- This is bad! - She declined surgery
for Kuroki's catheter treatment? - It will end quickly.
Surgery can only cure ASD.
But with my catheter, both can be cured.
- Perfect catheter! - By bringing him in, what are you planning to do?
To be awarded an IMA certification.
- The world's hospital review body. - Our goal is three stars!
You want to say that surgery is a better treatment?
Considering the QoL of patient, it is the best treatment.
At that time, surgery will lose its grounds?
Soon, Team Kuroki will be formed.
The present Meishin, is Team Dragon really necessary?
Are you kidding me! Why are we assigned internist duties? (TN: internist = doctor of internal medicine)
The day before yesterday too.
We have no choice. The entire cardiology department
is busy with catheter interventions.
I'm depressed, I was originally going to a Goukon today. (TN: Goukon = group date)
That's why you wear so much perfume today?
Hey, sicko!
They are really Meishin's present cash-cow.
Catheter staffs have increased to 15.
Even so,
why are internists ordering us surgeons around? - Isn't this good also?
No need to do those troublesome surgeries.
Yeah, it's troublesome.. Hey!
Kato-sensei is really helpless, completely off the edge.
Yeah, finally was invited back, in the end just acting as a backdrop.
- Oh! You've worked hard. - Eeyaa!!
We are off to our duties.
Why did you return here?
If you are seeking a high-level health care institution,
there are plenty else where.
- I was called back. - By whom?
Comrades.
That team?
I'll tell you one thing. That, is your weakness.
And that weakness will eventually kill you.
Live Demonstration?
The entire operation will be recorded?
IMA. The "Michelin Guide" of medical world,
evaluation is from 3 points.
Quality of health care for patients. Rational management.
And, the level of medical skills. - Yes.
To review the medical skills,
cardiac surgery authorities from around the world will come.
University of Cologne's Dr. Schneider.
University of Chicago's Glenn Phillip.
Cleveland Clinic's Thomas Hans.
Mayo Clinic's Richard Kane and Sam Elgar.
Cardiac surgeons world's top five.
To show off Meishin's high level medical skills,
we will be conducting a Live Demonstration. If this works as planned,
we will make great progress in our goal for IMA certification.
I understand. To be thoroughly prepared, I'll let Asada..
What are you saying, Kato-chan?
Ah this is so good for the body.
Is this the secret for your eternal youth? Miss Kito. Sorry. President.
Live Demonstration
will be done by Kuroki-sensei, it's none of your concern.
What does that mean?
Do you have a patient for live demonstration, Kato-sensei?
- That.. - You can't do without a patient.
Isn't it because internists have been recommending catheter interventions,
resulting in no surgical patient?
The patient themselves wished for catheter intervention treatments.
This decision is not fair!
- Give surgery a chance! - I've told you.
The purpose of the "Live" is to demonstrate high level medical skills for IMA.
Just performing those common surgical procedures
is meaningless.
- Do a quick bend there. - Yes.
- OK, right there. Insert it. - Yes.
- 27W. - Yes.
- Maintain this. - Yes.
A little back.
Team Kuroki is steadily taking shape.
Team huh?
You are fully prepared for Live Demonstration right?
Of course.
President is very much looking forward to it.
So, please.
Yamauchi Haruka. 15-year-old girl.
Currently Fujiyoshi-sensei has been observing her condition using Echo, and has controlled her disease.
An aortic valve replacement operation must be done.
Can this be done with catheter?
No way. This involves replacing a valve.
Right, the only option is surgery.
It's just a valve replacement operation. Why bother to report to me?
- Um.. so the surgeon? - Anyone will do.
Kato-sensei seems to be losing her drive.
Finally an operation, a valve replacement.
- What are you doing? - A God-hand is making its debut!
Image training! Maybe it's better to take off my clothes.
Live Demonstration.
Do you have a patient?
You can't do without a patient.
Valve replacement. Girl. 15 years old.
