In the O.R. for Life-Changing Surgery Transplanting a Baby’s Heart

Doctor: Sam Weinstein
Specialty: Pediatric Heart and Lung Surgery
Location: Montefiore Medical Center

Dr. Weinstein: The patient was 6 months old and had dilated cardiomyopathy, a condition in which the heart muscle becomes too sick to beat strongly enough to sustain life. He had months to live.

A good transplant has to go like clockwork. The patient arrived in the operating room, and I knew it would take me twenty minutes to open him up and prepare for the new heart. When I got the phone call that the heart had landed at Teterboro, I cut skin.

I started the operation by opening the chest and then connecting the patient to the heart-and-lung machine that keeps blood and oxygen circulating throughout the surgery. The heart was big, dilated—we use the phrase “bagged out.” The muscle was clearly diseased.

After removing the damaged heart, I prepared the remaining tissue for the new one and made sure there were no irregularities. That’s when the harvest team arrived with their igloo cooler. Anatomically, this heart was perfect.

First, I connected the new heart to the left atrium, then the right atrium, and then I sewed the pulmonary artery and aorta and let the heart fill up with blood. It took about five minutes for the first heartbeat. It’s an unspoken rule that we try to be quiet while we’re waiting for the heart to beat. Not every heart starts as vigorously as others, so out of custom or maybe even superstition, we don’t talk. We wait and watch. Once the heart was beating regularly, I said to the harvest surgeon, “Bill, you brought me back a winner.”

With child donors, it’s a tragedy. The heart had started the day in another baby. But now this little guy can have a life. He’s home. He’s gaining weight, sleeps well, plays. And his first biopsy showed that his body was not rejecting the heart.

As told to Katie Charles

The family and friends of this 6-month-old baby take a moment to pray for a successful heart transplant. Without this procedure, the baby had months to live. Photo: Q. Sakamaki/Redux

The mother and 6-month-old baby before the surgery. Photo: Q. Sakamaki/Redux

Dr. Weinstein details to the infant’s mother and father how the surgery will unfold. Photo: Q. Sakamaki/Redux

The infant as he’s being transported from the ICU to the operating room. Photo: Q. Sakamaki/Redux

As the baby is anesthetized, Dr. Weinstein prepares for surgery. Photo: Q. Sakamaki/Redux

With the baby asleep, Dr. Weintein feels his breastbone, deciding where the incision will be. Photo: Q. Sakamaki/Redux

Dr. Weinstein debriefing the team about the plan for the procedure. Photo: Q. Sakamaki/Redux

The diseased heart, moments after it is removed from the chest. Photo: Q. Sakamaki/Redux

Dr. Weinstein (right) uses a needle-driver to put stitches in the baby’s aorta, and prepares to hook it up to the heart-lung machine. Photo: Q. Sakamaki/Redux

The new heart, moments before being placed inside the infant’s chest. Photo: Q. Sakamaki/Redux

The healthy donor heart, which is roughly the size of the plum. Photo: Q. Sakamaki/Redux

Dr. Weinstein and Dr. William Jakobleff (left), the surgeon who harvested the donor heart, prepare the organ for implantation. “If you look into the chest cavity,” Dr. Weinstein says, “there’s no heart there. That’s an empty space.” Photo: Q. Sakamaki/Redux

The surgical team begins the implantation process. Photo: Q. Sakamaki/Redux

The donor heart has been implanted, and the surgical team waits”in near silence”for the first heartbeat. The baby’s heart starts beating five minutes later, but, says Dr. Weinstein, the process can sometimes take hours. Photo: Q. Sakamaki/Redux

Dr. Weinstein and the surgical team watch the baby’s blood pressure, EKG, and oxygen level on a monitor. Photo: Q. Sakamaki/Redux

“We see that the heart is beating again, and it looks strong,” says Dr. Weinstein, “so we’ve made a decision to close.” It’s now been nearly six hours since the baby was brought into the operating room. Photo: Q. Sakamaki/Redux

The baby’s mother embraces Dr. Weinstein after he tells her the surgery was a success. Photo: Q. Sakamaki/Redux

The infant’s uncle (left), grandmother, and father celebrate the good news. Photo: Q. Sakamaki/Redux

The baby’s mother takes in the moment. Photo: Q. Sakamaki/Redux

Dr. Weinstein on his way to the locker room after the operation. “It’s just relief now that the patient is fine,” he says. “I can relax.” Photo: Q. Sakamaki/Redux

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