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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, alright?
00:30I will do. Love 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.
00:39To live life as a surgeon.
00:42Bit of a rollercoaster.
00:43Oh, Christ, yeah.
00:45It all went really well.
00:47Professor O'Murray's 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.
01:35You 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.
03:42Mm-hmm.
03:42And it's a matter of perspective.
03:44But 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.
04:09Mike's operation carries risks.
04:10But 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.
04:24I'll see you bright and early.
04:26Good.
04:26The sooner it comes and it's over the better.
04:30Thanks again to see you.
04:31It's really good to see you.
04:32Thank you so much.
04:33Nice to meet you.
04:37Mike retired two years ago and lives in Hertfordshire.
04:40But he used to be an engineer.
04:42A practical man needs a garage.
04:45This is my domain.
04:47It'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.
04:58And my 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, it's very, with a heart being a pump, it's a very similar thing to a four-stroke engine.
05:15So, yeah.
05:16I 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.
05:39I'm scared too.
05:41In a different way.
05:51It's just before 7am at Cromwell Hospital and the day of Mike's heart surgery.
05:55Hello.
05:57Hi, good morning.
05:58Good morning.
05:58I'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.
06:23You can't always get through.
06:27You know, you need to operate in style, don't you?
06:32Oh, 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.
06:38You all okay?
06:39Hello, yes, good to see you.
06:40Did you sleep well?
06:41Not really.
06:421 hour and 80 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 a little longer.
06:51Yeah.
06:51That's the key here.
06:52Yeah.
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.
07:01We'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 on this stage?
07:15No, I don't think so.
07:16Okay.
07:16Then at the end of the surgery, send me another message and then I will meet with you on the
07:20intensive care unit.
07:21Oh.
07:22I will call you if you're not in the vicinity.
07:24Oh, I'm not going anywhere.
07:25Okay.
07:26Thank you, Mr. Burley.
07:28It's a good one.
07:28Yeah, thanks.
07:39I just don't want you to have to go through this.
07:46I'm being silly now.
07:48No, it's true.
07:51I thought we should be crying.
07:53Don't.
07:54I can't go when you cry.
07:55That really gets me going because it's all about me, of course.
08:01We'll do some nice shopping for you, Dad.
08:03Come and get some new jumpers.
08:04Get me a new jumper except there's no holes in the sleeves.
08:07We'll get you a chocolate orange for when you feel better.
08:13Oh, I can't wait to see you later.
08:15Oh.
08:18So what you see here is the mitral valve and this great big red flame,
08:23that flame represents a jet of blood inside the heart.
08:27Now, when that valve closes, closes, closes, closes,
08:31nothing should leak.
08:33That represents the blood flowing in the wrong direction.
08:37There's a huge leak there.
08:41I love you too.
08:42I love you too.
08:43I love you too.
08:44I love you too.
08:45I love you too.
08:47I love you too.
08:48Stand.
08:48You're going to be fine.
08:51All right.
08:51Come in.
08:52Stay soon.
08:55Right.
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
09:52heart.
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.
10:14About 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 bones 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.
10:58With 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.
12:21Is it?
12:22Yeah.
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.
12:42And 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.
12:57And we'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?
13:11Only time's going to tell that.
13:14So 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.
13:22Okay, sutures, please.
13:24The cow tissue is very similar to human tissue, and is highly durable.
13:29The 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.
13:40So, we'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
13:50a hole big enough for blood to leak through.
13:54With two valves successfully repaired, and one successfully replaced,
13:59Mike's aorta, his main blood vessel, will now be transporting a lot more blood than it's been used to in
14:04the 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,
14:19to see if Mike's heart will be strong enough to work on its own, without the support of the heart
14:24-lung machine.
14:26This clamp has been stopping the heart from getting any blood.
14:30I'm taking that clamp off now, and resuming normal blood flow.
14:33Okay.
14:35So, the heart is now gently beginning to beat.
14:38We're going to come off the heart-lung machine now.
14:41So, 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 is that for?
15:03It's coming from the aorta, I guess.
15:05Okay, I've heard it.
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,
15:14so that Inder and the team can find the cause of the bleed.
15:22Don't tell me the ills, it's just blown.
15:24Sudden bleeding.
15:25Empty out.
15:29Something's gone here.
15:30Something's just blown.
15:32Pump off the drain, please.
15:35We may have to stop the heart.
15:37Simon?
15:37Yeah?
15:38I need your flow right down.
15:39Empty out.
