Surgery Godfather

Chapter 2215: Chapter 1447: Professor Yang’s Words

After Director He left, the atmosphere in the operating room relaxed.

Xia Shu walked over to Yang Ping, and although wearing a mask, the respect and closeness between his brows couldn’t be hidden.

"Professor, how come you have time to roam the operating room today? Is it not busy in the laboratory?"

Yang Ping leaned against the chair back, adjusting himself to a comfortable position: "Busy, of course it’s busy, but one can’t stay cooped up in the laboratory all the time; it’s good to come out and get some air."

"Are Manstein and Weber accustomed to things over there?" Xia Shu asked again.

"They’re accustomed, it’s not Manstein’s first time here; he’s used to it. Weber’s also fine; his wife learned online shopping and bought a room full of flower seeds." When Yang Ping talked about this, the corners of his mouth lifted again, creating two lines of smile above his mask.

Xia Shu also laughed, his mask puffing up: "Online shopping is something no one can resist. My wife, Cai Qiaojun, is the same, receiving seven or eight packages a day. Weber’s wife is also conforming to local customs."

"That’s your indulgence," a nurse checking instruments nearby chimed in, "Director Xia, you indulge Cai Qiaojun; she holds the financial power at your house, right?"

Xia Shu did not deny it, chuckled twice, his voice somewhat muffled behind the mask: "Men, earning money is for the wives to spend; when she’s happy, I’m happy."

Yang Ping looked at Xia Shu, feeling somewhat emotional.

"Professor, how about that coronary bypass image, when will you be free to look at it?" Xia Shu brought the topic back to business. He couldn’t stay away from the operating table for too long; the next operation in the adjoining operating room was already preparing.

"Let’s look at it now, where are the images?" Yang Ping said.

Xia Shu immediately stood up, retrieved the thick stack of images from the corner cabinet; he’d specifically had them delivered early to the operating room, waiting for Professor Yang. He carefully and swiftly clipped them to the viewing lamp, as if arranging some precious exhibit.

Yang Ping stood up and walked to the viewing lamp.

The first image was clipped up, and his brows furrowed immediately.

"Porcelain aorta," rings of calcification on the aortic wall encased the entire aorta tightly like an eggshell; such severe calcification is quite rare.

"For this aorta, it’s not just about punching a hole; even a gentle clip could cause it to break," Yang Ping said.

Xia Shu nodded: "Yes, that’s why we don’t dare to do standard proximal anastomosis; we must completely avoid the aorta."

Yang Ping didn’t respond, continuing to look at the next image.

This is a coronary artery angiography image. The left main trunk narrowed by 90%, leaving only a slit for blood supply. The right coronary was completely occluded; no imaging appeared on the screen. The whole heart’s blood supply depended on a marginal branch.

"During anesthesia induction, if the blood pressure drops slightly, this patient might die directly on the table," Yang Ping said.

"So we plan to do the surgery on a beating heart, without extracorporeal circulation, performing the anastomosis while the heart is beating," Xia Shu said, "This can minimize interference with circulation."

Yang Ping nodded and continued to look down.

Next was the image assessing the target vessels. The words ’diffuse small vessel disease’ were vividly reflected on the images. The coronary artery that should be clearly visible now looked like an old out-of-repair water pipe, full of narrowing and plaques, hardly any segment longer than one centimeter could be found.

"Where will the anastomosis be?" Yang Ping asked.

Xia Shu pointed to several positions on the image, his voice somewhat muffled because of the mask, but his tone was very firm: "Here, here, and here, these are three segments that are still relatively normal. But the longest segment is only eight millimeters, barely enough for an anastomosis site."

Eight millimeters.

Normally, a coronary bypass anastomosis requires a one to one and a half centimeter vessel segment for stability. Eight millimeters, barely adequate, but any slight carelessness could lead to anastomosis narrowing or occlusion.

"What will you use for the graft vessels?" Yang Ping asked again.

"The left internal mammary artery can’t be used anymore; it was ligated in the last surgery. The right internal mammary artery is usable, and a radial artery can be obtained. The rest have to depend on the great saphenous vein," Xia Shu said.

Yang Ping calculated mentally. One right internal mammary artery, one radial artery, one or two great saphenous veins, barely enough. But the problem is, all proximal anastomoses can’t be done on the aorta; they must form composite "T" or "Y" shaped grafts, connecting all grafts together, using a common "trunk" to receive blood flow from the aorta. Where will this "trunk" come from? It can’t just appear out of thin air.

"How do you plan to do the proximal anastomosis?" Yang Ping asked.

Xia Shu quickly pulled a sheet of paper from the printer, pressing it onto the screen of the viewing lamp, explaining while drawing.

"I plan to use the right internal mammary artery and radial artery to make two independent in-situ grafts, the right internal mammary artery anastomosing to the anterior descending branch, the radial artery to the obtuse marginal branch. Then use the great saphenous vein to create a Y-shaped graft, one end anastomosing to the right internal mammary artery, the other end to the posteroinferior branch and left ventricular posterior branch."

Yang Ping looked at the diagram, silent for a moment.

"There’s a problem with this plan," he said.

"What problem?" Xia Shu became tense, his brows slightly furrowing above the mask.

"Is the radial artery long enough as an in-situ graft? You are harvesting the radial artery from the wrist, needing to anastomose all the way to the heart’s side; this distance is not short. If the length is insufficient, forced anastomosis will have tension, easily causing spasms or tearing post-surgery."

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