Surgery Finally Complete! Success!

Posted on August 9, 2012 by William 8 Comments

Well, actually it’s been complete for some time now, but I have had some major network trouble so I was not able to finish the post and upload it. Sorry for those of you that have been waiting to hear something.

The short version… it was complicated, it took about 50% longer than she thought it would take but it was successful and Evan is doing fine in the ICU.

And now for the long version, grab some popcorn and a comfortable chair.

We knew we were going to be second case for surgery but we had no idea what time that meant so we just went on with our day and had a good time. We went for walks and we played alot. Evan was very active again, crawling about and being very talkative.

 

 

 

 

 

A couple nurses came to pickup Evan at 1pm to take him to pre-op. At about 1:30pm the anesthesiologist took him to the operating room for what we thought was going to be a two hour procedure. Around 4:30pm I got really anxious and worried… why was it taking so long? Why haven’t we heard anything? Some really terrible things crossed my mind, I shook it off and continued playing around on the computer (shocking, I know). Dr. Hirsch walked into the waiting room a little after 5pm looking like it had been a long day. The surgery was complete and was successful overall but was not without it’s complications.

• Evan has A LOT of scar tissue. We all knew this ahead of time but she made it more clear how much was there and what that really means.
• It’s not a matter of the scar tissue being ‘difficult’ to cut through. The scar tissue obstructs the view and makes it much more difficult to identify structures such as vessels and organs so it’s very time consuming to get through it safely. Additionally, it’s useless tissue, it does not function like normal tissue, you can’t feasibly cut it out and you can’t attach anything to it (like a pacemaker lead) and expect it to work like cardiac muscle.
• The gradual buildup of scar tissue on Evan’s heart is what the doctors say caused the lead to fail. The electrical signal was just no longer able to make a good connection, like putting gum on the terminals of a battery and expecting it to work.
• Some people scar more easily than others and scar tissue after surgery is no different. Not only has Evan had numerous surgeries but he scars easily and abundantly. This was the 5th time that they have had to cut into his chest.
• Dr. Hirsch indicated that the next surgery will be quite complicated because of all the scar tissue. When they cut through the sternum and open the chest you can typically see the heart beating underneath. With Evan this is not the case, and she must very carefully cut through scar tissue to get to the heart.
• She also indicated that she may have to make an additional incision on the side of his chest (where your bicep rests when you have your arms down) to access an unadulterated (non scarred) portion of the ventricle to place the pacemaker leads.
• If you’ve seen Evan’s chest you know that there is a big bump on it. That bump is his sternum. It has thickened substantially from all of the surgeries that have been done. It is very thick. When a heart surgeon of Dr. Hirsch’s caliber and experience says that “it’s thicker than anything I’ve seen” and “it’s quite impressive” then you know it really is abnormal. Between this and the scar tissue it’s very tedious to get into the chest cavity safely. We really hope that she’s able to shave down the bone a bit during his final surgery to make it look and feel more normal. As it stands now it protrudes quite a bit and we expect that has something do to with why Evan doesn’t like being on his belly. It can’t be very comfortable with that and his g-tube.
• They decided during surgery to completely remove the pacemaker and put in a new one as well as new leads. They had to make the “pacemaker pocket” larger to accommodate the new pacemaker. As an additional precaution they used two different types of leads. One that is sutured into the heart muscle and another which screws into the heart muscle. Only one is currently active but if it becomes problematic they can switch over to the other lead. I believe they wanted to make sure the pacemaker and leads would last until the next surgery, which we were thinking was only 6-9 months away, until Dr. Hirsch suggested waiting until Spring 2014!!!

2014?! Really? Dr. Hirsch feels that Evan’s next surgery is going to be pretty difficult (she said she expects to need to book the OR for all day) because of all the scar tissue and wants to put it off a full year so that he’ll be bigger and she’ll have more room to work. She also wants us to work hard at getting Evan to eat so that we can get rid of the G-tube. It’s placement (high midline) really limits how much she can open the chest up and there’s a fear of infection as well from stomach fluids and such so close to his surgical site. She does a great job dumbing it down for us, “if his pacemaker gets infected, I think I would cry,” so that must mean it would be really bad.  😆

We got back to see Evan at about 6:30pm and it was such a wonderful sight. We walked in and his eyes were wide open and looking at us. He was still very drugged and out of it but seeing his eyes looking at us was very comforting and we knew that everything was ok. We’re in the cardiac ICU (PCTU) now and we’ve been deemed “the most stable patient in the PCTU,” which means we will not be here long. Evan’s breathing tube was removed before he even left the OR and they’re weaning him off of the canulla and he’s handling it well. He’s on a couple extra meds for pain and antibiotics and they will be restarting his feeds very shortly.

Evan fell asleep shortly after we showed up and has been sleeping ever since. It was a long day for everyone and we’re glad that it’s over. Thanks everyone for your prayers and positive thoughts. This was an unexpected and unwelcome surgery but we’re very grateful that it turned out well and that it was caught before it became a very serious issue.