I, Aki Tomoya, will not be a simp.

This patient is a VIP. Is Yoshida Aoba really that comfortable entrusting the surgery to him?

Aki Tomo didn't think too much about it and said with some anticipation, "No problem!"

"Don't be so confident. You've only been with this patient for a short time, and you're already saying there's no problem? This is our VIP patient in cardiac surgery. If something goes wrong... do you understand?"

Yoshida Aoba looked at Aki Tomoya helplessly.

That's why young people are so confident.

But such confidence is not good either; if anything unexpected happens, Aki Tomoya will be in big trouble.

"I know, but Dr. Yoshida, do you think Dr. Sasaki will agree to let me perform the VIP surgery?"

If it were a regular patient, it wouldn't be a problem, but this patient is a VIP, and...

Aki Tomoya glanced at Mrs. Omi's medical history, including her two surgeries, the surgical procedures used, and other details...

The last surgery was five years ago, and five years later I was hospitalized again to prepare for surgery to replace my double valves again, but it is not so simple, there is another problem.

Considering the patient's specific situation, he put himself in the surgeon's shoes and thought about how to perform the operation. At the same time, he didn't know if Sasaki Ichiru would feel comfortable letting him perform this surgery.

Even he could see the problem, and Aki Rin didn't believe Yoshida Aoba didn't know. But would Sasaki Ichiru really trust him to be the surgeon?

"Tell me first, what do you think? What are your thoughts?"

Yoshida Aoba didn't make any promises about Aki Tomoya being the surgeon; instead, he wanted to make sure Aki Tomoya was confident about the procedure.

"Mrs. Omi's first surgery was twenty years ago, and the second was five years ago. The first time, she underwent closed mitral valve commissurotomy on the left side, while the second time, she underwent mitral and aortic valve replacement surgery..."

This is her experience with two surgeries, which Aki Tomoya specifically mentioned.

His focus, however, was on the second surgery that was most recent.

"The second replacement surgery used a bioprosthetic valve due to considerations of age and actual circumstances."

Bioprosthetic valves are suitable for some patients over sixty years of age and those with contraindications to anticoagulation, and their lifespan is also shorter compared to mechanical valves.

Based on the patient's specific condition, a bioprosthetic valve was used for replacement.

"There's a problem: five years ago, during surgery, the mitral valve was replaced with a size 27 bioprosthetic valve. However, due to a small aortic valve annulus, a size 19 bioprosthetic valve had to be replaced instead. Then, in the follow-up report four years ago, the mean mitral valve pressure gradient was 4 mmHg, and the peak aortic valve pressure gradient was 38 mmHg..."

"During the follow-up examination two years ago, the mean mitral valve pressure gradient was 3.5 mmHg, and the peak aortic valve pressure gradient was 65 mmHg..."

"After this hospitalization, the examination report showed that the mean mitral valve pressure gradient was 10.6 mm Hg, indicating moderate to severe mitral regurgitation; the peak aortic valve pressure gradient was 71 mm Hg, indicating moderate tricuspid regurgitation..."

"The peak pressure gradient of the aortic valve is increasing year by year. It is preliminarily considered that the aortic valve needs to be replaced with a larger bioprosthetic valve."

Prior to this hospitalization and examination, Aki Tomoya had discovered that the peak pressure gradient of the aortic valve had been increasing significantly year by year.

Taking this into account, Aki Tomoya also recommended implanting a larger artificial valve.

"But what if there's a mismatch, leading to complications?"

Yoshida Aoba asked expressionlessly.

"Aortic curtain reconstruction and enlargement!"

Without hesitation, Aki Tomoya voiced his thoughts.

The aortic curtain, also called the aortic-mitral intervalvular fibrous body, is less than 1 cm in height and is located between the anterior mitral valve leaflet and the root of the noncoronary valve, adjacent to the roof of the left atrium.

Infective endocarditis, degenerative calcification, and previous mitral valve replacement surgery can all damage this structure, making aortic and mitral valve replacements extremely difficult.

In these cases, surgical reconstruction of the aortic plenum may be the only option.

Chapter 483 Psychological preparation

Aortic curtain reconstruction and enlargement—this is the answer given by Tomoya Aki.

The patient experienced severe heart failure due to the deterioration of the bioprosthetic valve from a previous surgery, but has since resumed normal daily life.

Regardless of whether she is a VIP or not, surgery for this type of patient should be arranged as soon as possible, otherwise her life may be in danger at any time.

We need to consider performing a curtain reconstruction procedure to implant a larger artificial valve and avoid postoperative complications.

One of the main reasons for this consideration is that the peak pressure gradient of the aortic valve has been found to be increasing year by year.

At that time, only the size 19 bioprosthetic valve could be implanted, so to implant a larger bioprosthetic valve, the only option was to enlarge it.