Just performing those common surgical procedures
is meaningless.
Girl...
President.
Hmm.. Kato-sensei is really stubborn.
- What do you mean? - It's getting interesting.
Asada.
There'll be an operation. Prepare yourself.
- What operation? - It's an aortic valve replacement.
OK.
But, it's not an ordinary aortic valve replacement.
Patient's a 15 year old girl. Ross procedure.
Translators & QCs: indokid, serene012 KEEP THIS A FREE FANSUB!
Ross procedure? That is the highest difficult surgery!
That's why we are doing it.
Seems like Kato-sensei had asked President Kito
to let us do this for Live Demonstration.
- Asada knows about this? - Of course he knows.
Such difficult surgery, only Asada-sensei can do it.
We'll show those catheter guys what we are capable of.
I was thinking if I should be going back,
it looks like there's no operation that requires my help.
- Are you satisfied now? - All of a sudden, Ross procedure?
Haha, but only Kato-sensei could have thought of this. Ross..
The highest difficult surgery
to be broadcasted live.
- This is unprecedented. - And
will be seen by the world's top five surgeons.
Meishin's cardiothoracic surgery will be legendary!
Next time, those catheter guys will not be so bossy towards us.
Our new era has arrived!
I hope we will not be too busy.
- Ah, you've heard? - Ah, "Live" Ross.
Asada is the surgeon. It'll be an exciting performance.
- Ross? - I heard it too.
the cardiothoracic..
Kuroki-sensei.
I don't quite understand.
Comparing to Kuroki's catheter ablation, for a live demonstration,
Ross procedure is more attractive.
I see. So it's set?
This is a video of Asada-sensei performing Ross while in Germany.
OK. Put it on.
Even if Kuroki does an alternative to catheter ablation, it's a no?
Excuse me.
Yamauchi Haruka. 15 years old.
As a result of heart failure from aortic stenosis,
must be operated on as soon as possible. - As such, Ross?
Aortic stenosis. In-between left ventricle and aorta,
heart valve outlet is narrowed, leading to poor blood flow.
Ross procedure is the surgical resection of aortic valve,
replacing it with the patient's own pulmonary valve.
In addition to this replacement,
in place of resected pulmonary valve, a prosthetic valve is planted.
Comparing to mechanical valve or tissue valve used
in ordinary aortic valve replacement, it's much more difficult.
Why is that mechanical valve
and tissue valve, am I right, cannot be used for this?
It's not you can't.
It's not you can't?
If a mechanical valve is used, to prevent blood clot,
she has to take Warfarin for the rest of her life.
This type of medicine is to avoid blood coagulation.
For a female, may lead to excessive menstrual blood loss,
and a life-threatening risk when giving birth.
If a tissue valve is used, you can eliminate the above concerns.
But with the development of the heart, size of the implanted valve will one day become inappropriate.
At that time, a surgery is required again.
On this, if your own pulmonary valve is used,
the valve will grow along with the development of the body.
Thus effectively lowers the need for re-operation,
and no worry of requiring life-long medications.
So, just one surgery to cure my disease, right?
Next time, there will be no complications while giving birth.
- That's great. - But, this procedure
is the highest degree, immensely difficult procedure.
Highest degree of difficulty?
You mean there's a possibility it may fail?
Please do not worry.
Meishin has a cardiac specialist who had succeeded in this surgery many times,
Asada Ryutaro sensei.
Certainly, in light of QoL of patient,
and us having Asada here, Ross is the best choice.
Come in.
This is the scrub nurse I invited from U.S, Kitagawa Hibiki.
I've asked her to participate in the Ross surgery.
Pleased to meet you.
Her reflexes in handling instruments does not lose to Miki's.
This I can assure you.
Operation is scheduled 4 days from now, in order to show the lMA judges,
it'll be a live demonstration. OK?
Has the patient agreed?
Of course.
