Adam's Heart Valve Surgery Blog – Page 48

With the exception of Barbara Walters’ heart valve surgery in May, this year was relatively quiet for public figures needing heart valve repair or heart valve replacement operations. However, our list of “well-known patients” did expand during the final week of 2010.

On Friday, December 24th, Charles Schwab, the chairman and founder of Charles Schwab Corp., underwent successful heart valve surgery.

Charles Schwab, 73, Heart Valve Surgery (Replacement) Patient

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Hi everybody,

Ethan, Robyn and I wanted to wish you all a very safe and very happy holidays!!!
 

Keep on tickin!
Adam

No need to preface this… Prepare for patient inspiration.

I feel honored to share with you that our website sponsors the Iron Heart Racing team. If you have a minute, you may want to learn about its extraordinary leader, David “IronHeart” Watkins, a former aortic valve replacement patient and endurance athlete.

Keep on tickin’ Iron Heart Racing Team & David!
Adam

It’s hard to believe that five years ago, at this precise moment, I was rolled into an operating room at USC Medical Center in Los Angeles, California. There, during a 3-hour procedure, Dr. Starnes performed an aortic and pulmonary valve replacement surgery that fixed my enlarged heart.

Patient, Caregiver & Surgeon Friends

It’s hard to believe that five years ago today, my life would slowly begin to transform.

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I just received a very appropriate question from Anne about minimally invasive approaches to heart valve surgery. Anne writes, “Adam – Like you, I was diagnosed with severe aortic stenosis. I need an aortic valve replacement. Why didn’t you get a minimally invasive surgery? Thanks, Anne”

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I just received an excellent question from Teri about heart valve surgery recovery, climbing stairs and recliners.

Teri writes to me, “Hi Adam – I want to know if I can climb stairs after heart surgery – once I return from the hospital. Our bedroom is on the second floor. Is that too much to expect? I am ordering an electric easy chair and need to know if I should have it delivered down stairs or up stairs in our bedroom — which is also close to a full shower. I really appreciated the great information in your book! Teri”

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While the patient benefits of attending cardiac rehab after heart valve surgery are well documented, the utility of these post-operative programs remains disappointing — as only 20% of patients who could benefit from cardiac rehabilitation are referred to outpatient facilities.

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As a follow-up to our recent discussion about re-operation rates, I just received an interesting question from Steve about tissue valve replacements and the potential reasons for premature failure.

Steve writes to me, “Hi Adam – It has been 16 months since my aortic valve replacement. I am being told I need another bovine valve replaced. This is not due to infection. How often does this happen? Why does this happen? Thanks for all you do! Steve”

Tissue Heart Valve Replacement

To get an expert response to Steve’s question, I contacted Dr. Junaid Khan and Dr. Allan Stewart — two leading heart valve surgeons.

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Robyn, Ethan and I want to wish all of our friends in the United States a very “Happy Thanksgiving!”.  And, even if you’re not from the U.S., we want you to know how grateful we are for you and your contribution to this caring community of patients, caregivers, cardiologists and surgeons.

So you know, Thanksgiving is my favorite holiday.

May you have a wonderful day!

Gobble! Gobble!
Adam

Recently, I spent two days at Inova’s Heart & Vascular Institute in Falls Church, Virginia — which is about 10 miles from downtown Washington, D.C. in Northern Virginia. It was my first visit to the new $150 million facility that (i) holds a #1 ranking from HealthGrades for Virginia hospitals and (ii) a 5-Star excellence rating for heart valve replacement surgeries.

Dr. Paul Massimiano, Me, Dr. Niv Ad

I have to admit… The four-story cardiac center was immaculate… and BIG. To give you some idea about the facility size, consider that it maintains 13 catheter labs, 6 cardiac operating rooms, over 200 patient rooms and an impressive cardiac rehab center.

However, what struck me most about the Inova Heart & Vascular Institute had little to with architectural design or hospital feng shui. Instead, I was most impressed by a unique approach to cardiac care nurtured by Dr. Niv Ad, the chief of cardiac surgery, and Dr. Paul Massimiano, the president of CVTSA, the private surgeon group at Inova.

Let me explain…

CONSIDER THAT INOVA IS A MAJOR CARDIAC SURGERY CENTER

During my brief 48-hour stay in Falls Church, I observed a (i) stand-alone mitral valve repair, (ii) a stand-alone MAZE procedure, (iii) a minimally invasive mitral valve repair and MAZE procedure, and, of all things, (iv) an actual heart transplant.

Needless to say, seeing a transplanted heart (shown below) beat for the first time is something I will never forget. I’ll also never forget seeing the patient’s old heart and dissected pump that was keeping him alive.

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I just received an interesting question from Frank about heart rhythms after heart valve surgery. Frank writes, “I had a tricuspid valve repair, a Patent Foramen Ovalve (PFO) repaired and a Maze procedure performed in July.  Now, it appears I will need to have a pacemaker put in next week. I was told that my Atrioventricular (AV) node may have been damaged and I am now in “heart block”.  I was wondering if this is common?  Thanks Adam!”

