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The Surgeon 2026 S01E04 MY5 H 264

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00:03Surgeons, they can change your life forever as they tread the line between life and death.
00:09We got a bed.
00:12What's it really like to hold someone's life in your hands?
00:15It's miracles and disasters, nothing in between.
00:19Let's get this bugger out!
00:20And how do you balance the needs of others with the needs of your family?
00:24Home sweet home.
00:25You take care and have a good sleep, all right?
00:30I will do.
00:30Love you, Mum. Bye!
00:32Now, we go behind the mask to find out just what it takes...
00:37I feel like you've been hit by a bus.
00:39...to live life as a surgeon.
00:42Bit of a rollercoaster.
00:43Oh, I cried.
00:44Yeah.
00:45It all went really well.
00:47Professor Ulmer is number one.
01:0259-year-old Inder Birdie is one of London's top heart surgeons.
01:07Good morning.
01:08You're set.
01:09He specializes in keyhole heart surgery and was the first person in the UK to perform a quadruple heart bypass
01:16through keyhole.
01:18I think I've pretty much seen everything there is to see in cardiac surgery.
01:23I don't see surprises anymore.
01:26After treating nearly 5,000 patients and working for the NHS for 35 years, he's now set up his own
01:33clinic.
01:34You've got my patient here, Mr. Smith.
01:36This is 101.
01:37Mr. Smith?
01:38Yeah.
01:38I'm going to be 60 this year, and I don't know where that number's come from.
01:44You know, we all think we look 25.
01:46It's only when we look in the mirror that we think, well, not quite 25.
01:50But I do feel this sense of time now.
01:52It's a sense of urgency to get so much more done in such a short period of time.
01:57So, actually, I'm busier than I've ever been 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.
02:16Hello.
02:17Oh, hello.
02:18Are you set?
02:19Yeah.
02:19Come on through, Michael.
02:22Mike 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.
02:30So, when Michael first came to see me, when your dad first came to see me,
02:33you said to me that you just thought your feet were getting bigger because you were getting older.
02:37Oh, yes.
02:38Yes.
02:38And I was losing the energy because I was getting older.
02:41The worst symptom I've had all the way through this has been this cough.
02:44Yeah.
02:45Because the cough, of course, has been the thing that stopped me sleeping easily
02:49every time I lay down in a proper bed.
02:51And so I've been sleeping on a chair for the last six months.
02:56Mike is such a bright man, and yet he put ankle swelling down to getting older.
03:02Had he recognized that as being a problem, we may have picked his problem up much earlier.
03:07The 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.
03:20Two valves will need to be repaired and one replaced, as well as a double bypass to help blood flow
03:26around two blocked arteries.
03:30There's a risk that Michael could die from this operation.
03:34It's about 10%.
03:36But you could perhaps look at it the other way around and say,
03:38well, there's a 90% chance that I'm not going to die from this operation.
03:42And it's a matter of perspective.
03:43But if we don't do anything, then what is certain is that this will get worse and you get sicker
03:51and sicker.
03:52But I've got some of the best people in that room with me tomorrow.
03:57Mike recognized the seriousness of his heart condition.
04:00I think he also recognized that without treatment, he wasn't going to do very well in a very short period
04:07of time.
04:08Mike's operation carries risks, but if Inder doesn't operate on Mike soon, he won't have long to live.
04:16You're one of the best people in the world to do this.
04:18So, 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.
04:26Good. The sooner it comes and it's over the better.
04:30Thanks again.
04:30Good to see you. It's really good to see you.
04:32Thank you so much.
04:32Nice to meet you.
04:37Mike retired two years ago and lives in Hertfordshire, but he used to be an engineer.
04:42A practical man needs a garage. This is my domain. It's quite a good man cave.
04:49There's a huge, huge amount of memories.
04:52This Mini was one that my mother had and we bought it with a defective engine.
04:58My father and I took it to bits and we replaced all the bits.
