-Max chain over 16 - 500
-Fibrillation occured less than 3 times - 700
-Completed with 240 left - 400
-No mistakes - 400
We're not going to worry about vitals at all throughout this operation until the very end. Get inside the patient. On her heart there will be another scalpel line so spread gel over it. As soon as you do this and switch to your scalpel, she'll start going into ventrical fibrillation. There will be a pause of a few seconds while she's fibrillating. Don't use any of your tools at this point, and instead use this pause to prepare for the incoming heart resuscitation. What I recommend you do here is to bring back both of your arms so that your hands are touching your torso. This gives you the greatest amount of distance covered when you move your arms forward without having to move the rest of your body so that the sensor bar can register the movement.
Try to get her resuscitatated in as few uses as possible but don't worry too much as it's not all that important in this operation. Once that's done, we're going to open up her heart. Here you'll see the valve. First drain the blood, then the scalpel lines will appear. We're going to make all three cuts in one single motion. Start near the top and move counterclockwise. When you get to the last dot, a new line will appear, but the dots start exactly where your scalpel should be, so don't stop and continue going counterclockwise. After you cut the last dot in that, a final completely circular scalpel line will appear. Don't ever let go of the button, simply continue going counterclockwise for one last pass. Remember not to rush. You want to get every dot without having to go back. You want to be constantly moving forward. It's not a big deal if you have to go back if you're fast enough, but my recommendation is to make a slow calculated path around the valve like in the video so you don't have to.
Now very quickly switch to your forceps, grab the valve and put it in the tray. Now STOP. Don't do anything. There's a very high chance the patient will go into fibrillation again at this point. Just sit tight for a few seconds and wait for it. Use the defibrillator in the same way you did the last time. There's actually a very small chance that the irregular heart beats are only a false alarm and the patient will stabilize on her own. If this happens just continue the operation as normal. The chances are too low to bank on though, so it's better to expect that fibrillation.
Now, that should be the last time you use the defibrillator here. You'll want to finish the operation before the heart gets a chance to stop beating again. Very quickly switch to your forceps and grab the new synthethic valve. We're going to place it where the old one was. But be extremely careful here. You need to place it exactly in the hole in the center. If you're off by even a little, you'll get a miss and forfeit the entire operation. It's true that you need to be fast before the heart starts causing problems again, but you have enough time that you can take it relatively slow and make sure the valve is placed correctly before letting go of the forceps. Now we're going to suture the valve in place and then suture the heart. These two sutures are new so you might not know how to get COOLs on them. For the valve, I recommend relatively narrow passes from left to right. Start at the left side of the valve and finish on the right side. Don't go over too much. For the heart, the opening is ridiculously big, but to get the COOL here, you want to actually make VERY narrow passes throughout the length of the opening. They should be much narrower than it. In any case, check the video to see what I'm talking about. Getting COOLs here isn't actually necessary for the XS, so if you don't feel like bothering or if you took too much time placing the new valve, you can go ahead and suture very quickly and not worry if you get GOODs.
When that's done, it'll be time to finish up. Make the final suture. Now it's time to raise vitals to max. Start pumping stabilizer into her before gelling. Her vitals are so low that your syringe will not hold out up to 99. When you see it start to get red, switch to the gel and start applying it over the bandage area. By the time you're done with this the syringe should have recovered a little. Enough to get vitals to max, at least, so switch back to it and inject a couple more times. This works well because by this time the gel has disappeared so you have a complete view of the area and can more easily get the COOL here.