I'm counting on everyone. It will be a memorable day for the cardiotharic surgery department. It must be!
Kuro-chan?
Sure enough, you're here.
How is the alternative to catheter ablation coming along?
No problem.
Why were you at Kuroki's catheter intervention?
Huh? A cross-examination?
Because he saved your life?
I'm an anesthetist. I'll go if I'm called.
Higher precendence than your team?
It's not a matter of priority. You don't have an operation for me also right?
It's been a while since something excites you?
Surgery is set 3 days from now. Surgeon is Asada-sensei.
Any concern, please say out.
- Umm... - Yes?
I heard there will be cameras recording the surgery, is it true?
No one has explained to you?
On that day, the cardiovascular society will come to visit.
And interviews from 4 TV stations. This is the list of media for the day.
Isn't this great? With these preparations,
it will significantly impress the IMA, now it's all up to the success of operation.
Yeah..
Patient does not want camera recording.
- Have you told her clearly? - She has accepted Ross,
and it's just a camera recording. - Hey!
Why are you so anxious?
Do you understand? If you keep letting Noguchi..
No.. it's to put a stop to medical referral decisions of internists.
Our purpose is not to win Noguchi.
How can you say that so calmly!
This relates to the survival of department!
I have a duty to protect the medical staffs of the department.
As I mentioned earlier, this procedure is very difficult,
thus is rarely done anywhere.
We want more people to understand this procedure.
So that people with the same disease as you,
can get encouragement. This is the purpose of the live operation.
OK.
But, of course we will not force you.
We understand if you do not want to be seen while in surgery.
Let's cancel the "Live".
However,
operation will be done by another surgeon. - Eh?
Of course, then we can't do Ross surgery.
It will be a regular valve replacement. I'm sorry.
That... Haruka!
But, to be seen while in surgery..
Actually, the main focus is to demonstrate the skill of surgeon,
through his monitor,
only the region being operated on will be shown.
Asada.
The patient has agreed.
(Day before Live Demonstration)
- Are you OK? - Yeah.
- Is it a difficult surgery? - Yes.
Kato-sensei said this surgery can only be done by Asada-sensei.
Of course.
Then it can't be helped..
I will do my best. Please take a good rest tonight.
Are you going to the Live Demonstration tomorrow?
- Ross procedure? - Ross..
- Of course, everyone from the clinical department is going. - Indeed.
So.. I'm a celebrity now?
I can understand her feelings.
Eh, really? But it's recording while she's asleep.
Even so, you won't feel that good.
Moreover, only 15 years old. With cameras surrounding her while in surgery..
Asada-sensei.
I'm looking forward to tomorrow, via the monitor.
(Day of Live Demonstration) ..soon at Meishin Matsushita Memorial Hall. A Live Demonstration will take place.
Performed by cardiothoracic surgeon Asada-sensei. World-class Ross procedure live operation.
You'll be fine.
Thank you for coming to Meishin,
to watch surgeon Asada-sensei's
Ross surgery Live Demonstration.
I will be your host for this event.
I'm a professor of cardiothoracic surgery, Kato Akira.
Please. The patient, Yamauchi Haruka.
Please.
It's more than expected.
The difficulty of the procedure is
the collection of pulmonary artery graft to rebuild aortic root.
The cameras are connected.
So let's look at the preparation going on in the operating room.
The surgeon, Asada Ryutaro sensei.
You mind?
Not.. at all.
I'm all right.
Excuse me.
Asada-sensei, can you hear me?
Asada-sensei.
Arase.
What are you doing?
Ah! What's happening?
- All cameras are cut off. - Sensei.
It's safe now. Don't worry.
Start counting.
- 1. - Asada-sensei!
Patient should have a complete peace of mind.
- But.. - Patient or "Live",
which one do you think is more important?
5 6 7. She's down.
- Control the crowd. - All right.
Now commencing Ross surgery to treat aortic stenosis. Scalpel.
