive surgery stings as it goes in
34:36okay but then it should just go now now to access sarah's heart inda will make a three centimeter keyhole
34:46incision between her ribs using a telescope and long instruments he will sew a new cord into sarah's
34:54mitral valve to stop the valve leaflet turning the wrong way the leaflets are just like doors that open
35:01and close to let blood in and out of the heart he will then sew in a prosthetic band around
35:07the edge
35:07of her valve to reshape and support it this will stop blood leaking into her left atrium
35:15i'm expecting sarah to be back to normal activities within a week or two
35:19after a keyhole mitral valve repair it's an absolute game changer for patients to be honest
35:26right let's go sarah has been anesthetized and her blood pressure is being monitored
35:33today instead of making a cut through the breastbone here we're going to make a small cut through the
35:39side inda is accessing sarah's heart by making an incision between her ribs
35:45this means there will be less risk of bleeding and a faster recovery compared to open heart surgery
35:51so we've made a space between two of the ribs and we're going to start setting sarah up for the
35:56heart-lung machine the heart-lung machine will circulate sarah's blood and breathe for her while inda
36:03stops her heart okay everything's connected now you happy to go on bypass good line pressure so far so
36:12good yeah that's fine full flow okay lungs off then boss okay so now we're on the heart-lung machine
36:20in order to stop this heart we have to stop blood to the heart so we're going to put a
36:24clamp across
36:25here so the clamp is now stopping blood getting to the heart now you see the heart's beginning to
36:30dissociate and stop
36:35with sarah's heart stopped and supported by the heart-lung machine
36:38inda can make his first keyhole incision into sarah's heart it's going to be a small chamber
36:43this isn't it gently pass this very long blade into the chest
36:53okay we're going to open the chamber of the heart now inda is cutting through the main part of sarah's
36:59heart and drains her blood he now needs to repair sarah's faulty valve without damaging the surrounding
37:07blood vessels thanks boss
37:20at cromwell hospital in london heart surgeon inda is an hour into operating on 59 year old sarah
37:29he's made the first cut into her heart and needs to repair a faulty valve through a keyhole incision
37:39yeah keep doing what you're doing very carefully open this here
37:46there's the nitrile valve and it's full glory
37:50wonderful view
37:53with the glasses on i'm going to get depth perception
37:58the long thin camera that inda has put through the small incision
38:02gives him a magnified view of sarah's heart on a monitor and his glasses make his vision 3d
38:11sarah's an incredible woman we've been together now for just nigh on 23 years we tried for
38:19a child quite early on nothing happened and then surprise surprise quite a few years later lily came
38:26along we had two cats which were great but having lily coming along that that made the family hopefully
38:35everything will go well and we can then sort of move forward
38:43oh yeah beautiful so this is the area of the leaflet that we think is abnormal and here
38:50there it is see it's ruptured
38:56so here's the new string that we're going to use it's very slippery but it's very very strong and it
39:02is going to behave exactly like sarah's faulty cord and what we're going to try and do is get this
39:10needle
39:10into position
39:19to repair sarah's ruptured valve first inda needs to sew a gore-tex cord into the valve leaflet
39:26to stop it turning the wrong way
39:31he's using an instrument that is 30 centimeters long
39:35it would be the equivalent of sewing with chopsticks
39:38so we've got see nice and strong and we're going to put this into the edge of that leaflet
39:45next inda is using extra long needle holders and forceps to sew a prosthetic band around sarah's heart
39:52valve to reshape and reinforce it so it looks so big in the side but it's so small in real
39:59life
40:00good okay so now we'll just tie all these strings
40:06so we're turning the the mitral valve so that the leaflets can meet properly
40:13so we've secured the cord we've put in the new band
40:19and now it's the final test with the cord sewn in and the valve shape reinforced
40:24inda inserts a saline solution to test if the valve is still leaking
40:30oh i think i'm happy so you see the hair the heart is now at the moment full of air
40:35so we're going to close the chambers and the next thing to do is to actually
40:39what we call de-air the heart get rid of all the air so that no air can go into
40:43the brain
40:45so that's the next challenge that we've got fill the heart for me please
40:49fill in the heart and now the heart will start to beat magic stick just gently stroke the heart
41:01sometimes can help it along there you are beginning to
41:07her blood tests are good we'll try and come off the heart lung machine so that her heart will then
41:11actually actually start doing some work with the valve repaired inda is ready to see how sarah's heart
41:17will beat and how her lungs will breathe without the support of the heart lung machine beginning to
41:23beat now so the lung is now that's good the lung is now up so sarah's lungs are ventilating her
41:32heart
41:33is beating yeah okay okay we're going to come off the heart lung machine now so gradually we're going to
41:40reduce the amount of blood that drains down these pipes and so eventually none will and so the heart's
41:45then got to do everything sarah's heart is now off the heart lung machine and is beating on its own
41:53and i've got nice white swabs and so i'm convinced we don't have any complication here with bleeding
41:59so we're going to take the pipes out
42:05okay good thanks everybody great job
42:14so we've got a good result she's asleep right now we'll leave her like that for a couple of hours
42:19once we're happy all is good we'll wake her up and that's the final thing to make sure
42:23neurologically she's completely intact in other words that her brain is working perfectly
42:31it's a bumpy road it's not straightforward it's major surgery at the end of the day you can't pretend
42:36that it isn't if she wakes up she's out of the woods sarah will spend the night in intensive care
42:44where she can be closely monitored
42:49and just my name when inder is not in surgery or clinic he spends his time teaching medical
42:57students in the nhs today he's in nottingham training the next generation of heart surgeons
43:04teaching students how to tie knots with needle holders that are used in keyhole heart surgery
43:10you're putting that needle through a tissue and you want to just turn it that little bit more you
43:13can do it in your hands go home and watch coronation street whatever tv you like sit and do that
43:17every day it'll become natural yeah i used to stitch on an orange every evening for an hour or two
43:27a day
43:27every single evening i would just do it so when i was in theater just felt natural it feels great
43:34to
43:34pass this on to younger generations i've got no plans to retire anytime soon i think that i'll be
43:41doing something when i'm 80 what it is i'll be doing when i'm 80 if i live that long i
43:44don't know yet
43:45but there'll always be something being a doctor is an identity and i think when people lose their
43:53identities that's when they lose themselves being a surgeon it's who i am it's who i was always meant
44:01to be and who i always will be
44:05so
44:10so