05:01And it was a lovely engine when it was finished.
05:04So, I think that's the sort of job I hope Mr Birdie does on my heart.
05:10So, with a 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.
05:21Mike has five children and has been married to Sue for 30 years.
05:26He's scared.
05:28He doesn't admit it, but I think he is scared.
05:32I think anybody would be.
05:34And I say to him, I'm very selfish, you know, it's not just about you, Mike.
05:38I'm scared too, in a different way.
05:51It's just before 7am at Cromwell Hospital and the day of Mike's heart surgery.
05:55Hello. Hi, good morning.
05:58Good morning. I've got a procedure of Mr Birdie today.
06:02On 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.
06:10And then I won't have anything after six in the morning until after the service completed.
06:14I'm focused specifically on that one individual that I'm going to operate on.
06:19Just trying to get the right size.
06:22You can't always get them.
06:27You know, you need to operate in style, don't you?
06:32Yeah.
06:33Oh, Mr Birdie.
06:33Hello, Mr Birdie.
06:34Good morning.
06:35It's good to see you.
06:36Yeah, it's good to see you, yeah.
06:37Good morning.
06:38You all okay?
06:39Hello, yes, good time.
06:40Did you sleep well?
06:41Not very.
06:42One hour and eight minutes.
06:44We've got the A team with us today.
06:46I've put on here the reasons we're doing it.
06:49Symptoms and live longer.
06:51Yeah.
06:51That's the key here.
06:51Yep, yep.
06:52It is not you signing yourself over to me.
06:54It's my responsibility to you.
06:56Once you're happy, I just need you to sign, print and date this format at the back.
07:01Yep.
07:02We're going to wait until the end of the surgery to decide how well things have gone.
07:06Yep.
07:06How you're behaving to decide whether we wake you up this evening.
07:10Yes, that's right.
07:11Okay.
07:12Any questions at this stage?
07:15No, I don't think so.
07:17Then at the end of the surgery, I'll send you another message.
07:19And then I'll meet with you on the intensive care unit.
07:21I'll call you if you're not in the facility.
07:24Oh, I'm not going anywhere.
07:26Thank you, Mr. Burley.
07:28It's good luck.
07:28Yeah, thanks, son.
07:39I just don't want you to have to go through this.
07:46I'm being silly now.
07:50I don't want you to cry.
07:53Don't.
07:54I can't cry when you cry.
07:55That really gets me going.
07:57Because it's all about me, of course.
07:58Yeah.
07:59Yeah.
08:01What is some nice shopping for you, Dad?
08:03Go and get some new jumpers.
08:04Get me a new jumpers.
08:06Except there's no holes in the sleeves.
08:07We'll get you a chocolate orange for when you feel better.
08:12Oh, I can't wait to see you later.
08:15Oh.
08:18So what you see here is the mitral valve.
08:21And this great big red flame represents a jet of blood inside the heart.
08:27Now when that valve closes, closes, closes, closes, nothing should leak.
08:32That represents the blood flowing in the wrong direction.
08:37There's a huge leap there.
08:41I love you too.
08:42I love you.
08:43I love you.
08:43I love you.
08:44I love you.
08:45I love you.
08:47I love you.
08:48Stand.
08:48You're going to be fine.
08:50I love you.
08:51Come on.
08:51Come on.
08:52Say something.
08:55Right.
08:57You sure?
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.
09:07He's in heart failure.
09:08Every time his heart beats, the leaking valves are just leaking blood the wrong way.
09:15To fix Mike's three leaking heart valves, the surgical team will temporarily stop his heart.
09:22First, Inder 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.
09:36Inder will sew a strong support ring around each valve to help them close properly and stop the leak.
09:43The aortic valve is too damaged to repair.
09:46So it will be replaced with a new valve made from cow tissue to control blood flow out of the
09:51heart.
09:55Once 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 come off the heart
10:07lung machine?
10:08I'm about to send Susan a message, his wife.