- Yes. - Tweezer. Gauze.
What are you doing, Asada!
Withdrawing the cameras according to patient's wishes. That's all.
Do you know what you are doing?
It's an IMA review!
- So what? - So what?!?
The world's top five is watching!
If they want to see my operation that badly, call them here. Tokutouseki. (TN: Tokutouseki = special seat, box seat)
- Sternal saw. - Muscle hook.
You'll have to take responsibility for this, Kato-sensei!
Eh.. there's a little system malfunction.
Please wait a moment.
Hurry! Hurry up! Come on!
Dissection of right coronary artery completed.
- Right angle clamp. - Vas..
Vascular loop.
Mosquito clamp.
Prepare heart-lung machine.
Kato-sensei, you're a doctor too.
To provide the best choice for patients
is what doctors must do.
Best choice..?
Aortic valve stenosis treatment completed.
- Put into saline water. - Yes.
- Hurry! - OK.
During this time, please let me say a few words.
Does anyone know what Barack Obama
likes to eat for dessert?
Don't bullshit out there!
Next, collect the pulmonary valve graft. Metzenbaum.
Yes.
I know.
His favorite is Macha ice cream.
Because of this, I became close to Barack.
That is..
The aortic annulus and pulmonary valve is of unequal size.
The aortic annulus is smaller than expected.
Size does not fit.
What now?
Konno procedure, cutting from aortic annulus to
the ventricular septum, expanding the annulus.
- Ross-Konno. - I see.
At the overly small aortic valve annulus,
cutting a notch to expand its size.
And suturing according to size of pulmonary valve.
- Suture holder. - Yes.
- 4-0. Pledget. - Yes.
- Next. - Yes.
Sutured in an instant.
That scrub nurse can catch up with Asada's speed.
Three years ago!
At the health insurance senate hearing,
is my first encounter with Barack.
Aortic base reconstruction completed.
Next is the pulmonary valve replacement.
- Prosthetic valve please. - No.
We will be doing aortic root substitution.
- Give me the excised aortic valve. - Huh? Yes.
Asada sensei! What..?
- Scalpel. - Yes.
Aortic root substitution.
To cut notches on the generally unusable aortic valve,
with careful handling, it can be re-used as a pulmonary valve.
I see. Although the aortic valve cannot fulfill normal functions,
but if you change its shape,
it can be used as a pulmonary valve where the blood flow is slower.
In this way, the prosthetic valve is not required.
Yeah, if you use a prosthetic valve for the pulmonary valve,
the possibility of requiring a re-operation still exists.
Asada completely eliminates that possibility.
- Yes. - Just for this,
Asada joined this operation.
This is the ultimate choice in consideration of patient's QoL.
Certainly, in view of patient's valve state,
aortic root substitution is feasible.
- 4-0. - Yes.
Asada-sensei had thought that far ahead..
Ijyuuin, loosen the thread.
- Next. - Yes.
- Metzenbaum. - Yes.
Starting distal anastomosis.
- 4-0. Proline. - Yes.
- Electrolyte? - No problem.
- Suction. - Yes. - Prepare patient's blood,
we are winning. - Yes.
Fast.. What is this speed?
This is.. Team Dragon.
Barack asked me:
"Takeo, what's the significance of this?"
I answered:
"It's OK. This is it." (TN: MJ!!!)
Forget it! That's enough!
Enough. You can go.
- Flow down. - Yes.
Release block.
- Backup. - Yes.
Movement in re-formed valve is good, no reflux.
All right!
Ross-Konno procedure, and even aortic root substitution.
- This is the world's best medical skills. - Yeah.
It's a pity no one else is able to witness this.
Sorry to keep you waiting. This is the end of the long opening act.
It's finally here.. Live Demonstration!
It's show time!
This is the world's best catheter interventionist, Kuroki Keijiro,
performing Japan's first catheter aortic valve replacement.