Chapter 1897: 1830 Machine-like Precision

Opening the sternum, quickly staunching bleeding, exposing the Operating Field, Zheng Ren found it just as expected, with heavy adhesions inside the mediastinum.

The second surgery proceeds thus; after one surgical strike, the body develops fibrous connective tissue proliferation, altering normal anatomical structure.

Seeing the messy, sticky tissue inside, Zhao Yunlong felt a bit headache.

The elephant trunk surgery itself is the biggest surgery in Cardiothoracic Surgery, and the two‑stage elephant trunk surgery…

Difficulty ×10!

Zheng Ren reached out, the Hemostatic Forceps and Blunt Scissors landing in his hand.

Lao He glanced and thought that opening the aorta would still take several minutes, and this was with Zheng Lao Ban as chief surgeon. If someone else did it, just smoothly dissecting to the aortic arch would take at least 30‑60 minutes.

He took out a USB drive, quickly found the audio file, and opened the Good Luck Come song.

The familiar, melodious tune sounded, but this time Su Yun didn't complain; he seemed not to have noticed the background music had switched, focusing intently on cooperating with Zheng Ren's dissection.

The two Hemostatic Forceps flew up and down, a splendid sight.

The Blunt Scissors dissected, accompanied by the snapping sound of the ultrasonic scalpel.

"Prepare heparinization." Zheng Ren said solemnly while dissecting.

Lao He was somewhat surprised, astonished by Zheng Lao Ban's confidence. Heparinization doesn't take long; usually it's done after preparing the operative area.

Zheng Lao Ban was confident in his own dissection, having estimated the time and ordered heparinization early.

Lao He began preparing steadily while monitoring the surgery's progress.

After 3′12″, the aortic arch appeared completely in the Operating Field.

Having dissected the aortic arch and its branches, each was looped with a vessel tie.

"Heparinization complete."

At the moment Zheng Ren Gang just finished tying, Lao He said.

The timing was just right; Lao He knew it wasn't his own good coordination, but Zheng Lao Ban's extremely accurate assessment of his own ability.

If the medical team were a machine, I would be just a component. My skill level had long been figured out by Zheng Lao Ban, calculated into the surgical process.

Watching the seamless coordination, it was actually a manifestation of Zheng Lao Ban's calculative ability. Lao He merely sighed, then didn't think further.

The surgery was still proceeding at high speed, leaving no room for distraction.

After heparinization, Zheng Ren inserted a 24F arterial cannula 2–3 cm into the right subclavian artery. He dared not insert it too deeply, because deep insertion could enter the innominate artery and severely affect cerebral perfusion.

Then he inserted a right atrial secondary catheter or superior/inferior vena cava cannula.

"Full flow conversion cooling."

Only one person spoke in the Operating Room; the quiet atmosphere attested to the surgery's difficulty from the side.

Oxygenated blood flowed from the right subclavian artery via the innominate artery to the aorta to supply the whole body, then via a right atrial blind‑inserted coronary sinus retrograde perfusion tube.

"Report nasopharyngeal temperature."

"35°C."

"33°C."

"30°C."

"27°C."

When the nasopharyngeal temperature dropped to 26–28°C, the ascending aorta was clamped, and cold blood cardioplegia was retrogradely infused via the coronary sinus.

While continuing to cool, he simultaneously completed lesion exploration, prosthetic valve replacement, proximal anastomosis of the prosthetic graft, and assessment of coronary artery anastomosis during bypass grafting.

Zheng Ren moved quickly, but the more he explored, the more Su Yun felt a little panicked.

Marfan syndrome is a congenital disease; after the ascending aortic valve‑conduit replacement plus coronary artery transplantation two years ago, the patient's local changes were far greater than originally anticipated.

Adhesions were severe, but that's aside for now. The mid‑anastomotic segment faintly showed a bubble sign, indicating the possibility of a later dissection.

Should the surgery also include the first‑stage bypass?

Even Su Yun was caught off guard by this situation, feeling a bit headache.

When he saw the situation in the operative field, he glanced up at Zheng Ren.

Zheng Ren seemed utterly devoid of emotional change, performing the surgery calmly.

Su Yun felt a bit reassured, with the Boss around, what's there to fear?

"22°C." Lao He continued reporting the temperature.

"20°." Zheng Ren said.

The two numbers they spoke were entirely different concepts. Lao He was reporting nasopharyngeal temperature, a key point to watch in deep hypothermic circulatory arrest.

Zheng Ren's 20° referred to the patient's head‑down angle. After Zheng Ren said that, the three simultaneously paused the surgery, and Lao He began adjusting the operating table's angle.

The head was tilted downward, forming a 20° angle.

Zheng Ren then sequentially clamped the innominate artery, left common carotid artery, and left subclavian artery, reducing arterial flow to 8 ml/kg·min, performing continuous selective cerebral perfusion, while releasing the ascending aortic clamp and beginning surgery on the aortic arch and its descending portion.

"20°C." Lao He was still wholeheartedly reporting the temperature.

This temperature was the bugle call for the all‑out assault.

After Lao He finished reporting the temperature, Zheng Ren immediately clamped the ascending aorta, and cold cardioplegia was administered to the aortic root.

"Slush."

The prepared slush was delivered to Zheng Ren's hand.

Zheng Ren first tried it: it had ice and water, 4 °C. There were no large ice chunks, only small ice flakes, which could cool the heart as quickly as possible.

In ordinary cardiac surgery, being able to produce such nearly perfect slush can raise the procedure's completion rate by several percentage points.

This is a detail, yet an indispensable detail.

Zheng Ren was very pleased, placing slush on the heart's surface to cool it.

When the nasopharyngeal temperature fell to 18°C, Zheng Ren began clamping the three head‑arm vessels of the aortic arch, changing the extracorporeal arterial perfusion flow to 6 ml/(kg·min) for selective antegrade cerebral perfusion.

Along the long axis of the aortic arch, the aortic arch was incised, proximally to the original prosthetic anastomosis and distally to the near opening of the left subclavian artery.

Because the heart had stopped beating, deep hypothermia extracorporeal circulation had already been established, so when the aortic arch was opened, there was no blood flow out.

The aortic arch was pristine, the operating field clear.

The goal of deep hypothermia circulatory arrest surgery was precisely for this moment, and at this point it appears almost perfect.

"Watch the cerebral thrombus volume." Zheng Renyi, while cutting open the aortic arch, said in a low voice: "If Lao He isn't familiar with it, turn the screen 22 degrees to the side; I'll keep an eye on it."

Lao He felt a bit embarrassed; this should have been the anesthesiologist's job.

But in the middle of surgery, and with this brand‑new machine I've just encountered, when would I have time to get familiar with it, understand it, and break it in?

He followed Zheng Lao Ban's instructions without hesitation, placing the ultrasound probe on both sides of the patient's neck, not interfering with the surgical site or the head. Meanwhile, the screen was turned toward Zheng Lao Ban, with countless data drifting across it.

The sheer volume of data left Lao He at a loss.

This should be a laboratory product, still in its early stage, requiring precise computer calculations to output the results.

But now there is no final result; all we can see on the screen are countless data signals appearing like snowflakes.

Zheng Ren occasionally glanced up at the color Doppler ultrasound screen, but his hands never stopped moving.