Surgeons performed hospital ship USNS Mercy’s (T-AH 19) first-ever pacemaker replacement surgery April 29, 2020.
A pacemaker relies on batteries to regulate the heart’s functions. When the batteries reach the end of their lifespan, the device, which is no larger than a sewing needle, needs to be replaced.
“In addition to a bad battery, the patient’s pacemaker’s leads, or wires, were dysfunctional,” said Cmdr. Andrew Kaplan, a cardiac electrophysiologist from Phoenix, who led the surgery.
After Kaplan made the initial incision, about half the size of a business card, he removed the pacemaker and accessed the patient’s left, subclavian vein to insert the new pacemaker lead using X-ray guidance, specifically a C-arm mobile X-ray system, to position the new lead into the right ventricle. The system provided real-time, internal video to surgeons via the X-ray system’s screens, which made this heart surgery minimally-invasive.
All medical personnel and support staff present in the operating room donned lead aprons and thoracic collars to shield themselves from unnecessary X-ray exposure.
During the surgery, the pacemaker’s manufacturer provided guidance to cardiologists aboard Mercy via proprietary software via a WiFi conference call, which allowed for the virtual presence of technicians. The highly-trained technicians are pacemaker-programming experts and pioneers in the field. They were able to view technical data, communicate and direct personnel in the operating room using this interface. Normally, representatives from the manufacturer would be present during pacemaker procedures, but due to safety restrictions, no outside personnel are allowed aboard Mercy.
Kaplan estimates that he has performed 10,000-15,000 similar surgeries, and credits the procedure’s success to cohesion between the Sailors embarked aboard Mercy.
“This successful surgery shows that we have the capability to bring state-of-the-art technology to patients, whether in a humanitarian capacity or Sailors in a crisis,” said Kaplan. “It demonstrates the ability that both active duty and reservist Sailors can quickly come together to create a highly-functional team in a safe manner aboard the ship.”
A reservist himself, Kaplan drills with Operational Health Support Unit San Diego (Detachment B), and has never worked with any of the other surgical team members before.
“Both the cardio technologist, Hospital Corpsman 1st Class Amelia Ibrahim, and the other cardiologist, Cmdr. Travis Harrell, are assigned to Naval Medical Center San Diego,” said Kaplan.
Mercy deployed in support of the nation's COVID-19 response efforts, and serves as a referral hospital for non-COVID-19 patients currently admitted to shore-based hospitals. This allows shore base hospitals to focus their efforts on COVID-19 cases. One of the Department of Defense's missions is Defense Support of Civil Authorities. DOD is supporting the Federal Emergency Management Agency, the lead federal agency, as well as state, local and public health authorities in helping protect the health and safety of the American people.