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How Heart Surgery Is Done

Updated: Jun 12, 2023

The short answer is this depends on the type of heart surgery.


Most heart operations are done on cardiopulmonary bypass, or "on pump," although there are exceptions to this rule.


The sequence of the operation is as follows:


  1. Open the chest. This is done using a saw to split the sternum.

  2. If the operation involves bypasses, we must get our "conduit." This refers to the vein or artery re-routing the blood past the blockage. We get the vein from the leg and, in most cases, the artery from behind the breastbone.

  3. Initiate cardiopulmonary bypass. This is done by putting large tubes called cannulas into the aorta (large blood vessel coming from the left side of the heart) and atrium (where all the veins drain into the right side of the heart). The blood can now drain into the bypass machine, which performs the function of the heart and lungs and returns oxygenated blood to the body).

  4. Arrest the heart. We apply the cross-clamp to the aorta and deliver a solution called cardioplegia. This essentially causes the heart to be still. This provides a bloodless field and excellent visibility to carry out the operation.

  5. Insert operation. The next part depends on what the initial problem was. If the issue was a tight or leaky valve, we either fix the valve or replace it. If the problem is blockages, a bypass is performed using the previously harvested veins/arteries. Sometimes it is a combination of the above. Valve repair/replacement and CABG are the most commonly performed operations, although there is an array of other heart issues for which heart operations with this sequence are indicated.

  6. Separate from bypass or "come off pump." The heart is filled, and we watch the ultrasound of the heart to assess the function while we come off the pump. Once the heart is functioning well, the cannulas are removed.

  7. Chest closure. The breastbone is brought together using either sternal wires or sternal plates.


The sequence of events. The specific steps in chronological order which are needed to reach a desired outcome.


This is a given in heart surgery. We follow the same steps daily. We know that performing these steps in this order will allow us to achieve a successful operation.


But what about applying the same strategy to our other goals?


In September 2022, I asked myself the sequence of events to write a book. At the time, all I had was an idea. I was passionate about the mindset of people in high-stress careers and how they navigate adversity. I wanted to study it and share what I learned.


But how would I do this? As a busy surgeon and mother to a toddler, this seemed like a challenging endeavor.


Nonetheless, I began to research how I could do it.


Instantly, I was bombarded with tons of conflicting information online and from speaking with other authors.


This is where we often get stuck—too much information.


To combat this, I sat down and created a specific set of steps and wrote them down. I made a list just like I did at the start of this blog post. Instead of a successful operation as the end goal, the goal at the end of this list was a published book.


With this sequence, I set out to do what I knew how to do, what I did in every single operation. I would carry out the steps in chronological order. No exceptions.


My book, "The Heart of Fear," launched on May 1st, 2023.


Where are you stuck?


What is your sequence of events?



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