15:40I need to see what's happening here.
15:42Is it this here?
15:43Okay.
15:46The bleed doesn't seem to be coming from the repaired valves,
15:49but from the main part of the heart.
15:52The team need to have the blood drained from the heart,
15:54so they can see where the bleed is coming from.
15:57Something has just blown.
15:59Yeah, it looks like it's ruptured there.
16:02Why don't we just put a finger on that, stop the heart,
16:04and look at it properly.
16:04Look, it's gone here as well.
16:06Mike's chest is rapidly filling with blood,
16:09but 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,
16:17it could be fatal.
16:20Clearly got a problem here.
16:33I just watched it.
16:35It just blew.
16:36Just bang.
16:37Heart surgeon Inder
16:39has been operating on 70-year-old Mike for four hours.
16:43He successfully repaired and replaced his three leaking heart valves.
16:47But 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.
16:57Bio-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,
17:14so he refills the heart with blood.
17:18Running well.
17:20And takes him off the heart-lung machine for the second time.
17:23Okay, the clamp is now off.
17:25Mike's heart is beating again,
17:27but 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
17:39to 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.
17:54Mike's 12 years older than I am.
17:57We worked for VT,
17:58and 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 was like,
18:07oh my God, what am I going to talk to him?
18:09I don't know him.
18:10I'm not going to have any conversation to talk to him.
18:12I think they had like a six-hour round trip.
18:14And the time just flew by.
18:16We just got on really well.
18:18And just over the months,
18:19we went on more and more trips,
18:21and then we found more and more trips to go onto together.
18:25So very lucky to have found him,
18:28and had 30 years of happy marriage with him.
18:35We're all right, Dan.
18:37We're all right now.
18:42Right, back up.
18:47Looks better, yeah?
18:49I think it looks a lot better, doesn't it?
18:51Yeah.
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.
19:04I thought we fixed it.
19:05These sutures should have fixed it.
19:07We've really got a problem here.
19:08You'll have to go back onto bypass.
19:10We've got a big problem.
19:12Back up.
19:15Off and drain, please.
19:18Still reeking a bit, you see.
19:21I hate to stop the heart 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 clamp, please.
19:30We're going to have to stop the heart again.
19:35The glue and stitching in the heart isn't working.
19:39Inder 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.
19:50There it is.
19:51There.
19:52There. What's that there?
19:55Can you give me a pointy sucker?
19:56There.
19:57There's a hole.
19:58There's a hole there.
20:01Good to see it.
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.
20:13We'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 going to have to look from the inside,
20:25which is going to be a light road.
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
20:37to reach and fix the hole.
20:40Something that could be fatal.
20:43There's something very, very bad going on here.
20:46It's a terror, isn't it?
20:47See?
20:48It's a dissection.
20:50It looks nasty.
20:53It's never been here before.
20:55No.
20:56No, I've seen it before.
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.
21:11But his weakened aorta isn't strong enough to cope with the pressure.
21:16Every time his heart is taken off the heart-lung machine,
21:19the inner layer is tearing.
21:22Aorta's dissected around the back,
21:23so we try to repair it on the inside rather 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,
21:33so they sew and attempt to repair the aorta from the inside.
21:38Seriously, if this doesn't work, we are going to be in really big trouble.
21:46With the repair complete, Inder and his team refill the heart with blood
21:50to test if it's worked.
21:52ECG is nicely recovered.
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.
22:05OK, 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 on a hiding to nothing, I think.
22:21Mike'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.
22:37It's better, yeah?
22:38Yeah.
22:39Yeah, we're good.
22:43The repair appears to be holding.
22:46The heart's working well.
22:48We fixed it from the inside, and hopefully it will be OK.
22:55It was really unfortunate what we've just suffered, but anyway,
22:58it's good having so many eyes and ears here.
23:02After six hours in the operating room,
23:05Inder and his team have successfully managed to stop the bleeding.
23:09Well done, guys.
23:11Well done.
23:12Now, it's down to nature.
23:15It's down to how nature needs to now help us help Michael.
23:28The bleed might have stopped, but 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 OK.
23:41So very, very gently, like the most delicate egg on your kitchen top.
23:49Just making sure it doesn't roll onto the floor.
23:53You know, just keeping it up.
23:54Delicate, delicate, delicate.
23:55So no rushing this guy now.
23:58So I'll need to speak to the family and let them know that we're OK,
24:02but we're extremely worried.
24:07All right.
24:08All right, so...
