The work of a medical equipment trading company (dealer): Cardiac surgery edition

In a previous article, I explained the work of medical equipment trading companies (dealers), focusing on their job responsibilities.

This time, I'd like to write about the work involved in cardiac surgery.

In the field of cardiac surgery, specialized dealers often have control of the operations, but this is not the case in all hospitals.

This time, I'll give a general overview from a dealer's perspective of what's needed for this type of surgery.

For details about each disease and the surgical procedures themselves, please refer to the many pages on the internet provided by hospitals.

Aortic valve replacement (AVR)

It's safe to say that this is one of the most popular cardiac surgeries.
As the name suggests, this surgery replaces the aortic valve with an artificial valve.
Since an artificial heart valve costs around 800,000 yen (as of 2018), it can be said that this is a highly profitable surgery for dealers.

What dealers should be concerned about is whether to use a bioprosthetic valve or a mechanical valve.
The guidelines state that those 65 years of age and older should use bioprosthetic valves, while those younger should use mechanical valves.
In reality, the doctor will make the decision based on a comprehensive assessment that includes other factors as well.
Once we receive a request, we will need to confirm which one the client plans to use.

Also, it's important to remember that the sizer used to determine the correct valve size must be sterilized.

Since bioprosthetic valves are temperature-sensitive products, they must be stored in a manufacturer-specified cooler box during both winter and summer months and kept under strict temperature control.
According to the manufacturer, it can still be used at high temperatures, but at temperatures below 0 degrees Celsius, the glutaraldehyde solution will freeze.
This could alter the bio-valves in the solution, potentially affecting their durability, which is extremely dangerous.

Shipping via courier service requires the utmost care.

Mitral valve replacement/repair (MVR/MVP)

In recent years, mitral valve replacement surgery has become rare, with most procedures now limited to valve repair only.
In the case of valve replacement, just like with AVR, careful consideration is needed when choosing between a bioprosthetic valve and a mechanical valve.
In emergency surgeries such as endocarditis caused by infection, valve replacement is often the solution.

In valve repair, a ring called an artificial valve annulus, or a "C"-shaped band, is used to repair the valve.
The price of an artificial valve ring is probably around 300,000 yen.
Each manufacturer offers various types, such as hard or soft materials, and whether they are rings or bands.
This also requires a sizer, so please be careful.

Tricuspid valvuloplasty (TAP)

This surgery is rarely performed alone and is often carried out in conjunction with MVP or AVR.
This is because in the early stages of regurgitation, there are usually no symptoms.

By the time the condition becomes severe, other valves are often also in poor condition, so it seems that it's common to perform MVP (Movement Valve Prosthesis) or AVR (Abdominal Valve Resection) at the same time.
While there aren't as many types of mitral valve rings available, these are also replaced with artificial valve rings.

Aortic arch graft replacement

The surgery was lengthy, and it would be fair to describe it as a major operation.
A surgery that completely replaces the arch is sometimes called a "total arch" procedure.
We use an artificial blood vessel specifically designed for that area, which branches into four sections.

In some cases, instead of replacing the aortic arch itself, the ascending and descending aortas are replaced.
In such cases, a single-branched artificial blood vessel, a straight artificial blood vessel, or an open stent graft may be used instead of a four-branched one.

While thoracic aortic aneurysms are often planned cases, dissecting aortic aneurysms (Stanford type A) are considered emergency cases.
Therefore, even during holidays, it's crucial to ensure that we never run out of artificial blood vessels for the arch area.

Abdominal aortic graft replacement (AAA)

Many hospitals do not perform this procedure in the cardiac surgery department.

Lately, perhaps because stent grafts have become more common, I feel like the number of open AAA surgeries has decreased.

A Y-shaped artificial blood vessel will be used.
This is a matter of urgency, so we want to make sure we don't run out of stock.

Bentall surgery

The procedure is essentially an AVR (Arterial Velocimetrymosis) plus ascending aortic replacement.
However, what is distinctive is the use of a valved graft, which is an artificial blood vessel with an aortic valve sewn onto it.

While some products have the valve and graft integrated from the start, these are only available in mechanical valve types (as of May 2018).

If you are going to perform a Bentall procedure using a bioprosthetic valve, you will need not only the valve but also an artificial blood vessel that has the shape of the sinus of Valsalva, which is the root of the aorta.

If the hospital has a small number of Bentall valve cases, it may be necessary to have documentation showing size compatibility for various valve and artificial blood vessel combinations from different manufacturers.

Maze surgery

This is a surgical procedure performed for atrial fibrillation.

In recent years, this procedure has become possible with catheter-based treatment, so it is no longer performed as a standalone surgical procedure.

You will need the main unit for cauterization and the consumable devices that will actually be used.
Since this is not an emergency, I think there will be enough time to prepare in advance.
In recent years, Maze devices have also emerged that use a low-temperature necrosis method.

In any case, I don't think it's a surgery that dealers should be so afraid of.

Coronary artery bypass grafting (CABG)

While emergency admissions are common, it seems that standalone admissions are becoming less frequent in recent years due to the increasing use of OPCAB (described later).

This procedure may be performed simultaneously with treatment for valvular heart disease.
It's highly unlikely that a dealer would go to the trouble of preparing a part specifically for this case.
 

OPCAB

This is CABG performed off-pump.
While a cardiopulmonary bypass circuit won't be used, specialized devices to suppress the heartbeat will be necessary.

Two types of devices are essential: a stabilizer to suppress the heartbeat, and a positioner to help the heart move for easier surgery.
This surgery generates more revenue for dealers than CABG.
 

summary

Cardiac surgery mainly consists of procedures related to valvular heart disease and the area around artificial blood vessels.
The arrangement patterns aren't that complicated, so let's memorize them.

If it's valve surgery, which valve, replacement or repair, bioprosthetic valve or mechanical valve?
If it's surgery on a major blood vessel, which blood vessel is it?
As long as you keep those points in mind, you should be fine for the most part.

However, a characteristic of cardiac surgery is that many surgeries are performed due to congenital diseases.
For specialized surgeries, it is important to consult with the doctor and the manufacturer.