3 Girls and a Daddy: The Arterial Switch Procedure

Emersyn had her switch procedure on December 12th. She went to the OR at 7:30am and it was absolutely heart breaking allowing them to take her away. Even though this procedure has a 98% success rate, there are plenty of risks- the worst of which obviously being infant death. No matter how much you try not to think about that, it is impossible to let your child go without the thought that they may not return crossing your mind...such a horrible thought.

The OR nurse told us that he would come out occasionally to update us on Emmy's status, so we waited in the surgical waiting room for hours. Around 9:30, the nurse came out to let us know that all of the lines were in and she had been placed on cardiac bypass. The surgeon, Dr Nigro, was preparing to start the repair. We were told that it would be at least a couple hours before we would be updated again.

At 12:00pm, the nurse came back out and said that the repair had been successful and that they would be taking her off bypass soon. After she was removed from bypass, Dr Nigro would keep her chest open for a while to monitor for bleeding at the surgical sites. Sternum closure would be very slow to ensure that the bleeding was controlled and her heart was not going to swell too much for full closure.

After surgery, Emersyn would go directly back to her ICU room for recovery. We were told to wait in the CVICU waiting room and that the nurse would call us back to the room once they had her settled and we were able to see her. Dr Nigro came to update us in the waiting room with all good news. The surgery had been "a textbook switch procedure" and everything had gone perfectly. He had been able to close her chest completely which we were thankful for. He said that we should be able to see her within the next 20min...feelings of relief and anxiety to see her swept over us.

An hour later, we were brought back into her room. There were several doctors and nurses surrounding her little warmer so Bryan and I just sat on the couch and stayed out of the way. Everyone was busy...doing 5 or 6 jobs it seemed, but it was very well coordinated- a controlled chaos. Emersyn was bleeding from her chest, and they were unable to determine where it was coming from. After a call to her surgeon, he showed up at the bedside, and removed her surgical dressing. She had pacing leads that went through her skin and were stitched directly to the heart to be used in case of an emergency. The blood was coming from one of the pacing wire sites. Dr Nigro stitched the site closed and covered it with surgical glue, then redressed her incision...nothing to be concerned about, thankfully.

When we got our first look at our baby, it took our breath away. She was covered head to toe with lines and tubes and leads. She was nasally intubated and on a ventilator to help her breathe. She had a nasogastric tube in the other nostril which was hooked up to suction to remove gastric secretions from her stomach. She had a midline chest incision that went from about an inch above nipple line to 2 inches below. She had a chest tube just below her dressing to drain excess fluid from around the heart. The pacing leads were coming from the right and left sides of her chest. She had a foley catheter in to drain her bladder, and a rectal probe which constantly measured her temperature. Then there were the IV sites: 2 central lines- one coming from the right side of her neck and the other in her right arm. An arterial line had been placed in her left arm and a peripheral IV in her right foot. As far as medications, she was on dopamine, epinephrine, and milrinone to stabilize her blood pressure and heart function, hydrocortisone and T3 also for stabilization, fentanyl for pain, TPN and lipids for nutrition, clindamycin and ancef to prevent post surgical infection, and heparinized IV fluids.
The picture was horrifying but the medical team gave us consistent reassurance that she was doing well.