24:09Let me sit down so you're sensible.
24:11The operation has taken longer than we'd anticipated.
24:14When we came off the heart loan machines, his 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, we had to restock the heart and open the aorta pie.
24:30And we could see what had happened was the aorta where we had opened it,
24:35and 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.
24:42This is plan B, not plan A.
24:45And my experience with this is we've just got to be patient.
24:48I've actually never seen this happen before.
24:51The best way for me to describe it is there's three situations.
24:54Plan A, everything's gone to plan, I'm really happy.
24:57Plan B, we've had a difficulty, but I think we've got it under control,
25:01but he's not out of the woods right now.
25:03And C, I'm really worried, and 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 as possible scenarios at this stage,
25:13as part of managing a difficult situation.
25:16Okay?
25:17So when 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, and we come in tomorrow,
25:29and we're in a situation where we feel he's been so stable
25:32that we can wake him up from the ventilator, that's going to be important.
25:35At one point.
25:36And then, of course, the next hurdle, we don't really know that his brain
25:39and his faculties are working until he wakes.
25:46Mike is now being closely monitored.
25:49All his family can do is wait.
25:58Mike experienced further complications with bleeding later in the evening,
26:02and required further treatment.
26:07Mike is now recovering in intensive care.
26:11You just run through things in your mind.
26:14You replay this, you 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,
26:21but 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, or 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 we've done everything we can.
26:37And I'm confident that we've made the right assessment.
26:41And any 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,
27:07and he's recovering in intensive care.
27:11Happy birthday to you, Andrew.
27:16Happy birthday to you.
27:20Have I got to blow it?
27:22Inder is turning 60,
27:23and has come to Nottingham, his hometown,
27:25for a few hours to be with his family.
27:28I just wanted to say thank you so much for my birthday.
27:31Obviously, this is a special number,
27:33and this has meant so much to me to see you all today.
27:36I'd love to stay, but I can't.
27:37I have to go back to London, because 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.
27:49I feel old, actually, to be honest with you.
27:5260 years.
27:53It's a milestone birthday.
27:56He's celebrating with his parents, his wife,
27:59his five grandchildren, and three sons.
28:02I'm really proud of my dad.
28:04It's always going to be a sacrifice to be made for,
28:07to be successful in your career,
28:08to be a father of three boys.
28:11You'd expect there to be a sacrifice, of course.
28:13I think he's done a great job, really.
28:15And actually, sometimes maybe we haven't realised
28:17where maybe he's been under significant stress
28:19with, you know, patients or things that are upcoming,
28:22but still able to kind of be calm and collected, let's say.
28:30A lot of people think that heart surgeons are really thick skin.
28:34We're not, actually.
28:35We're just human beings.
28:36And we just feel the same emotions that everyone does.
28:39Anxiety, insecurity, fear, nervousness.
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, but think about how it affects you
28:51in your private life as well.
28:54I've seen death in my career.
28:57all the time.
28:59And 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 at every moment
29:05with every member of my family
29:07because I realise how fragile our life is.
29:1959-year-old Sarah has come to see Inder
29:22with her husband, Ashley.
29:26After a cut on her finger wouldn't heal,
29:28she saw her GP who listened to her chest
29:31and picked up a heart murmur.
29:35Over the last two years, I've had niggles.
29:39Hello.
29:40Hello.
29:41I put it down to just everyday normal.
29:44Nice to meet you.
29:45Nice to meet you.
29:45Getting older.
29:47Sorry, please come on.
29:48Lifestyle.
29:50Until three months ago, I ended up going to my GP
29:53with what I thought was the onset of sepsis
29:55because I'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
30:07at least moderate, possibly severe mitral valve leakage.
30:12Tests revealed one of Sarah's heart valves
30:14isn'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.
30:30We call this keyhole mitral valve repair.
30:35Whatever you think needs to be done
30:38is the right thing to be done.
30:42Let'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.
30:54You've got a rip-roaring murmur there.
30:56Have I?
30:56Yeah.
30:58See you next week.
31:03There are two doors of the mitral valve.
31:06Anterior door, posterior door,
31:08and 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
31:23a 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.
31:45I'd like to hope that I'm a good mum
31:48and, like, put everything in place for her
31:50that she needs and will need later on in life.
31:55Do you want butter, Ashley?
31:56Oh, yes, please, darling.
32:02Sarah 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?
32:14Lily.
32:15Lily.
32:15Come on.
32:18We'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.