10:11Susan, so far so good, about to start.
10:19Her next message from me will be at the end of the procedure.
10:24Mike's surgery is so complicated, Inder has brought to the table some of the best surgeons in the country.
10:32Antanas has very expertly opened the breast bone and we see the heart in its full glory.
10:39Together, they have 60 years of experience in heart surgery.
10:43Thanks, boss.
10:47Inder 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 and will breathe for him.
10:55Good, so that's working nicely.
10:57With Mike now connected to the heart lung machine, Inder can stop his heart.
11:03Now, we're going to take that clamp off and go onto the heart lung machine.
11:07Happy everybody? On to bypass them, please.
11:12As we do that, the heart starts to decompress.
11:17So the machine is now doing the work of the heart and the lungs. The heart is no longer beating.
11:22Okay, good.
11:24With Mike's heart stopped and fully supported by the heart lung machine, Inder needs to work as quickly as possible
11:30on the three faulty valves.
11:33And the key for any heart surgeon is to balance perfection with efficiency, because the longer we're on the heart
11:39lung machine, the harder it is going to be for Michael to recover from the surgery.
11:45First, Inder 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
11:58in.
12:02He attaches strings to the cloth valve ring, and also into Mike's mitral valve, so the ring can be carefully
12:09slid and secured into the correct position.
12:12It's delicate work.
12:15And we're going to slide this ring into the heart.
12:18There's a bit of concentration going on here.
12:21Yeah.
12:23Perfect.
12:25And there's the mitral valve, looking much more like a proper mitral valve now.
12:28Now we've reshaped it, and so hopefully the leaflets are going to meet again and seal.
12:35Yeah, that works nicely.
12:37Next, Inder 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.
12:47Look how much it stretches, and it's so large that the leaflets just can't meet.
12:51These critical things are the difference between Michael's health and ill health.
12:57We're going to stitch something around here.
13:04And there we are. There it is, in place.
13:06The trickiest moment here, I think, is going to be at the end.
13:09Will this heart work?
13:10Only time's going to tell that.
13:14So now we're replacing the aortic valve.
13:16Finally, Inder is replacing Mike's aortic valve with a valve that is made from cow tissue.
13:22Okay, sutures, please.
13:24The cow tissue is very similar to human tissue, and is highly durable.
13:28The aortic valve's been removed, and we're going to parachute the valve into here.
13:33So, the aortic valve's in place, doing the job it's meant to do.
13:37Beautiful. All three valves have been repaired or replaced.
13:41We're closing the aorta now.
13:43It's going to take a lot of pressure, this aorta, in the end.
13:46So we have to stitch it very carefully, and I've got to make sure each of these stitches don't leave
13:49a hole big enough for blood to leak through.
13:53With two valves successfully repaired, and one successfully replaced, Mike's aorta, his main blood vessel, will now be transporting a
14:02lot more blood than it's been used to in the last few months.
14:06Inder needs to make sure it's fully sealed.
14:10Perfect.
14:10Happy?
14:12Good.
14:13With the first part of the operation a success, Inder is ready for the critical moment in the operation, to
14:20see if Mike's heart will be strong enough to work on its own, without the support of the heart-lung
14:25machine.
14:26This clamp has been stopping the heart from getting any blood. I'm taking that clamp off now, and resuming normal
14:33blood flow.
14:35So the heart is now gently beginning to beat.
14:38We're going to come off the heart-lung machine now. So Shane, over to you.
14:43So 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 on
14:53its own.
14:54Some bleeding going on here.
14:56But almost straight away, Inder notices some sudden bleeding.
15:02What does that mean?
15:03It's coming from the aorta, I guess.
15:06You'll have to go back onto bypass, we've got some bleeding going on.
15:09Get your pacing sorted out, go back on.
15:11Mike's heart has to be put immediately back on the heart-lung machine, so that Inder and the team can
15:16find the cause of the bleed.
15:22Don't tell me the aorta's just blown it.
