On Tuesday November 1, Ashton underwent:

• a single-patch repair of the complete atrioventricular canal defect;
   
  
• division of the anterior bridging leaflets, with re-suspension, of the mitral and tricuspid components, to the pericardial patch (or refashioning of the existing components of the mitral and tricuspid valves, using material from the pericardium);
   
  
• Reed annuloplasty of the mitral valve (or repair of the opening of the mitral valve);
   
  
• closure of the mitral valve cleft;
   
  
• pulmonary valvotomy (or enlargement of the pulmonary valve opening);
   
  
• excision of the extensive parietal muscle bundles within the right ventricle; and
   
  
• ligation of the patent ductus arteriosus.
   
  

Ashton Feakes - pre-operative heart

Diagram 8.6 Ashton Feakes - post-operative heart 1 - Single pericardial patch of atrioventricular canal defect 2 - Partial excision of the extensive parietal muscle bundles within the right ventricle 3 - Resuspended tricuspid valve 4 - Ligated ductus arteriosus 5 - Pulmonary valvotomy (or enlargement of the pulmonary valve opening) 6 - Resuspended mitral valve (with subsequent dehiscence)

The operating team is set out in the accompanying chart.

TABLE 8.5: Persons involved in the operation on Ashton Feakes, November 1, 1994
OR team member		Persons involved
Surgeon		J. Odim
Surgical assistant		B.J. Hancock
Anaesthetists		H. Reimer, J. Doer (resident)
Scrub nurses		C. Youngson, C. McGilton
Circulating nurses		B. Zulak, C. Weber, K. Cox
Perfusionists		M. Maas, D. Smith

The myocardial protection used was moderate hypothermia and intermittent cold blood cardioplegia.

TABLE 8.6: Length of phases of the operation on Ashton Feakes, November 1, 1994
Phase of the operation		Time taken
Induction		1 hour 47 minutes
Bypass		3 hours 21 minutes
Aortic cross-clamp		1 hour 57 minutes
Total surgical time		6 hours 20 minutes
Total operating-room time		8 hours 22 minutes

Odim testified that in his opinion, the repair in Ashton's case went very well. The other participants in the operation raised no issues about this procedure. However, Soder said that a procedure of this length would give him some anxiety.

During surgery Ashton experienced problems with heart block that continued during his post-operative treatment. He had third-degree heart block during the closure of his chest, which required cardiac pacing.

Aside from the fact that withdrawal from bypass required substantial doses of inotropes, Cornel concluded that the "surgery appears to have been otherwise uneventful. Intraoperative pressure recordings were consistent with a satisfactory repair. The pulmonary artery pressure was elevated but the left atrial pressure and central venous pressure were within expected range." (Exhibit 353, page 59) In their joint report, Cornel and Duncan noted that the patches appeared to be intact and appropriately placed. In his testimony, Dr. Walter Duncan said, "I think it was well done. This is a difficult repair, I think his patches were intact, his valves looked okay, his pressures were perfect." (Evidence, page 41,451)