Circuit Surfers

The Currents, Eddys & Riptides- of Open-Heart Surgery


A Profile in Courage: Covid (+) Returning to the Heart Team

Covid19: A Transformative Beast… I kind of feel like we are curving up from that BOTTOM of the slippery slope that we have been on for the last 1 ½ years- at least I hope so.  We are no longer frightened. We are no longer obsessed with the fear of exposure or how it relates…


Perfusion Art: “Blood on the Tracks””

Perfusion Art: “Blood on the Tracks” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative:  “Blood on the Tracks’ Time & Place:   2021: UpNORTH About The Artist:  CCP Commentary:  A long Emergency Case- Late Night


Perfusion Art: “Davinci”

Perfusion Art: “ Davinci” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: A MidCab with Robotic IMA Harvest Time & Place:   2021: UpNORTH About The Artist:  CCP Commentary:  The symmetry on display here is amazing! Impressive watching such an intricate communication process-


Perfusion Art: “The Ready Room”

Perfusion Art: “The Ready Room” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: Rows of surgical shoes- at the ready Time & Place:   2021: UpNORTH About The Artist:  CCP Commentary:  It’s a busy place- Reminds me of the Corpsman barracks at the Marine Fleet Marine Force training center- Del Mar 21 Area- Camp Pendleton.


Perfusion Art: “Twister”

Perfusion Art: “Twister” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: Ready to go on pump- looks a bit like a tornado column Time & Place:   2021: UpNORTH About The Artist:  CCP Commentary:  Blood in the Prime- the divide between PRBC’s and Crystalloid


A Locum’s ScrapBook: Hospital 57

Editor’s Note: Hospital 55 was south of the Savanah River, Hospital 56 was at a convergence of transitional highways leading North South East & West- North of Indy and South of Chi-Town. Hospital 57 is the Mecca of all that is North– and is truly an amazing place to work. First and foremost- it is…


LESS than a “10” An ECMO Journey

Editor’s Note: First of all… Happy Easter all 🙂 We all like to talk about adversity and how we overcome it. Rarely do we elaborate on clinical events and the sequence of clinical and/or operational failures that lead to unintended outcomes. The story below is a pretty straight forward account of mishaps and miscues that…

CCP Angel 2

Perfusion Art: Clouds or Hope?

Perfusion Art: “Clouds or Hope?” Photographer: Unknown- Taken from a Perfusion FB Group and shared by an International brother. Equipment: Your Eyes: How you choose to process random cloud formations. Editing: Anger Hair Filter Narrative: When there are so many bad things in the world… I’d prefer to believe that HOPE always prevails 🙂 Time & Place:   2021: North of the…


VAXXED: The New Norm? CDC Guidelines…

Editor’s Note: I got my 2nd dose of the COVID Vaccine the other day. I don’t recommend any particular vaccine over the other, but I will say that I didn’t suffer some of the reported side effects from the 2nd dose. Didn’t feel a thing to be honest. No fatigue or flu-like symptoms. As I…


I Woke up Friday and I DIDN’T CARE

That’s my Son 🙂 Editor’s Note: It’s not that I stopped caring, stress just gets you to a point sometime where the typical flair and zest you have for life and the job we do- well sometimes you end up manufacturing the smiles and enthusiasm. Anyone reading the title would have to be discouraged. It…


A CO2 PE during SGV Harvesting? WTF?

Editor’s Note: I had an interesting case the other day, here at hospital 56. It was an op cab – and it ended up being more than the original grafts that were advertised. This was a fairly routine patient presentation in terms of degree of difficulty, with a particular surgeon for whatever reason always works…


A Locum’s ScrapBook: Unmasking COVID: Virtual Reality has BECOME our Economy.

