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Your questions answered

Open heart surgery

Viewer response to David Payne's open heart surgery by Francis wells was phenomenal. A deluge of questions poured in throughout the operation, ranging from a discussion of the risks involved to how relaxed the surgical team were feeling! During the programme #slive became the third most popular trending topic on Twitter.

Here are a selection of questions that were answered on the night. Mr Wells also kindly answered more of your questions specially for this website.

What are the predominant risks that this cardiac surgery procedure involves? (via Twitter)

'The biggest one is death. It's a major operation and there is a small, but definite risk of death, on average, in a mitral valve repair in somebody who has no other risk factors, that means they're otherwise healthy. That risk is one in a hundred.

'But of course if the patient has a number of other risk factors, the risk can go up. Other risks are those that you would normally associate with an operation, such as chest infection, wound infection, bleeding, the usual things.'

Sam Nashef, Cardiothoracic surgeon, Papworth Hospital

It seems very informal, is it always this relaxed? (via Twitter)

'Yes, it's not that we're not concentrating and working very hard... it's just that we do a lot of it. But I can tell you there's a huge amount of concentration here at the moment. This is not the easiest view of cases.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital (while operating)

Was there ever a time you didn't like blood and guts, and the aspect of this - does it take getting used to? (via Twitter)

'I still don't like blood and guts. Um... we tend to keep it under control, but it does help that my father's a butcher, so I've kind of grown up with it.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital (while operating)

I actually had a liver transplant five years ago, and what it is is I was wondering how long does it take for the average person to recover from the operation and recover to normal fitness and really is there anything that can be done by someone in advance of the operation or post-op to assist in recovery? (Jonathan Compston, by phone)

'I don't think you need to do much beforehand other than remain reasonably fit and active. Afterwards, have a very positive attitude. You will spend about five or six days in hospital.

'It's not a particularly painful operation, probably your liver transplant would have hurt you a lot more but afterwards there is no doubt that it's a big operation that will take the wind out of your sails, so for the first few weeks you will tire easily and you will find that you will need a little bit of moral and physical support.

'Within six weeks most people are feeling back to normal, and at three months there are no restrictions on you whatsoever... After these operations: day one, people sit up in bed; day two, they sit up in their chair; day three, they go to the loo; day four, they walk up and down the corridor; day five, they walk around the duckpond at Papworth and then they go home.'

Sam Nashef, Cardiothoracic surgeon, Papworth Hospital

Why do they still need to open up the whole ribcage? Why can't they use keyhole surgery for this? (via Twitter)

'And this is why the minimally invasive surgery which people keep talking about is not good for you, because to get the level of perfection that we're trying to get here, you simply can't do it through minimal-access surgery, and what happens to patients in 30 years' time after the repair is what matters, not how they are three weeks after the operation.

'Again, a very good example of how with minimal-access surgery, you simply couldn't do this operation satisfactorily. As you can see I'm not a fan of it, it's a bit like wallpapering the front hall through the letterbox. You know, we can do it, but would you like the results? And I think that very much of minimal-access surgery.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital (while operating)

What causes heart valve problems in the first place? We understand what the problem is with the valve, but why does it happen, and in particular is this problem more common today due to our lifestyle and food habits because we're hearing about it more often? (mix of questions)

'Well, you'll be relieved to know it has absolutely nothing to do with food habits, so no need for any guilty feelings about food. What used to cause most heart problems in the past, until about 10-15 years ago was a disease called rheumatic fever, which damaged heart valves. I don't know if any of you have heard of it. Variations of it were scarlet fever and a few other conditions, and most of the valves that we used to see were damaged by years of scarring and ravages caused by this.

'Nowadays rheumatic fever almost doesn't exist in the Western world, although they do see a lot of it in Asia and in Africa. Most of the valve disease that happens is just degeneration. It's wear and tear.'

Sam Nashef, Cardiothoracic surgeon, Papworth Hospital

How long does the surgeon have to perform the operation? How long can you stop the heart for? (via Twitter)

'With very careful myocardial protection, the surgeon will have up to two hours to perform the surgery with repeat instillation of cardioplegia. Beyond that we get very worried about the heart's function at the end of the operation. This of course varies depending on how good or how bad the heart is to start with.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

When blood vessels are cut then sutured back I wonder why they don't leak. Stitches wouldn't work same on garden hose. (via Twitter)

'Sutures in blood vessels, provided they are placed accurately and carefully, will give complete haemostasis (as we call it) because the tissues also blend together. They are not rigid like a garden hose, in illustration by the questioner. Of course, a certain amount of skill and accuracy is needed in placing the sutures properly. The needles are curved, therefore we don't tear the tissues, a gentle wrist action following the curve of the needle is vital. Also the person who is following the stitch needs to do this with great care so there is no snag on it. These details, and others, contribute to a good haemostatic end product.

'Of course in some situations the tissues are so soft that it is not always possible to gain complete haemostasis every time.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

As a current medical student, I know some surgeons play music in theatre during surgery. Do you do this and, if so, what do you play? (via Twitter)

'Yes, I do sometimes play music; the type depends upon the case and mood. Dire Straits for a nice, simple case and some Mozart piano sonatas for more difficult ones.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

Is it true that patients can undergo cerebral damage during cardiac surgery, leading to depression and short term memory loss? (via Twitter)

'It is true that patients undergoing cardiac surgery can have some cerebral damage. In my experience with modern bypass techniques and good care and attention, this is very rare these days.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

Are patients who receive this procedure likely to require further cardiac surgery in the future or is the repair permanent? (via Twitter)

'The vast majority of patients who undergo mitral valve repair do not need further surgery, and this is a life time fix.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

During defibrillation, does the patient recieve any major burns or other adverse side-effects? (via Twitter)

'No, the patient does not receive any burns during defibrillation provided the voltage is kept to a reasonable and biological level. Of course, we have pre-defined limits for that.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

Why is it covered in yellow stuff is it fat? (via Twitter)

'All hearts have fat around the coronary arteries to a varying degree. This heart was fairly typical; being yellow coloured is not abnormal. There are two principle types of fat in the body; one is more brown-yellow like that which is seen around the heart and other areas.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

What aspect of heart surgery do you enjoy most? (via Twitter)

'All of it!'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

Might sound silly, but are we all the same inside or do some patients have more "fiddly" little bits than others? (via Twitter)

'There are great personal differences inside patients and part of the skill and interest in dealing surgically with patients is being able to cope with whatever we are confronted with when we are doing the cases.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

Why did you choose to repair the valve rather than replace it? (via Twitter)

'A valve repair was utilised, rather than a replacement, because it is superior for the function of the heart in giving a more natural valve mechanism, but this particular valve also supports the left ventricle with chords acting like tie rods in an engineering sense. Therefore, repair is very definitely superior over valve replacement. However, if repair is not possible then the valve replacements that are available nowadays are excellent and perform extremely well.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital

It is obvious that Frank is a very talented and experienced surgeon who quite clearly feels comfortable with dealing with such complex surgeries. How did Frank feel when he first did this kind of surgery? (via email)

'When I started out on this surgery, like all other trainees in the same position, it was a time of great anxiety and intense training. There were periods of time when great uncertainty existed, but gradually with good teaching, experience and dedication everything gets better and easier.'

Frank Wells, Cardiothoracic surgeon, Papworth Hospital


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