32:34Lily 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 to sit a child down and say,
32:54your mum's going into hospital next week.
33:02It's 6.45 in the morning
33:04and the day of Sarah's heart surgery.
33:08Hello.
33:09How are you?
33:09I'm good, thanks.
33:11The team are all here, top team.
33:13We're going to do an operation called
33:14keyhole mitral valve repair.
33:17This is the one operation that I do as a heart surgery
33:19that's going to put you back on a normal life curve
33:21if I can repair your heart valve.
33:23And that's the intention today.
33:24Yep.
33:26See you soon.
33:26See you shortly.
33:27OK, 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.
33:39But let's see.
33:46Thinking about the surgery, I'm absolutely terrified.
33:55My mum was ill when I was little, when I was 13.
33:57In fact, she passed away when I was 13.
34:00Lily's age.
34:04I think, should everything go well?
34:07Good morning.
34:08Welcome in.
34:09Hello.
34:10We'll look back and we'll just live for every moment.
34:14And it won't be manana, it'll be let's do it now
34:18and make the most of life.
34:19You might feel something warm in your hand as we hear these lines.
34:25Sarah's the right candidate for minimally invasive surgery
34:28because she's fit.
34:30We've made the diagnosis early.
34:32She's got a heart condition that is amenable
34:34to minimally invasive surgery.
34:36Stings as it goes in, OK?
34:38But then it should just go numb.
34:39Yeah.
34:42To access Sarah's heart, Inder will make a three-centimeter keyhole incision
34:47between her ribs.
34:50Using a telescope and long instruments,
34:52he will sew a new cord into Sarah's mitral valve
34:55to stop the valve leaflet turning the wrong way.
34:59The leaflets are just like doors that open and close
35:02to let blood in and out of the heart.
35:05He will then sew in a prosthetic band around the edge of her valve
35:08to reshape and support it.
35:11This will stop blood leaking into her left atrium.
35:16I'm expecting Sarah to be back to normal activities
35:19within a week or two after a keyhole mitral valve repair.
35:24It's an absolute game changer for patients, to be honest.
35:27Right, let's go.
35:30Sarah has been anaesthetised
35:31and her blood pressure is being monitored.
35:34Today, instead of making a cut through the breastbone here,
35:37we're going to make a small cut through the side.
35:41Inder is accessing Sarah's heart
35:43by making an incision between her ribs.
35:46This means there will be less risk of bleeding
35:48and a faster recovery compared to open heart surgery.
35:52So we've made a space between two of the ribs
35:55and we're going to start setting Sarah up for the heart-lung machine.
35:59The heart-lung machine will circulate Sarah's blood
36:02and breathe for her while Inder stops her heart.
36:06Okay, everything's connected now.
36:09Are you 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, lungs off then, boss.
36:18Okay.
36:19So now we're on the heart-lung machine.
36:21In order to stop this heart, we have to stop blood to the heart.
36:24So we're going to put a clamp across here.
36:26So the clamp is now stopping blood getting to the heart.
36:29Now you see the heart's beginning to dissociate and stop.
36:35With Sarah's heart stopped and supported by the heart-lung machine,
36:39Inder can make his first keyhole incision into Sarah's heart.
36:43It's going to be a small chamber, this isn't it?
36:48Gently pass this very long blade into the chest.
36:54Okay, we're going to open the chamber of the heart now.
36:57Inder is cutting through the main part of Sarah's heart
37:00and drains her blood.
37:02He now needs to repair Sarah's faulty valve
37:05without damaging the surrounding blood vessels.
37:08Thanks, boss.
37:21At Cromwell Hospital in London, heart surgeon Inder
37:25is an hour into operating on 59-year-old Sarah.
37:30He's made the first cut into her heart
37:32and needs to repair a faulty valve through a keyhole incision.
37:40Yeah, keep doing what you're doing.
37:42Very carefully.
37:44Open this here.
37:47There's the mitral valve and it's full glory.
37:50What a wonderful view.
37:53With the glasses on, I'm going to get depth perception.
37:58The long thin camera that Inder has put through the small incision
38:02gives him a magnified view of Sarah's heart on a monitor
38:06and his glasses make his vision 3D.
38:12Sarah's an incredible woman.
38:14We've been together now for just nigh on 23 years.
38:19We tried for a child quite early on.
38:23Nothing happened.
38:24And then surprise, surprise, quite a few years later,
38:27Lily came along.
38:28We had two cats, which were great,
38:31but having Lily coming along, that made the family.
