My Telltale Heart

The first cut was into my groin to put a tube into the femoral artery, which would receive blood from the heart-lung machine during much of the operation and circulate it backwards through the body. Next he carved open my chest, beginning two inches below my Adam's apple and continuing 8 3/4 inches toward my navel -- first with a knife, then a reciprocating electric saw that cut up and down through the sternum, the flat bone in the middle of the chest that is about 3/4 inch thick. Cutting it open took no more than 10 seconds, though the scar this created will now last as long as I do.

"The chest muscles come in and attach right at the midline of the sternum, so we go right between those muscles; we don't cut muscles," Corso explained. "Then we have a retractor that pulls the sternum open . . . Then there is fat that covers the sac the heart's in. We free that up and cauterize that, and open the sac . . . to evaluate what's going on."

He quickly saw that my aorta was enlarged and bruised in the area just above the heart, where the dissection was occurring. Now Corso needed to open the aorta, but he could not do this as long as it continued to carry blood from my heart to my body. Repairing a working aorta would be like trying to patch a high-pressure water main while it remained in use. Corso would have to shut down the circulatory system.

This would require the heart-lung machine and deep hypothermia, two modern medical miracles about which I knew essentially nothing before they helped save my life. In crude terms, deep hypothermia and the heart-lung machine allowed Corso to put my body, including the heart and brain, to sleep for 32 minutes. For the first time in 60 years, neither of those vital organs did anything, and the rest of me existed in a kind of suspended animation. An electrocardiogram (EKG) during those 32 minutes would have reported no heart function. An electroencephalogram (EEG), which measures brain waves, would have shown none.

When Corso first told me this, five months after the operation, I was taken aback. "So in what sense," I asked, "is one alive? If your brain and heart are both suspended in this way?"

"If your definition of life is based on electrocardiogram and the EEG," he replied, "you're dead."

"But I was still breathing?"

"Well, no, you're not breathing. You're paralyzed. Nothing's happening. Now, we know that you're not dead. We've created this situation. The cells are kept alive, they are alive, they're just not making electrical noise. Once you've warmed back up and we bring you back to normal, then, obviously, [the heart and brain] work again . . ."

Except during the critical 32 minutes, when nearly everything was stopped, the heart-lung machine did my breathing for me. This is the apparatus that makes modern open-heart operations like mine possible. To oversimplify, the machine sucks "blue," deoxygenated blood through a tube from the right atrium of the heart and directs it across the fine surfaces of the device. The machine delivers oxygen as the blood passes over the interface, and the blood cells absorb it, as they normally do in the lungs. The oxygenated blood can then be pumped back into the body.

The heart-lung machine also has a refrigerator-like coil that chills the blood, creating deep hypothermia. A body in deep hypothermia remains in a sort of super-cooled suspended animation during the critical phase of the surgery. The machine cooled a quantity of my own blood down to 50 degrees -- 48.6 degrees colder than normal. The cold blood was pumped very slowly into my brain. It came in backwards, through the superior vena cava, the vein that ordinarily returns blood from the brain to the heart. After completing its backwards journey through the brain, providing the oxygen the brain needed to survive, the blood dripped through the carotid arteries (ordinarily the suppliers of blood to the brain) into the arch of the aorta.

The arch of the aorta is the top of a loop, but because I was almost upside down on the tilted operating table, it was now the bottom, and could trap the deoxygenated blood until a plastic tube returned it to the machine for re-oxygenating, re-cooling and re-circulation through the brain.

The cold blood that preserves the heart during the surgery doesn't have to circulate. Instead it is exchanged for a new batch about every 20 minutes. During heart transplant operations, hearts are kept alive this way for up to three hours.

What, I asked, did Corso do while I was, literally, chilling out on the operating table? "We're just standing around, listening to the radio," he replied -- usually smooth jazz or classic rock-and-roll.

In deep hypothermia, with blood circulation (except through the brain) at a standstill, the aorta became just an empty pipe, and Corso could cut into it to explore further. "Because I didn't know where the tear started," he explained later, "I just opened it anywhere, just to sort of get in there and start looking around."

The naked eye, and a surgeon's magnifying viewer, was all he needed to confirm the dissection just beyond the aortic valve, next to the heart. Exploring farther, he found a tear about an inch and a half long farther along the inner wall of the ascending aorta. This is where the blood got in between the layers of the aorta to create the dissection. But the lining of the aorta's inner wall outside these two areas seemed relatively healthy. When repairing other dissections, Corso said, he has found that this lining was shredded "like wet tissue paper."

So far, it was all good news. Corso decided the operation could proceed along the lines he had initially envisioned. He amputated the aorta just above the heart. Now he could see everything inside. In the upper part of the aorta, he decided to stitch the tear, and to close and seal the false channel it created by injecting BioGlue. This is a miracle product made from a cow protein and a designer chemical that dries to the consistency of soft rubber. BioGlue is not permanent, but it gives the body's own regenerative powers a chance to go to work.

This first phase went well. "We now had an intact aorta, no obvious dissection anywhere, it's well fixed."