15:24Sudden bleeding. Empty out.
15:29Something's gone here. Something's just blown.
15:32Pump off the drain, please.
15:35We may have to stop the heart.
15:37Simon, I need your flow right down. Empty out. I need to see what's happening here.
15:42Is it this here?
15:46The bleed doesn't seem to be coming from the repaired valves, but from the main part of the heart.
15:52The team need to have the blood drained from the heart, so they can see where the bleed is coming
15:56from.
15:57Some fingers just blown.
15:59Yeah, it looks like it's ruptured there.
16:02Why don't we just put a finger on that and stop the heart and look at it properly.
16:04Look, 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 from.
16:12Okay, clamp is on.
16:15If Inder doesn't find the cause of the bleeding, it could be fatal.
16:20Clearly got a problem here.
16:33I just watched it. 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, as Inder tested to
16:51see if Mike's heart could beat on its own, it started to bleed.
16:57Fire glue, please.
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.
17:08Put 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.
17:23Clamp 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.
17:32Okay, 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, it was like,
18:07Oh 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.
18:12I think we had like a six-hour round trip.
18:14And the time just flew by. We just got on really well.
18:18And just over the months, we went on more and more trips,
18:21and then we found more and more trips to go on to together.
18:25So I'm very lucky to have found him.
18:28And had 30 years of happy marriage with him.
18:35Go all right now.
18:37Give me that.
18:41All right now.
18:42Back up.
18:47Looks better, yeah?
18:49Yeah, 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 something is not right here but mike's heart is still bleeding i thought we'd
19:04fixed it these sutures should have fixed it we've really got a problem here you'll have to go back
19:09onto bypass we've got a big problem off off and drain please still leaking a bit it's in i hate
19:21to stop the start again be careful i think we're going to have to arrest the heart again it's too
19:26bad the blood is too much give me a cross clamp please we're going to have to stop the heart
19:32again
19:35the glue and stitching in the heart isn't working inder and his team can't clearly see the cause
19:40of the bleed inder decides his only option is to stop mike's heart again
20:02inder can see a hole in the aorta the main part of the heart that takes blood to the rest
20:07of the
20:07body i think we have to stop it and open the aorta we've got a big problem there
20:17we've got no other choice but to stop the heart and open the aorta
20:23yeah i'm gonna have to look from the inside which is gonna 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 is to open up the aorta to reach and fix
20:38the
20:39hole something that could be fatal now there's something very very bad going on here it's a tear
20:46isn't it see it's a deception looks nasty i've never been here before
20:59because 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
21:16every time his heart is taken off the heart lung machine the inner layer is tearing
21:22it's just dissected around the back so we try to repair on the inside rather than do anything
21:25too complicated and i was just closing this aorta up inder and his team can't reach around
21:32the back so they sew and attempt to repair the aorta from the inside seriously if this doesn't
21:39work we are going to be in really big trouble with the repair complete inder and his team refill
21:49the heart with blood to test if it's worked ecg is nicely recovering
21:57so we're now gradually just beginning to take the 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 aim for systolic about 65 70 to start with
22:12we want to hope that it doesn't tear again because if it does we really are
22:17on a hiding to nothing i think mike's heart is taken off the heart lung machine for the third time
22:26if his aorta tears again they might not be able to repair it
22:42the repair appears to be holding the heart's working well we fixed it from the inside and hopefully it will
22:52be okay
22:55it was really unfortunate what we just suffered but anyway it's good having so many eyes and ears here
23:01after six hours in the operating room inder and his team have successfully managed to stop the bleeding
23:09well done guys well done now it's down to nature it's down to how nature needs to now help us
23:18help michael
23:28the bleed might have stopped but opening up the aorta was a high-risk move and inder doesn't know
23:35how mike'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 the
23:52floor
23:52you know just keeping it up delicate delicate delicate so no rushing this guy now