38:34Hopefully, everything will go well and we can then sort of move forward.
38:44Oh yeah, beautiful.
38:46So this is the area of the leaflet that we think is abnormal.
38:49And here, there it is.
38:51See, it's ruptured.
38:56So here's the new string that we're going to use.
38:59It's very slippery, but it's very, very strong.
39:02And it was going to behave exactly like Sarah's faulty cord.
39:08And what we're going to try and do is get this needle into position.
39:20To repair Sarah's ruptured valve,
39:22first Inder 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 centimetres long.
39:35It would be the equivalent of sewing with chopsticks.
39:39So we've got, see, nice and strong.
39:41And we're going to put this into the edge of that leaflet.
39:45Next, Inder is using extra-long needle holders and forceps
39:50to sew a prosthetic band around Sarah's heart valve
39:53to reshape and reinforce it.
39:57So it looks so big in the side, but it's so small in real life.
40:01Good.
40:01OK, so now we'll just tile these strings.
40:07So we're turning the mitral valve so that the leaflets can meet properly.
40:14So we've secured the cord.
40:17We've put in the new band.
40:19And now it's the final test.
40:21With the cord sewn in and the valve shape reinforced,
40:25Inder inserts a saline solution to test if the valve is still leaking.
40:30Oh, I think I'm happy.
40:33So you see the heart is now, at the moment, full of air.
40:36So we're going to close the chambers.
40:38And the next thing to do is to actually, what we call, de-air the heart.
40:41Get rid of all the air so that no air can go into the brain.
40:45So that's the next challenge that we've got.
40:48Fill the heart for me, please.
40:50Fill in the heart.
40:54And now the heart will start to beat.
40:58Magic stick.
41:00Just gently stroke the heart.
41:01Sometimes it can help it along.
41:04There you are.
41:05There you are.
41:05Beginning to...
41:08Her blood tests are good.
41:09We'll try and come off the heart-lung machine so that her heart will then actually start doing some work.
41:14With the valve repaired, Inder is ready to see how Sarah's heart will beat and how her lungs will breathe
41:20without the support of the heart-lung machine.
41:23Beginning to beat now.
41:26So the lung is now up.
41:28That's good.
41:28The lung is now up.
41:31So, Sarah's lungs are ventilating.
41:33Her heart is beating.
41:35Yeah?
41:36Okay.
41:36Okay.
41:36We'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.
41:44And so, eventually none will.
41:45And 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.
41:56And so I'm convinced we don't have any complication here with bleeding.
42:00So we're going to take the pipes out.
42:04Okay.
42:06Good.
42:07Thanks, everybody.
42:08Great job.
42:15So, we've got a good result.
42:17She's asleep right now.
42:18We'll leave her like that for a couple of hours.
42:20Once we're happy, all is good.
42:22We'll wake her up.
42:22And that's the final thing.
42:23To make sure neurologically she's completely intact.
42:25In other words, that her brain is working perfectly.
42:31It's a bumpy road.
42:32It's not straightforward.
42:33It's major surgery at the end of the day.
42:36You 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.
42:49Hiya.
42:50How are you doing?
42:51Inder's my name.
42:52Hi.
42:52Inder's my name.
42:53When Inder is not in surgery or clinic, he 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.
43:11You're putting that needle through a tissue, and you want to just turn it that little bit more, you can
43:14do it in your hand.
43:15Go home and watch Coronation Street.
43:17Whatever TV you like, sit and do that.
43:19Every day, it'll become natural.
43:20Yeah?
43:23I used to stitch on an orange.
43:25Every evening, for an hour or two a day, every single evening, I would just do it.
43:30So when I was in theatre, it just felt natural.
43:34It feels great to pass this on to younger generations.
43:37I've got no plans to retire anytime soon.
43:40I think that I'll be doing something when I'm 80.
43:42What it is I'll be doing when I'm 80 if I live that long, I don't know yet.
43:46But there'll always be something.
43:49Being a doctor is an identity.
43:51And I think when people lose their identities, that's when they lose themselves.
43:58Being a surgeon, it's who I am.
44:00It's who I was always meant to be.
44:03And who I always will be.
44:18Being a coach for them.
44:18You need anompour- minute road.
44:18такой school is ready.
44:19And remember, at your positEMus, I'm jealous of those who I name it.
44:19I feel you can reallyakan오면 that you areextrableed tavsi.
44:36You were lucky if I had a group group of people playing around the world trying to create Bondion.
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