UCH breaks new grounds in open heart surgery
By Oseheye Okwuofu
The University College Hospital (UCH) Ibadan, Nigeria’s premier teaching hospital has recorded a major breakthrough in medicine in the country when it successfully carried out a “bloodless” open-heart surgery on a patient. The operation known as Coronary Artery By-pass Gland (CABG) was carried out on 19-year-old Kazeem Ojo by a team of surgeon from the hospital lead by Chief Medical Director, Professor Temitope Alonge. The patient was expectedly happy at the feat performed by the hospital which has drawn commendation from health professionals. The cheery news on the successful CABG was broken last week by Alonge who said the surgery was carried out without complication. This indeed was a major breakthrough for UCH and the Nigerian Medical practitioners. An elated Alonge, said with the feat, Nigerians would no longer need to travel abroad for such tertiary treatment as more Nigerian doctors are currently being trained to offer such medical care in the hospital.
The orthopaedic and trauma surgeon said, “following acquisition of the Cardiac capitalisation machine by Toshiba in 2011, it was installed and put to use in 2013, UCH is able to resuscitate its open heart surgery. That allows us to evaluate the state of the arteries supplied by the heart muscles and if for any reasons there is any blockage, the blood vessels can be opened up with the balloon, but if the damage is extensive such that we cannot do the so called balloon and geo-plasty, then we resolve to open heart surgery.
“This technically means that the chest will be split into two, the heart is exposed and then, the blood that is entering and leaving the heart is diverted into a machine called the heart-lung machine and we stop the heart.
“So, technically the person is dead and the blood is going through the machine and going back into the patient and then repair work are carried out on the heart and after that we wake the heart up again.”
Professor Alonge was not alone in the euphoria of the celebration of the great achievement. Members of the Nigeria Medical Association (NMA) and Nigerian Union of Allied Health Professionals also came to savour in the joy of the medical breakthrough.
The national President, Nigerian Union of Allied Health Professionals, Dr. Felix Olukayode Faniran, described the feat as a great breakthrough.
According to him, “the essence of our being here is to examine health care practices in the country, one of them is what you heard Professor Alonge said that they just had a breakthrough in open heart surgery being carried out at UCH.”
Speaking further on the successful bloodless open heart surgery, Professor Alonge said that issue of open heart surgery was not new in Nigeria, the ability to resuscitate the procedure started last year at UCH.
He explained further that the University of Nigeria Teaching Hospital in Enugu was actually the first institution to have embarked on open heart surgery but the challenges have always been that of equipment, manpower and ability to sustain it.
To offer its services to others in the country, the management of the institution last week invited well-meaning Nigerians and corporate bodies to support an endowment which it launched to further assist patients needing open heart surgery but could not afford the high cost of treatment.
He invited all Nigerians to support the good cause by assisting in raising the standard of medical care been offered in the hospital.
According to him, the population of Nigerians seeking medical treatment for cardiac surgeries such as open-heart surgeries, hole in the heart conditions in foreign countries would take a downturn, as patients would now be able to access these advanced surgeries at the state-of-art Cardiac Catheter Resuscitation Centre (CATH LAB) in UCH.
He added: “There is no better place to have a cardiac surgery than in the country you reside. Proximity of care is important for recovery because follow up treatment is needed for some cardiac cases.
“This facility is comparable to what obtains in India, United States and the United Kingdom. Nigeria would now be the place to come to for cardiac surgeries in Africa. That would be our medical tourism.”
The University College Hospital (UCH), Ibadan was established in November 1952, in response to the dire need for the training of medical personnel and other healthcare professionals for the country and the West African sub-region, remains the tertiary hospital with the highest number of patients on its list annually.
The oldest teaching hospital in Nigeria, has evolved over the years, with the finest tradition of infrastructure renewal to keep abreast with modern technology, to be able to offer the best medical care obtainable anywhere in the modern world.
The management of the hospital, comprising of renowned medical practitioners, has in addition to Federal Government efforts in refurbishing the teaching hospital, taken steps to widen the scope of services provided with the resuscitation of the open heart surgical procedure of the hospital
Since its inception, the hospital, which is strategically located in heart of the city of Ibadan, has recorded so many feats in medical care, training and human development.
In the area of training and human development, UCH, according to Professor Alonge, has trained over 6,051 doctors, 501 dentists, 4,513 nurses, 2,307 midwives, 471 peri-operative nurses, 1,062 laboratory scientists, 576 environmental health officers tutors, 326 primary health care tutors, 590 community health officers, 640 physiotherapists and 551 health information management personnel.
The patients turn out in the accident and emergency (A&E) Department of the hospital alone averages 6,000 annually and about 160,000 new patients are seen in the various out-patient clinics every year.
In May 2006, a surgical team successfully performed open-heart surgery on three paediatric patients, an important landmark in medicine in Nigeria.
Over the years, UCH has also produced many core professionals for the nation’s health sector, and more of its products have continued to excel overseas.
What is open heart surgery?
An open heart bypass surgery is performed under general anesthesia, which requires that the patient be on a ventilator during surgery.
Surgery begins with harvesting the blood vessels that will become the grafts. The saphenous vein in the leg is commonly used because it is long enough to create multiple grafts. If the saphenous vein cannot be used, vessels from the arm can be used instead. The left internal mammary artery is used for a single graft and is taken once the chest is opened for surgery.
Once the saphenous vein has been recovered, the chest is opened by making an incision along the sternum, or breastbone. The surgeon then cuts the sternum, allowing the chest cavity to be opened, giving the surgeon access to the heart.
In the traditional CABG procedure, the heart is stopped with a potassium solution so the surgeon is not attempting to work on a moving vessel, and the blood is circulated by a heart-lung machine. At this time the heart-lung machine does the work of the heart and the lungs and the ventilator is not used.
The surgeon places the grafts, either rerouting blood around the blockage, or removing and replacing the blocked vessel. The amount of time on the heart-lung bypass machine is determined by the speed at which the surgeon is able to work, primarily, how many grafts are needed.
Once the grafts are complete, the heart is started and provides blood and oxygen to the body. The sternum is returned to its original position and closed using surgical wire, to provide strength the bone needs to heal, and the incision is closed.