In clinical practice, patients requiring aortic curtain reconstruction surgery are not common.

At the same time, this also presents a significant challenge for the surgical team.

The surgery required replacing both valves and reconstructing the aortic curtain, further increasing the difficulty of the procedure.

When the news broke that aortic tunica albuginea reconstruction was needed, Aki Tomoya was already mentally prepared, guessing that he might not be the one to perform the surgery.

To be on the safe side, if this surgery is to be performed, it will most likely be led by Sasaki Ichiru or Yoshida Aoba.

"Over there in the US, they call this kind of surgery a commando operation. You've only ever read about it in academic papers, right?"

Yoshida Aoba frowned slightly.

One set of data shows that among more than 500 patients with valvular heart disease who underwent surgery, only a handful of patients with aortic and mitral valve disease had damage to the curtain structure and needed curtain reconstruction.

He has encountered patients who need this kind of surgery before, but precisely because of this, it would be worrying to entrust such a surgery to Tomoya Aki.

Even though he vouched for Aki Tomoya's ability to perform surgeries, Aki Tomoya had never performed a surgery before.

"On one side is the department, and on the other side is the patient. In addition to getting the people in the department to agree to let you perform the surgery, you also need the patient's consent."

Yoshida Seiun was also worried, even though he was willing to speak up for Aki Tomoya.

But at the same time, there are also worries in my heart.

This surgery is not something that just anyone can do.

And that was a VIP membership.

Whether they are ordinary patients or VIPs, they all hope that the person performing their surgery is an expert, a famous doctor.

It is precisely because they are VIPs that they are willing to pay so much money so that experts can provide them with medical care.

If you tell them that the surgeon is performing the operation for the first time, both ordinary patients and VIPs will feel dissatisfied.

Aki Tomoya was naturally aware of these things, so he did not insist that Yoshida Aoba would assign him to perform the surgery.

The suggestion I just made was based on specific circumstances.

Aki Tomoya believes that curtain reconstruction is necessary, or rather, must be performed during this double valve replacement surgery.

The small bioprosthetic valve is no longer suitable for the patient, and a larger bioprosthetic valve needs to be implanted. In order to eliminate the mismatch, it is necessary to reconstruct the aortic curtain and enlarge it.

"I'll go talk to Sasaki. There's a consultation this afternoon. Come with me then."

Yoshida Aoba still intends to try to help Aki Tomoya.

Because aortic curtain reconstruction is rare, it's actually pretty much the same for everyone.

He was Mrs. Omi's attending physician, and if it were a matter of who would be the surgeon, it would be Yoshida Aoba, even if it wasn't Aki Tomoya's turn.

However, there is also one difference: Yoshida Aoba was the lead surgeon, and Aki Tomoya was the lead surgeon.

The former has extensive experience in heart surgery, while Aki Tomoya, in most people's eyes, is just a newcomer.

So Yoshida Aoba also reminded Aki Tomoya that if it didn't work this time, then it would be next time, and he shouldn't be disappointed.

Aki Tomoya expressed his understanding, saying that when he thought about having to undergo aortic curtain reconstruction, he knew the chances were slim.

It's more reassuring to entrust the task to a more reputable doctor than to let this inexperienced doctor do it.

So, if I had to say I was disappointed, it wouldn't be too much.

After calming down, Aki Tomoya realized that he didn't need to be the surgeon this time; the next time would have been enough.

The required surgery is very complex, and it's a VIP procedure, so it's not something that can be easily handed over to him.

……

"It appears that curtain reconstruction is necessary in order to implant a larger bioprosthetic valve."

After learning about the matter from Yoshida Aoba, Sasaki Ichijin agreed with Aki Tomoya's point of view.

Given the current situation, curtain reconstruction, which allows patients to have larger bioprosthetic valves implanted, is imperative to improve the aortic valve pressure gradient.

"But you came to me wanting me to perform the surgery?"

Sasaki Ichiru looked at Yoshida Aoba with a scrutinizing gaze.

It wasn't that he couldn't see Yoshida Aoba's purpose in coming to him, but rather that he couldn't say anything about things like this.

Therefore, it would be better to pretend to want to take over the surgery and shut Yoshida Aoba up.

However, Yoshida Aoba's understanding of him was unmatched by anyone else.

Seeing that Sasaki was starting to evade the topic and try to avoid it, he replied somewhat unhappily, "Dr. Sasaki, you should know why I came to see you."

"...But you should also know that for a surgery like this, the first surgeon is Dr. Aki. Even if you feel at ease, will others feel at ease?"

"He proposed the plan."

"But this is a solution that you and I could both come up with."

Sasaki's momentum remained undiminished upon entering, and this matter also gave him a bit of a headache.

Although he believed that Aki Tomo was capable of being the lead surgeon, it was somewhat inappropriate to start with such a surgery.