Chapter 2224 - 1451: With Him by My Side, the Surgery Is Halfway to Success (Part 2)

Chapter 2224: Chapter 1451: With Him by My Side, the Surgery Is Halfway to Success (Part 2)

"Dr. He, is the great saphenous vein ready?"

"It’s ready, twenty-four centimeters, and the entire quality is good." Dr. He hands over the prepared vein graft.

Xia Shu takes it and examines it carefully. The vein wall is smooth, without damage, and the diameter is uniform. He rinses the lumen with heparin saline, then soaks it in papaverine solution to prevent spasms.

"Begin the anastomosis."

The first step is the anastomosis between the right internal mammary artery and the anterior descending artery. This is the keystone of the entire surgery: if this anastomosis fails, everything else will be in vain.

Xia Shu trims the distal end of the right internal mammary artery into an oblique surface, and uses micro scissors to make a small opening on the blood vessel wall. The target vessel segment of the anterior descending artery has already been temporarily blocked by Li Zehui with a vascular clamp. Xia Shu makes a longitudinal incision on the anterior wall of the artery, matching the diameter of the internal mammary artery.

"7-0 Prolene, double-headed needle."

Xia Shu takes the needle and thread and begins suturing. His movements are slow, each stitch thoughtfully considered: the angle, depth, margin of entry, the exit position, the tension of tying each knot... Every detail is controlled within the most precise range.

This is the essence of microsurgery and the gateway to cardiac surgery. Suturing a circle on blood vessels with a diameter of less than two millimeters, with a total of twelve to fourteen stitches, each stitch must penetrate the full thickness of the vessel wall but must not penetrate the intima. Otherwise, thrombosis may easily form postoperatively. The stitch distance must be uniform, the margin appropriate, the tension consistent... These requirements combined create the greatest technical challenge of the coronary bypass surgery.

Xia Shu completes six stitches and pauses to let Li Zehui rinse the surgical field with heparin saline, clearing out any potential blood clots. Then he continues suturing until the final knot is tied.

"Open the blood flow!"

The vascular clamp is released, and the fresh blood from the internal mammary artery rushes into the anterior descending artery. Xia Shu focuses on the anastomosis, watching it slowly fill as the color changes from pale to bright red. There’s no bleeding, no twisting, and the blood flow is smooth.

"Good." He says softly, his tone lacking pride, only a sense of relieved calm.

Next is constructing the great saphenous vein bridge. Xia Shu divides the twenty-four centimeter vein into two segments: one fifteen centimeters, the other nine centimeters. The fifteen centimeter segment serves as the main bridge, with one end anastomosed to the lateral wall of the right internal mammary artery, and the other end ready to make three distal anastomoses. The nine centimeter segment acts as a supplement to the radial artery, used if the posterior descending artery or the left ventricular posterior branch requires dual blood supply.

"Is the radial artery ready?"

"It’s ready, twenty centimeters." Dr. He hands over the second graft vessel.

Xia Shu soaks the radial artery in papaverine solution, allowing it to fully expand. Then he begins the side-to-side anastomosis of the internal mammary artery and great saphenous vein, which is the most ingenious part of the surgery and the core of the plan he and Professor Yang designed.

He trims one end of the great saphenous vein into a "Y" shape, with the two branches anastomosed to the lateral wall of the internal mammary artery. This way, the blood flow from the internal mammary artery can simultaneously supply the anterior descending artery and the entire great saphenous vein bridge, achieving a single source and multiple supplies framework.

"The flow rate at this anastomosis needs to be sufficient." Xia Shu says as he sutures, "The flow from the internal mammary artery is limited; if there is a constriction here, all three subsequent distal anastomoses will experience ischemia."

Yang Ping observes Xia Shu’s every action with seriousness, nodding occasionally. He knows that Xia Shu’s level in cardiac surgery is already world-class.

The side-to-side anastomosis completed, Xia Shu uses a Doppler flowmeter to measure the flow rate, forty-five milliliters per minute, enough to supply the three distal anastomoses.

"Continue, obtuse marginal branch."

The target vessel segment of the obtuse marginal branch is of decent quality, diameter of about one-point-two millimeters, length of one centimeter. Xia Shu trims a branch of the great saphenous vein and anastomoses it with precision and slowness. After opening the blood flow, the Doppler shows a flow rate of eighteen milliliters per minute, with good patency.

"Posterior descending branch."