Diagram of Pacemaker Implant

Frank raises a great question. As we have seen in prior blogs, several patients receive pacemakers after heart valve surgery. However, Frank’s question addresses two, other surgical considerations which you may not be familiar with — The Maze procedure and heart block.

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[Update: Please note that Dr. Allan Stewart is no longer performing surgery at NewYork-Presbyterian Hospital and Columbia University Medical Center.]

I’m very happy to announce that Dr. Allan Stewart has been named our Heart Valve Surgeon of the Month at the Heart Valve Surgeon Finder for November!

As many of you know, Dr. Stewart — who is the Director of Aortic Surgery at NewYork-Presbyterian Hospital and Columbia University Medical Center — has been an incredible supporter of our growing community. In addition to answering many of your questions, Dr. Stewart has teamed up with several, former patients to promote awareness to heart disease and recovery.

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I just received a very interesting question from Bernie about the pericardium and heart valve surgery.

Bernie writes, “Hi Adam – At 51 years old, I need to replace my disease aortic valve due to a stenotic bicuspid valve. I’m curious to know about the pericardium. I know the sac has to be opened. But, then what? Do they stitch-up the pericardium after the valve is fixed? Or, is it left open? Thanks, Bernie.”

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Robyn, Ethan and I want to wish everybody a very happy and very safe Halloween!

For his 2nd Halloween, Ethan is dressing up as “DJ Lance Rock” from the hit television show Yo Gabba Gabba.  The show has become a morning staple for Ethan as he gulps down his first glass of milk. Ethan loves running around, screaming “Yoooooooo” as waves his hands in the air like DJ Lance Rock.

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As many of you know, I’m fascinated with technology.

That said, when I’m invited to see a clinical application of a new heart valve technology, I jump at the opportunity. So, last week, I found myself in a hybrid catheterization laboratory / operating suite at the University of Virginia in Charlottesville, Virginia. Dr. Scott Lim, Associate Professor of Pediatrics and Medicine, Division of Cardiology, was performing a MitraClip procedure.

Dr. Scott Lim, M.D. And Me (Adam)

“We’ve been investigating the MitraClip therapy in select patients as an alternative, less-invasive therapy for mitral regurgitation,” Dr. Lim shared with me. “By clipping the mitral leaflets into a double-orifice configuration we can reduce leakage across the valve – without inducing stenosis.”

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I just received a very interesting question from Joseph about the different types of tissue heart valve replacements.

Joseph writes, “Have you ever heard of any surgeon using equine tissue valves for aortic valve replacement? In the 10 months of researching my aortic valve disease, I’ve not heard of EQUINE valves being implanted — not once. Can you provide some insight? Thanks, Joseph”

ATS 3F Bioprosthetic Aortic Valve – Equine Tissue Valve

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Considering our recent discussion about heart valve re-operations, often referred to as “Re-Dos”, I wanted to wish Bob Uecker a very successful surgery today. If you didn’t know, Bob Uecker — who was anointed  “Mr. Baseball” by Johnny Carson — will undergo his second heart valve surgery during the past six months.

Bob Uecker – Heart Valve Surgery Patient

According to reports, a pseudoaneurysm (a tear) happened where his heart valve replacement is located. According to his medical team, it’s believed a skin-related staph infection entered his bloodstream and got into his surgical repair site.

“I’m approaching this with the same optimism that I had the first time,” said Uecker. “I appreciate all of the kind thoughts and well wishes from Brewers fans and everyone who has reached out to me.”

Keep on tickin’ Bob!
Adam

Interest in catheter-based technologies for heart valve repair and heart valve replacement continues to skyrocket.

As you have seen, we recently (i) reviewed new data for the SAPIEN aortic valve replacement and (ii) observed a MitraClip case for mitral valve repair. Recently, I learned that Medtronic, one of the leading heart valve manufacturers, received FDA approval for its investigational device exemption application. That means that Medtronic can conduct a patient trial to determine the safety and efficacy of its percutaneous CoreValve system for aortic valve replacement.

Aortic Stenosis – Narrowed Trileaflet Valve

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I just received an interesting question from Alma about a critical step during heart valve repair and heart valve replacement surgeries. Alma writes, “Adam – I’m going in for surgery next week. Thanks to your book, my anxiety has greatly decreased. I’m curious… I know my heart is going to be cooled and stopped during surgery. But, will my surgeon actually put ice on my bare heart? Alma”

Coincidentally, I just took the picture below while observing a heart valve surgery last week. As you can see, the answer to Alma’s question is typically… Yes.

Ice Chips On Heart During Cooling Process

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When the latest results of the PARTNER trial became available, many in the medical, investment and patient communities quickly analyzed the data specific to the new SAPIEN heart valve replacement. As you may be aware, the SAPIEN (i) requires no trauma to the sternum during aortic valve replacement, (ii) is currently used for high-risk patients suffering from aortic stenosis, and (iii) has yet to receive FDA approval in the United States.

While many physicians and investors took instant favor to the findings published in The New England Journal of Medicine, I was curious to know what cardiologists and heart surgeons thought of the study — after the data was digested.

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