[Verse 1]
Round the table, cardiologists and surgeons lean in close,
MRI volumes, CT slices, cath lab pressures dosed,
Exercise test pushing limits, Holter catching every skip,
Arrhythmia mapped for ablation before they make the trip,
Someone's eyeing the valve-in-valve, the transcatheter road ahead,
Conduit's failing slow or sudden — that's the question that gets read,
Every image, every number, feeds the verdict on the chart,
Multidisciplinary minds decide the fate of this old heart.
[Chorus]
Five days off the warfarin, let it drain out of the vein,
Bridge it with enoxaparin if the clot risk stakes the gain,
Aspirin rides along quiet, screen the nose and bank the blood,
Pads before the knife goes in — case the rhythm turns to mud.
[Verse 2]
Redo sternotomy's a minefield, scar tissue hugs the bone,
Cell salvage spins the losses back, nothing wasted, nothing thrown,
Crossmatched units waiting cold, platelets, plasma standing by,
Fibrinogen concentrate for when the clotting cascade's dry,
But if your antibodies run high and panel-reactive screams,
Antigen-negative blood's the only safe stuff in the stream,
Lab calls ahead, the bank prepares, redundancy the golden rule,
No surgeon wants a crimson surprise mid-operation, running the pool.
[Verse 3]
Warfarin's the slow burn, pull it five days out the door,
High-risk hearts get bridged on enoxaparin, milligram per kilo, twice a day, no more,
Last shot drops at twenty-four hours, clean window before you cut,
Aspirin often stays in the mix — platelets still play their part, don't shut,
Dental check clears hidden sepsis, rotten tooth can seed the graft,
Swab the nose for MRSA, MSSA, decolonize that staph,
Iron low or anemic? Fix it weeks before you're wheeled,
Less transfused, less infected, better odds the wound stays sealed.
[Chorus]
Five days off the warfarin, let it drain out of the vein,
Bridge it with enoxaparin if the clot risk stakes the gain,
Aspirin rides along quiet, screen the nose and bank the blood,
Pads before the knife goes in — case the rhythm turns to mud.
[Verse 4]
Arterial line for beat-to-beat, central line for volume's tale,
NIRS patches watching oxygen where the tissue light grows pale,
TEE probe down to watch the walls, the valves, the conduit's flow,
Defib pads stuck on early — re-entry rhythm's quick to go,
Scarred adhesions, sternal wires, the saw can nick a graft or vein,
Need the paddles charged already, no time to tape again,
Induction's a tightrope walk — keep coronary pressure fed,
Avoid the hypercarbic drift, the acid creep, the hypoxic dread,
Low airway pressure, gentle breaths, don't choke the struggling right side,
RV afterload's the villain here — give it room, don't let it collide.
[Bridge]
Scan it, plan it, bank it, screen it, line it, probe it, pad it tight,
Every step before the scalpel guards the fragile RV fight,
This ain't rushed, this is rehearsed — redundancy in every phase,
Preparation's the quiet hero underneath the surgeon's gaze.