The situation with the posterior descending branch is worse than anticipated: the distal end is almost completely occluded, with only the proximal segment barely usable. Xia Shu anastomoses the second branch of the great saphenous vein here, and then has Dr. He anastomose one end of the radial artery to the posterior descending artery as well, creating a dual blood supply.

"Left ventricular posterior branch."

The final anastomosis, with the vessel diameter of the left ventricular posterior branch less than one millimeter, Xia Shu must use a higher magnification lens. Sweat begins to bead on his forehead, and a nurse gently wipes it away for him.

"7-0 Prolene, single-headed needle."

The moment the needle tip penetrates the vessel wall, Xia Shu feels that familiar resistance, not the normal elastic tissue, but the brittleness brought by calcified plaques. He adjusts the angle of entry, avoiding the plaque, piercing through the relatively normal vessel wall.

One stitch, two stitches, three stitches... Each stitch feels like walking a tightrope; any carelessness could rip the vessel. Xia Shu holds his breath, concentrating fully, as if the entire world consists only of the square millimeter of vision under the needle tip.

With the final stitch tied, the blood flow opens, and fresh blood from the radial artery rushes into the left ventricular posterior branch, converging with the flow from the great saphenous vein, forming a dual supply.

"Doppler!"

Li Zehui places the probe, and the screen displays a clear blood flow waveform: "Patent, flow rate twelve milliliters per minute."

Xia Shu straightens up and exhales deeply. He glances at the wall clock: three hours and fifteen minutes. Longer than he anticipated, but still within an acceptable range.

"Before closing the chest, ensure thorough hemostasis." He says.

This is another crucial phase, as the patient’s coagulation function is poor and any small bleeding point could evolve into major issues post-surgery. Xia Shu and Li Zehui together meticulously check the surgical field, electrocautery, suture, compress... No potential bleeding point is overlooked.

"Platelet infusion, cryoprecipitate, begin." Xia Shu instructs anesthesiologist Old Zhou.

"It’s already infusing."

"Has tirofiban been used?"

"Yes, it’s been administered."

Xia Shu nods and begins closing the chest. Steel wires secure the sternum, and he sutures the muscle, fascia, subcutaneous, and skin, layer by meticulous layer. Every step is carried out with precision, as he knows: the success of the surgery depends not only on the procedure on the table but also on every detail post-operation.

"Surgery is over!"

The monitor shows data: heart rate seventy-eight, blood pressure one hundred twelve over sixty-eight, blood oxygen saturation ninety-six percent. Urine output is normal, drainage is minimal.

The surgery is finally completed, and Yang Ping smiles with satisfaction.

Xia Shu knows that without Yang Ping by his side, he wouldn’t have been so confident and relaxed during such surgery. Although Yang Ping didn’t operate, his presence alone made Xia Shu feel half the success was assured.

"Professor, thank you for your hard work."

"You all worked hard." Yang Ping says while removing his surgical gown and gloves, "Postoperative management is crucial; platelet function hasn’t fully recovered, anticoagulation should be delayed. You might want to personally oversee the first day, taking turns."

"Understood!"

Yang Ping exits the operating room and changes out of his scrubs in the changing room, donning his white gown. He checks the time; it’s half-past noon. He has business at the institute in the afternoon, but decides to have lunch first and give Tang Shun a call to check on things.

The cafeteria isn’t crowded, Yang Ping grabs a simple meal and sits in a corner. Just after taking two bites, his phone rings.

It’s Xu Zhiliang.

"Professor Yang, where are you?"

"Cafeteria, just finished surgery, what’s up?"

"There’s a patient... brainstem... I’ll send you on WhatsApp." Xu Zhiliang seems to be bottling up a lot of stress there.

Soon, Yang Ping receives Xu Zhiliang’s WhatsApp message: "A patient with a cavernous hemangioma in the brainstem has fallen into a coma, and the family wants to transfer him here. I’ve assessed it, and it’s operable, but the location is very deep, at the dorsal side of the medulla, with extremely high risks. I’d like you to come and review the images."

Yang Ping puts down his chopsticks, "Send the images to my email, I’ll be there at two-thirty."

"Alright, thank you, Professor."

After hanging up, Yang Ping quickly finishes his meal and walks towards the institute.

The institute remains bustling as always, with people discussing experimental data in the corridors. Passing by the cell laboratory, Yang Ping sees Manstein leading two students under the microscope, observing something intently.

He doesn’t disturb them and proceeds directly to his office.