Editor’s Note: – That is my family. Up there- I want to be able to say that a year from now… – We (or better stated) “I” have worn Masks for YEARS. – Today is a continuation of more than a years struggle in terms of trying to cope with an entirely innocuous yet devastatingly…


Excerpts from: Heart Surgery in America: The Heart-Lung Machine

This book is NOW over 99% written and moving into the Editing Phase! The title of the book is “The Tips of Spears- An Inside Look At Heart Surgery in America” It is a rendering of the reality, sometimes sad and at times funny, emotional, and clinical vignettes of the many different aspects relating to open heart surgery- from the perspective…


Perfusion Art: “Sequester”

Perfusion Art: “Sequester” Photographer: Frank Aprile Equipment: IPhone 10 ish Editing: Anger Hair Filter Narrative: Sequestering Blood during Circ Arrest 🙂 Time & Place:   2021: South of the Savannah About The Artist:  CCP Commentary: Removing blood from unnecessary trauma and turbulence during the circulatory Arrest phase of an Aortic Arch reconstruction/repair


Molecular Cardioprotection and the Role of Exosomes: The Future Is Not Far Away

This review discusses anesthetic implications of exosome production and the future micro-RNA applications for cardioprotection.


The COVID Wars: At What Point do you Not Answer “YES” ?

Editor’s Note: This is January 27, 2021. A year ago news stories were talking about the Wuhan virus in China, and few of us really took note although it to catch my attention. I think perhaps the American response to all of this was dampened by the political morass that we were embroiled in, and…


Perfusion Art: “A Different Kind of Filter”

Perfusion Art: “A A Different Kind of Filter” Photographer: Frank Aprile Equipment: IPhone 10 ish Editing: Heavy Filters Narrative: Lunch Break- Selfie at Subway🙂 Time & Place:   2020: South of the Savannah About The Artist:  CCP Commentary: Chilling at a vendor table outside of Subway. Grabbing lunch before the next run


Perfusion Art: “A Picture Within”

Perfusion Art: “A Picture Within” Photographer: Frank Aprile Equipment: IPhone 10 ish Editing: Heavy Filters Narrative: Taking a picture of them taking a picture 🙂 Time & Place:   2020: South of the Savannah About The Artist:  CCP Commentary: Reassessing VA ECMO Cannulation…


Morphing to 2021: Hello and Happy New Year!

Editor’s Note: What is there say about the 2020? In my opinion probably one of the most transitional years we’ve ever experienced. At this point in time we as a medical community are like a punch-drunk fighter who is completely desensitized to the imminent pain that he is currently or about to suffer. A reasonable…


Perfusion Art: “Put a Little LOVE in your Art…”

Perfusion Art: “Put a Little Love in your Art…” – = Photographer: Frank Aprile, BBA, LP, CCP Equipment: Iphone 8+ Editing: Photoshop Narrative:   What stands out in this picture is not the first set of hands holding the crystal heart- RATHER the second set- supporting the first 🙂 Time & Place:  South of the Savanna River, 2020 About…

The Lobster Tank

The COVID Wars: The Lobster Tanks… Inside Looking Out

Editor’s Note: It was that kind of day, here on the other side of the Savannah river.  When I came down here to assist at the first apex of the COVID-19 crisis, everything was shut down, and fear was palpable in the air.  More ubiquitous than the virus itself, was an apprehension of the organism’s…


Perfusion Art: “Access DENIED!”

Perfusion Art: “Access DENIED !” – Photographer: Frank Aprile, BBA, LP, CCP Equipment: Iphone 8+ Editing: Photoshop Narrative:   And….   The Cryptic Reality of COVID-19-   This is our Chief Cardiac Anesthesiologist- Truly a gatekeeper to ALL things deleterious to our outcomes.  My sincerest respect 🙂 Time & Place:  South of the Savanna River, 2020 About The…


Del Nido Microplegia Compared to Standard 1:4 Crystalloid Del Nido for Myocardial Protection

Editor’s Note: We had a fun discussion with a couple of our surgeons today regarding the use of Del Nido cardioplegia.  At this institution we have been deploying the microplegia version of Del Nido, and subsequently substituting Blood as the crystalloid component, delivering the primary dose in 1,200 ml aliquots, and then redosing at 60…


The COVID Wars: Fighting An Apex Predator…

Editor’s Note:   I thought I would highlight the last week we have experienced here down South of the Mason-Dixon Line- in pictures with annotations that are just a brief glimpse of the furious pace that we are engaged in, in terms of trying to circumvent a culling of our species, by an opportunistic Apex…