Johns Story


Hangzhou, China
 
In November 2014, a team from the Mazankowski Alberta Heart Institute was invited to the People’s Specialist Hospital in Hangzhou, China for a cardiac surgery mission. The purpose of this mission was to perform 3 days of cardiac surgery cases, and participate in an education symposium for the hospital’s cardiac surgery program.
 
Our visiting team consisted of cardiac surgeons Dr. Shao-Hua Huang (team lead), Dr. Rod MacArthur, anaesthesiologist Dr. Blaine Achen, OR nurse Allison Ross, and yours truly as perfusionist.
 
The team was greeted at the hospital with an exceptionally warm welcome, and a little more fanfare than we had anticipated. We were next led on a tour of the facility, the operating rooms, and intensive care unit, followed by a meeting with hospital administrators and medical leadership.
The final part of the afternoon was spent reviewing the patients proposed for our surgical team. And here’s where the plan all changed. The original invitation was for our visiting team to perform straightforward, isolated CABG cases, and educate the local team in the technical aspects of these procedures, which they performed relatively infrequently. While we were presented with one CABG case, it was on a very sick patient with a recent MI. The remaining cases presented to us were more complex than we had originally anticipated or been led to believe – an aortic valve + CABG, and an aortic root replacement/Bental. After much discussion and deliberation, and recognizing the limitations of our equipment and resources, we agreed to proceed with the challenging cases presented to us, as these patients had little chance of survival without the expertise of our team. How could we come all this way just to say no?
 
In the operating room, the equipment was a disparate blend of both old and new. Some aspects of the capital equipment and supplies were quite modern and sophisticated, while much was antiquated, makeshift, or absent altogether. The heart-lung machine itself was a bare-bones unit equipped with nothing more than an oxygen blender. Safety devices, what safety devices? No level, bubble, temperature, or pressure sensors. Arterial line pressure was displayed from a transducer on a transport monitor. One single-tank heater-cooler allowed for control of either systemic temperature or cardioplegia – a real challenge for a potential deep-hypothermia case. Patient rectal temperature was the only monitored temperature. Our circuits were a mish-mash of components, with two venous lines for bi-caval cannulation. What was more modern was the OR environment itself, and very strict attention was paid to sterility and infection control. Anaesthesia machine and monitoring were also state of the art. Surgical suctions were a couple of glass bottles on the floor, and the "sharps" container was a clear plastic produce bag, disposed with the biohazard materials at the end of the case.
 
The next morning proceeded with the more "straightforward" CABG case. My role was to assist and advise the local perfusionists during the case. Despite the obvious language barrier, we were able to communicate our ideas and manage a pretty good understanding throughout the case. The perfusion staff were all trained on the job, but had developed a pretty solid understanding of the fundamentals of CPB. The afternoon was spent in a long session of interdisciplinary lectures and educational presentations from our team – surgeons, anaesthesiologist, and perfusionst. My presentation focused on the building blocks of a quality-oriented perfusion practice and department. All our lectures and presentations were very well-received and greatly appreciated by a large auditorium of attendees.
 
The following day we tackled the CABG+AVR case, and although successful in the end, we struggled with limited cannula selection and the limitations of the CPB system itself. Now the perfusion staff were observing my practice and technique, with me explaining every step from circuit modifications and assembly to priming and case management. A smattering of their English, Google Translator, hand gestures, and diagrams eventually got our questions, ideas, and recommendations across the language divide. A few of the OR nurses provided invaluable translation assistance at key points during the procedure. This case only served to highlight the challenges we needed to overcome to take on the more complex aortic root/Bental case the next day.
 
On arrival to the OR the next morning, I was amazed to find that a second heater-cooler had been borrowed from another hospital, and the circuit had been assembled exactly as I had modified it the previous day. The perfusionists were quite proud of their accomplishments and I conveyed my gratitude for their diligent efforts to accommodate our needs. Suffice to say, despite struggling with the vagaries of cannulas, jury-rigging the circuit, and white-knuckling a complex DHCA case with no safety devices, the patient left the OR in very stable and satisfactory condition. We left after a very long day for some well-deserved adult refreshments,...but that's another story for another time!
We closely followed the progress of our patients post-operatively as they recovered in a very well-equipped ICU under the care of some very skilled critical care nurses and physicians. At the end of our week stay, we were pleased to learn that all of our patients were extubated, recovering well, and expected to be transferred to the ward and discharged within the week.
 
During the entirety of our stay, we were treated like celebrities. Every dinner was a feast, drinks and toasts flowed freely (sometimes a little too freely?), and we were showered with gratitude and gifts. We were treated to evening gala shows, a riverboat cruise, and a tour of a Buddhist temple. The morning before our departure we spent on a bicycle tour through the city and the beautiful lake park. I'm amazed any of us survived cycling in the crowded chaos of the city traffic!
 
In summary, I will confess that I was initially very reluctant to participate in this mission. I was too busy at work, too many Board of Directors items needed attending to, it was too soon after our AGM, I was missing family time and using valuable vacation time and Airmiles. All just empty excuses. Because in the end, the whole experience was a life-changing adventure and a highlight of my career. Looking back, I wouldn't change a thing (except maybe some pump alarms!), and can't wait to return. I would whole-heartedly recommend the challenges and rewards, the professional and personal growth, the friends gained and camaraderie shared to anyone presented with the opportunity. No need to wait for the opportunity to come to you – they are out there just waiting for you to step up and take the plunge!
 
I am pleased to report that the People's Specialist Hospital of Hangzhou has invited this same team to return in the spring of next year to help further advance the quality of practice and patient care in their cardiac surgery program. Enjoy the photos!