23:58so i'll need to speak to the family and let them know we're okay but we're extremely worried
24:07all right so um let me sit down so you're sensible 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
24:19some bleeding and we really couldn't understand where it was coming from and in the end we had to
24:26restop the heart and open the aorta pi and we could see what had happened was the aorta where we
24:34had
24:34opened it and it had tore back on itself we've repaired that and i wouldn't pretend to say that
24:40we're out of trouble this is plan b not plan a and my experience with this is we've just got
24:47to be patient
24:48i've actually never seen this happen before the best way for me to describe it is there's three
24:53situations plan a everything's gone to plan i'm really happy plan b we've had a difficulty but i
24:59think we've got it under control but he's not out of the woods right now and c is where i'm
25:04really
25:04really worried and i'm not sure i can get him out of this i think he's in in b these
25:09are things that
25:09are in my mind as possible scenarios at this stage as part of managing a difficult situation okay
25:17is that someone could you know that he's going to be okay is that a difficult question okay i don't
25:25know the answer to that but if he has a stable night and we come in tomorrow and we're in
25:30a
25:30situation where we feel he's been so stable that we can wake him up from the ventilator that's going
25:34to be important point and then of course the next hurdle we don't really know that his brain and
25:40his faculties are working until he wakes mike is now being closely monitored all his family can do is
25:51wait mike experienced further complications with bleeding later in the evening and required further
26:04treatment he is now recovering in intensive care you just run through things in your mind you replay
26:14this you replay that it's the now not knowing how things are going to go so i'm going to go
26:19see my
26:20family this weekend but i'm going to be completely distracted with it and that's that's the hard part
26:26of being a heart surgeon the hard part of being a doctor or anyone in the medical profession because
26:32we all feel it all of my colleagues will feel it and the truth of the matter is we've done
26:36everything
26:37we can i'm confident we've made the right assessment and every time will tell now
26:54it's seven days since inda performed major open heart surgery on mike
26:58to repair three faulty heart valves and bypass two blocked arteries scans have shown that he doesn't
27:06have brain damage and he's recovering in intensive care
27:22inda is turning 60 and has come to nottingham his hometown for a few hours to be with his family
27:28i just wanted to say thank you so much for my birthday obviously this is a special number
27:32and this has meant so much to me to see you all today i'd love to stay but i can't
27:37i have to go
27:38back to london because i've got a patient that needs me you understand that you've understood that
27:43for years and i thank you very very much thank you
27:49i 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
28:03really proud of my dad it's always going to be a sacrifice to be made for um to be successful
28:07in
28:08your career be a father of three boys you'd expect there's to be sacrifice of course i think he's done
28:13a great job really and actually sometimes maybe we haven't realized where maybe he's been under
28:18significant stress with you know patience or things that are upcoming and but still able to kind
28:24of be calm and collected let's say
28:30a lot of people think that heart surgery is really thick skin
28:34we're not actually we're just human beings and we just feel the same emotions that everyone does anxiety
28:41insecurity fear nervousness we feel all of those but somehow we bury them and i think that's not always
28:47a good thing for us you can't help but think about how it affects you in your private life as
28:52well
28:54i've seen death in my career all the time and it's a good thing and a bad thing in a
29:00way because it
29:01allows me to always make sure that i make the most of every moment with every member of my family
29:06because i realized how fragile life is
29:1959 year old sarah has come to see inda with her husband ashley
29:26after a cut on her finger wouldn't heal she saw her gp who listened to her chest and picked up
29:31a heart murmur
29:35i've had a heart murmur
29:36over the last two years i've had niggles
29:39hello hello i put it down to just everyday normal
29:44nice to meet you nice to meet you getting older lifestyle three months ago i ended up going to
29:52my gp with what i thought was the onset of sepsis because um i'd had a really bad infection and
29:59my
29:59heart was palpitating a doctor picked up a heart murmur and in investigating that heart murmur
