hank’s big day

After the entire cardiology department met last Wednesday to discuss Henry’s case, we learned that they were ready to take him for his permanent pacemaker placement.  Exciting and scary at the same time for sure.  Hank’s surgery got scheduled for Monday, June 18.  He was to be the 2nd case of the day, at 2:30 in the afternoon. 

Prep for surgery started the night before.  Hank got moved from his crib to a warmer bed so he could transfer down to the OR with no problems. 

He was made NPO at 5am the day of the surgery.  Since he couldn’t eat, they placed an IV and gave him a dextrose solution to keep his blood sugars up.  Poor baby got really hungry throughout the day, so much that he had to be sedated with Ativan to keep him calm. 

With dad, enjoying his paci while waiting to get called to the OR. 

Right before the surgery, Dr. Phillip Burch, the same cardiothoracic surgeon that did Hank’s surgery before came and spoke with us.  Essentially, he told us that he would do two main incisions.  First, in Hank’s chest, where he would do a sternotomy (crack his sternum open to reach his heart), and put his pacer leads there, on his heart.   Second, he would make an incision down on the left side of his abdomen, through the fascia and muscle and make a pocket.  This is where they would put the actual pacemaker.  From there, the wires would go through his tissue up to his heart.  He told us they would loop the wires near the pacemaker, and near the heart to account for the length wise growth he would be making over the next months and years.   Dr. Burch reminded us that Hank’s surgery was essentially open heart surgery and told us of the risks, but felt that Hank would do pretty good.  We felt really comfortable with Dr. Burch doing the surgery as we have been told by many that he was very meticulous, careful, and his nickname was “gifted hands”.  I think those things were true. 

Hank, right before the OR.  His last shot with the external pacer box. 

Hank went to surgery at about 3pm.  Right before he went, the anesthesiologist told us his plan, and that he would be intubating (putting in a breathing tube) Hank, then extubating (taking out the breathing tube) right before he left the OR.  I was a bit skeptical about that, just because Henry is not fast at weaning from any type of respiratory support.  Then, off he went.  They called us in the surgical waiting room every hour to give us updates.  In general, we were told what part of the surgery they had completed and how he was at the time.  We heard a lot of “he is comfortable and warm”, which was good.  He finally was complete with his surgery around 6pm, and Dr. Burch came and told us everything went well and that Hank looked good and the surgery was a success so far. 

The pacemaker they decided to put in Hank is a St. Jude’s Zephyr Model 5820. 

Photo from:  http://www.medwow.com/med/pacemaker/st-jude-medical/zephyr-dr-5820/33538.model-spec

Some info about his pacer from the product website.  http://www.sjmprofessional.com/Products/US/Pacing-Systems/Zephyr-Pacemakers.aspx

Zephyr DR 5820

• Dual-chamber, rate-responsive pacemaker
• 43 x 44 x 6 mm, 18 g, 8.5 cc*
• ACap™ Confirm threshold management
• Beat-by-Beat AutoCapture Pacing System
• Ventricular Intrinsic Preferenced (VIP) Feature
• Stored electrograms (EGMs)
• AF Suppression algorithm
• AT/AF diagnostic suite
• Auto Mode Switch algorithm and diagnostic suite

Instant Follow-Up with the Merlin™ Patient Care System

Zephyr devices feature the ACap™ Confirm algorithm and the Ventricular AutoCapture™ Pacing System that automatically test patient thresholds. Additionally, the device automatically senses intrinsic signals and lead impedances, resulting in 100% of follow-up completed outside of the clinic.

Upon interrogation, the Zephyr device displays the last measured sense and capture threshold results obtained automatically within the last 24 hours (from both the atrium and ventricle in dual-chamber models). Once a day, the pacemaker automatically measures intrinsic P-wave and R-wave activity and displays the last test results in combination with a weekly P- or R -wave trend. Results are displayed with follow-up EGMs for quick verification of the test measurements.

If the clinician chooses to perform the test during an in-clinic visit, preset test values will facilitate prompt testing.

Dual-chamber models also provide the ability to reduce ventricular pacing, via the Ventricular Intrinsic Preference (VIP®) feature, and to maximize flexibility in managing AF.

I’m not really sure what all of that stuff means, but over time, we might understand it. 

After surgery, Hank went to the Cardiac Intensive Care Unit (CICU), which I will admit, I was not thrilled about.  Nothing against them, we are just used to our home in the NICU with all our regular nurses that know Hank well. 

  

Hank right after surgery.  So full of fluid.  

Poor baby Hank.  Here’s what he gained during and after surgery. 

• A brand spankin’ new pacemaker, my favorite thing!
• A new heart rate to boot. (100 bpm for now). 
• A chest tube to drain fluid from the incision in his chest.
• A breathing tube (hopefully to come out soon), with a lovely ventilator
• A ton of fluid weight.  Currently being removed by diuretics (lasix and diuril) and albumin.
• Antibiotics for 48 hours (cefuroxime)
• TPN (nutrition through his IV)
• A few IV lines
• An arterial line
• A foley (has since been removed)

  

Here he is about 24 hours after surgery.  Looking much better.

Since being down in the CICU, my outlook has changed a bit.  Maybe due to the never ending supply of slushees! 

    (I totally need one of these machines) 

No really though, they have done a fabulous job here, weaning him from his ventilator and making sure his pacemaker is behaving correctly, which it is!  We have been really grateful for his great care here. 

So, here is Hank’s last chest x-ray.  You cannot see the pacer box in the picture (it’s down on the bottom right side), but you can see the wires and leads.  The top lead is the atrial, the bottom is the ventricle.  You can all see how the wires are wound on the left side of the picture to account for his growth.  Since they went in through his sternum, you can see how they close it up with wires, which stay there forever.  It’s really amazing what modern medicine can do.  I know I am grateful! 

More updates to come!