I have a question??

[Bonbet]

I wonder if anyone has experience or knows about restarting the heart when the surgery is over. Cleveland Clinic says that the heart typically restarts once the pump is disconnected.
After my AVR on 5/24; when the ICU nurse was reporting off to my PICU nurse, my bf heard her say that they had to shock me 3 times to restart my heart. So when the surgeon stopped by, I asked him why they had to shock my heart 3 times. He said sometimes the have to do that, nothing to worry about. So it didn't just start as it typically does, and then one shock doesn't do it? I needed 3 shocks!
There must be a reason. I have since talked to the PA and same answer, which is no answer.
Inquiring minds want to know!!!

 

[Paleowoman]

Hi Bonbet - This is what it says in my Operation Note which I was sent on discharge in the bit about restarting my heart:

"“The heart was rewarmed and the aortotomy was closed using continuous 4/0 Prolene sutures. De-airing of the heart was started through the right upper pulmonary vein and ascending aorta. The procedure was repeated several times. The cross clamp was removed and de-airing of the heart continued through the ascending aorta. The heart was in intermittent sinus rhythm. Four pace wires were applied. The heart was paced in sinus rhythm. Cardiopulomonary bypass was discontinued with no support with a blood pressure of 120/70.”"

I’'ve no idea if that is typical but it would seem to suggest that the heart is restarted before bypass is stopped - which kind of makes sense to me. It would appear that my heart was in intermittent sinus rhythm, so after they applied the pacing wires it was 'paced', which is delivering an electrical pulse (shock ?), into sinus rhythm - only then was bypass removed.

 

[Warrick]

I know from my op notes the following
"After de-airing the heart was easily weaned from cardiopulmonary bypass requiring a single DC shock for VT VF. Then went into a spontaneous rhythm of 65 beats per minute."
So one zap for me, my father who had AVR back in 1984 took an hour for them to get his heart to restart.

As to why some take more than others, only a guess but perhaps it has something to do with the drugs they inject to stop it, also maybe the voltages used , the exact placing of the paddles and the thickness of your heart muscle would be my guess, I would imagine they would try to use as low a voltage as possible to start with.

 

[ForeverThankful]

This is the way it was explained to me: Warm blood is returned to the heart and flushes it out, then sometimes the heart just starts on it's own and sometimes they shock it directly to get it started. However, even if the heart starts on it's own it isn't always in the correct rhythm so it will need a shock to get it into a good rhythm.

I don't think it matters much whether the heart spontaneously starts or needs a shock to start it up or correct it's rhythm. In other words I don't think it's a bad thing when it needs to be shocked. Actually it sounded to me like requiring a shock was common.