30:05they've picked up the fact that you have at least moderate possibly severe mitral valve leakage
30:12tests revealed one of sarah's heart valves isn't closing properly so blood is leaking into her heart
30:20the other thing we've noticed is that the rest of your body is very healthy if we deal with it
30:24early we can also think about doing procedures other than just opening the breastbone to repair this heart valve
30:30call this keyhole mitral valve repair whatever you um think needs to be done is the right thing to be
30:39done
30:41let's have a little listen to your heart
30:45because sarah's faulty mitral valve has been picked up early and she's otherwise fit and healthy
30:50she's a good candidate for keyhole heart surgery very good you've got a you've got a rip-roaring murmur
30:55there have i yeah see you next week
31:03there are two doors of the mitral valve anterior door posterior door and it's the back door that's
31:09flipping the wrong way and letting blood leak backwards into the smaller chambers of the heart and then
31:13back into the lungs we've got one chance to get this right and the good thing about all of that
31:18is we can do it through the keyhole procedure and that means that we'll be able to get a very
31:23good
31:23outcome and a very swift recovery sarah lives in north oxfordshire with her husband ashley and 13 year
31:39old daughter lily i'm obviously a slightly older mum i'd like to hope that i'm a good mum and i
31:48put
31:49everything in place for her that she needs and will need later on in life do you want butter ashley
31:56oh yes
31:57please darling sarah obviously cares about me incredibly but you know lily's 13 and she needs a
32:10mother basically and you know what happens if it all goes wrong
32:17we've sat down and we've talked about some of those issues
32:22not issues we really want to talk about because we want to look at the positives
32:26but yeah that you know there is a contingency that we hope doesn't get used lily is
32:42it's the only thing that sets me off i mention lily's name that's it i'm gone
32:51there's no right or wrong way to sit a child down and say your mum's going into hospital next week
33:02it's 6 45 in the morning and the day of sarah's heart surgery
33:08hello how are you i'm good thanks the team are all here top team we're going to do an operation
33:14called keyhole mitral valve repair this is the one operation that i do as a heart surgery 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
33:24today
33:24yeah see you soon see you shortly okay thank you
33:32i'm hoping that i'm going to beat all the levels for recovery and i'm going to be home at the
33:38weekend
33:39but let's see thinking about the surgery i'm absolutely terrified
33:55my mum was ill when i was little when i was there in fact she passed away when i was
33:5813. lily's age
34:04i think should everything go well good morning welcome in we'll look back and we'll just live for
34:13every moment and uh it won't be manana it'll be let's do it now and make the most of life
34:19you might
34:20feel something warm in your hand as we uh clear these lines sarah's the right candidate for minimally
34:27invasive surgery because she's fit we've made the diagnosis early she's got a heart condition that
34:33is amenable to minimally invasive surgery stings as it goes in okay but then it should just go numb
34:42to access sarah's heart inda will make a three centimeter keyhole incision between her ribs
34:50using a telescope and long instruments he will sew a new cord into sarah's mitral valve
34:55to stop the valve leaflet turning the wrong way the leaflets are just like doors that open and close
35:02to let blood in and out of the heart he will then sew in a prosthetic band around the edge
35:08of her valve
35:08to reshape and support it this will stop blood leaking into her left atrium
35:16i'm expecting sarah to be back to normal activities within a week or two after a keyhole mitral valve repair
35:24it's a an absolute game changer for patients to be honest right let's go sarah has been anesthetized
35:31and her blood pressure is being monitored today instead of making a cut through the breastbone
35:37here we're going to make a small cut through the side inda is accessing sarah's heart by making an
35:44incision between her ribs this means there will be less risk of bleeding and a faster recovery compared
35:50to open heart surgery so we've made a space between two of the ribs and we're going to start setting
35:56sarah up for the heart lung machine the heart lung machine will circulate sarah's blood and breathe for
36:03her while inda stops her heart okay everything's connected now you happy to go on bypass good line
36:11pressure so far so good yeah that's fine full flow okay lungs off then boss okay so now we're on
36:20the
36:20heart lung machine in order to stop this heart we have to stop blood to the heart so we're going
36:24to
