Extracorporeal surgery is open heart surgery in which it is necessary to stop its functioning in order to intervene on it.
Professionals of the Cardiovascular Surgery Service of the Regional University Hospital of Malaga have performed the 10,000th extracorporeal surgery. This type of intervention requires the participation of a dozen professionals in the operating room due to the complexity of these open-heart surgeries.
The first extracorporeal surgery was performed on August 6, 1980 on a 19-year-old patient who was admitted to the General Hospital -formerly Carlos Haya- on an emergency basis. Since then and to date, the technology surrounding these interventions has evolved along with the technique, allowing 10,000 people to undergo surgery.
The head of the service, Enrique Ruiz, explains that extracorporeal circulation is the technology that makes it possible to operate on heart patients:
It is a machine that functions as a heart and lung during surgery. It works as a heart because the blood leaves the patient, goes to the machine and the machine propels it back to the body. And it acts as a lung because it oxygenates this blood, since it also has an artificial lung. What is achieved is that the patient’s heart is stopped, so that the surgery can fix what is malfunctioning, whether it is the coronary arteries, the heart valves or some congenital holes. At the end of the surgery, when the patient’s heart is fixed and has been restarted, the process is reversed and this organ begins to function on its own, without the need for the machine.
These surgeries account for 90% of those performed by this service in the operating rooms of the General Hospital. The pathologies that require this type of complex interventions are the narrowing of the coronary arteries that cause a lack of irrigation in the heart muscle itself. “The muscle hurts and manifests itself as angina or infarction. What we surgeons usually do are bridges to carry flow beyond the obstruction, using the patient’s own arteries or veins,” explains Ruiz.
On the other hand, heart valve diseases, such as those on the left side (mitral and aortic) or on the right side (tricuspid and pulmonary), are also operated with extracorporeal circulation. “When a valve is damaged, two things can happen: either the opening is not wide enough, or the closure is incomplete and there is a slight opening through which the blood flows backwards. Sometimes both things happen at the same time. Repairs are often made to these valves, although it is often necessary to replace them with a prosthesis or artificial valve, which can be biological or mechanical,” he points out.
Lastly, and more infrequently, cardiovascular surgeons also intervene in aortic aneurysms to prevent them from rupturing.
Since the first extracorporeal surgery and up to the present day, there have been multiple teams and the method of work has evolved. “We have advanced toward less invasive techniques that require smaller incisions, which has a positive impact on the patient’s well-being and recovery.
The team involved in these operations is multidisciplinary and acts in a coordinated manner. From the anesthesiologist, who controls the patient, the surgeons who, with the nursing professionals, work on the patient and the instruments, to the perfusionist, a nurse with specific training in the management of extracorporeal circulation, who controls the details while the extracorporeal system works and coordinates the entry and exit of the procedure.
In this sense, Juan Carlos Santos, one of the perfusionists who performs these interventions and who has participated in the 10,000th, explains that with the extracorporeal circulation they do the heart and lung function, and a solution is administered to stop the heart, so that the surgeon can perform the surgical intervention. “In addition, we use different procedures to avoid blood transfusions and always supported with the best technologies that guarantee maximum safety for our patients during the entire extracorporeal circulation,” he adds.
For Santos, reaching this figure means “remembering all the professionals who have been working in the operating room during all these years. At this moment, all those colleagues who have participated in them with their dedication and enthusiasm, with their good and bad times, come to mind. But above all I think of the thousands of patients who have benefited from these interventions that have made their lives better,” he adds.
Similarly, Enrique Ruiz points out that “several generations of surgeons and other professionals have made this journey possible. Few hospitals or centers can boast a figure like this. We can be proud of our trajectory as a hospital with cardiovascular surgery and build a great future among all the professionals who work there to continue improving the heart health of the people of Malaga,” he concludes.
Original news in the Press Room of the University Hospital of Malaga, more information here.
Translated with www.DeepL.com/Translator (free version)