This video is part of the 2020 Sentara Cardiac Grand Rounds, "Heart in a Box: The Future is Now," originally broadcast September 15, 2020. Dr. Jonathan Philpott describes how to surgically prepare the heart to load onto the rig in the OCS device. With the optimization of donor organs and diagnostic assessment of organ viability through the OCS, more organs can be utilized, providing transplant patients with better outcomes.
so I'm gonna break the next part of the talking to to kind of sections and again for the people in the WebEx. This is very picture and video laden, so I'll do my best to kind of annotate as we go along. But the first step, it's getting the heart out and what you can see on the screen. There is a bloodline to drain the blood when they put the cannula into the patient, and the yellow and red lines that you see coming off from the left side of the screen are therefore the del Nido cardio pledge a. Once the blood is evacuated from the patient so the blood is taken out and the profusion and the surgeon the profusion is, is standing just off to the left. Here the blood is taken out, and as soon as it's taken its heparin ized into this large bag, and then they walk over and take that to the pump where it sits while they begin to assemble the pump and set it up. Meanwhile, for us, we get the heart out, and when the heart comes out, it's going to be placed. It's gonna be sealed up so that blood coming out of the coronary Sinus flows into the atrium and then into the pulmonary artery on. We measure that we actually measure the blood flow going through the heart and were able to sample gasses. That means it can't have a p f o. So the first check here is us looking into the left atrium that you see there, the hearts upside down looking for a P F o. And then with a nifty little trick that you could tell, they kind of learned how to do by doing this by themselves. If you place a couple of clamps and put some forceps through them, you can actually stabilize the aorta. So it sticks straight up in the air, and then four suitors are placed in the quadrants. And as you place the suit, you place pledge it on the inside and the outside and tied into position. And then when the string goes over the side of the table, you put a little hemostat on it. Uh, and as you do that and you keep placing these suitors, you're able to pin the aorta straight up in the air with these four quadrants, like that. So now it's suspended so that the artist you're basically looking down the barrel of the aorta and these four pledge it's are important because the cannula that you're gonna put into the order cannot leak. It needs to be completely watertight when you put it in and when you get started, the kit comes with these little different sizes. And there's these different sized aortic cannula and you kind of practice seeing which one is gonna fit the most comfortably. And the idea is is that you put it in. You pull up on those four per string suitor so that the cannula is completely seated inside the aorta. And then just like we do in the ODI, you lab, you use a zip tie and it the kit comes with these guns and those cute, literal red scissors that are designed to cut zip ties and you put the gun into position and the zip tie. The key here is that it sits just below those pledges, and the pledges on the outside act kinda is a bumper. So the pledge it's on the zip tied together. Hold it so that this heart will not come off the cannula, and that's what it looks like when it's all done. And here's just a So in the video, you can see the cannula going in, and then we take those four suitors and pull straight up in the air and you place the Zip tire and you could see technically, this is not difficult, guys. I mean, this is like an intern in surgery. Could I wouldn't let the intern cut the heart out. That's actually a little tricky, but in terms of these techniques, this I was so worried about this. I thought we had to get this heart out and slam it on the pump. That's not the case. We pleased the heart. We get it out, and for us, it's actually this is all kind of relaxed. You know, we're kind of taking our time here. Meanwhile, over on the profusion side of the arm there, stressing out at this point Now I don't I almost tried to edit this out, but the ass I didn't read the instruction on this gun right here, so I had to redo it, zipped. I watch it, sentient boom! And now you can see it's sealed. Yeah, so We also have to put a candle in the pulmonary artery, and that's it. It's kind of got a nice little blunt tip. And that's the pulmonary artery sticking up straight at us now, and a purse strings future is placed around it, and then a second securing future and it's ready to go. And then finally, we want event the left ventricle, you know, as the heart begins to be. We do not want it distended. So this vent goes in. You kind of just make sure that it's in about it. The right location, that's it. Dimpling the apex of the heart, and you pull it back a little bit and tied into position. And at this point, this hearts ready to load onto the rig. Now you can see it's flaccid. It's been pleased it's completely asleep, but it's ready to go