36:25put a clamp across here so the clamp is now stopping blood getting to the heart now you see the
36:30heart's
36:30beginning to dissociate and stop with sarah's heart stopped and supported by the heart lung machine
36:39inda can make his first keyhole incision into sarah's heart it's going to be a small chamber this isn't it
36:48gently pass this very long blade into the chest okay we're going to open the chamber of the heart now
36:57inda is cutting through the main part of sarah's heart and drains her blood
37:02he now needs to repair sarah's faulty valve without damaging the surrounding blood vessels thanks boss
37:21the cromwell hospital in london heart surgeon inda is an hour into operating on 59 year old sarah
37:30he's made the first cut into her heart and needs to repair a faulty valve through a keyhole incision
37:40yeah keep doing what you're doing very carefully open this here
37:46there's the nitral 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
38:03gives him a magnified view of sarah's heart on a monitor and his glasses make his vision 3d
38:12sarah'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 along
38:28we had two cats which were great but having lily coming along that that made the family
38:35hopefully everything 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
39:02and it was going to behave exactly like sarah's faulty cord and what we're going to try and do
39:10is get this needle into 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
39:39so we've got seat 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
39:52heart valve to reshape and reinforce it so it looks so big in the side but it's so small in
39:59real life
40:01good okay so now we'll just tie all these strings
40:07so we're turning the the mitral valve so that the leaflets can meet properly
40:14so 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
40:25inda inserts a saline solution to test if the valve is still leaking
40:31oh i think i'm happy so you see the hair the heart is now at the moment full of air
40:36so 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
40:44the brain
40:45so that's the next challenge that we've got fill the heart for me please
40:54now the heart will start to beat magic stick just gently stroke the heart sometimes can help it along
41:04there you are beginning to
41:08our blood tests are good we'll try and come off the heart lung machine so that
41:11heart will then actually actually start doing some work with the valve repaired inda is ready
41:17to see how sarah's heart will beat and how her lungs will breathe without the support of the heart
41:22lung machine beginning to beat now so the lung is now that's good the lung is now up so sarah's
41:31lungs
41:32are ventilating her heart is beating yeah okay okay we're going to come off the heart lung machine now
41:38so gradually we're going to reduce the amount of blood that drains down these pipes and so
41:44eventually none will and so the heart's then got to do everything
41:49sarah's heart is now off the heart lung machine and is beating on its own
41:54and i've got nice white swabs and so i'm convinced we don't have any complication here with bleeding
42:00so we're going to take the pipes out okay good thanks everybody great job
42:15so we've got a good result she's asleep right now we'll leave her like that for a couple of hours
42:20once we're happy all is good we'll wake her up and that's the final thing to make sure neurologically
42:24she'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
42:35surgery at the end of the day you can't pretend that it isn't
42:39if she wakes up she's out of the woods
42:42sarah will spend the night in intensive care where she can be closely monitored
42:50hiya inda's my name hi inda's my name when inda is not in surgery or clinic
42:56he spends his time teaching medical students in the nhs
43:00today he's in nottingham training the next generation of heart surgeons
43:05teaching 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
43:14can do it in your hands go home and watch coronation stream whatever tv you let sit and do that
43:18every
43:19day it'll become natural yeah i used to stitch on an orange every evening for an hour or two a
43:27day
43:28every single evening i would just do it so when i was in theater it just felt natural
43:34it feels great to pass this on to younger generations i've got no plans to retire anytime soon
43:40i think that i'll be doing something when i'm 80. what it is i'll be doing when i'm 80
43:44if i live that long i don't know yet but there'll always be something
43:49being a doctor is an identity and i think when people lose their identities that's when they lose
43:55themselves being a surgeon it's who i am it's who i was always meant to be
44:03and who i always will be
44:51and who are like
45:10Transcription by CastingWords
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