Adam's Heart Valve Surgery Blog – Page 66

Use of Coumadin for patients that select a mechanical valve replacement is typically required to prevent blood clots. As a result, many pre-surgical patients considering a mechanical valve (versus a tissue valve) often wonder, "What is life like on Coumadin?"

In the last 24 hours, I have received this question from 5 different patients and two caregivers. One of those patients thinking about Coumadin and mechanical valves is Mary Anne.

I'm not a fan of overused cliches. However, if there is one cliche I never get tired of it is, "Laughter is the best form of medicine."

That said, Kerrigan just sent me this pig valve replacement cartoon that got a good chuckle out of me. Without further ado, I hope this injects some laughter medicine into your veins:

Related Links:

• Joke: A Cardiac Surgeon and A Car Mechanic

• Friday Fun: Why Do Boys Need Their Parents

• Silly: The Human Body and A Man's Thumb

Keep on tickin' and laughin!!!
Adam

I recently learned that the manufacturer of On-X heart valve devices is going to double the size of its operations in Austin, Texas. The parent company, On-X Life Technologies (ON-X LTI), signed a building lease for over 40,000 square feet due to the result of increased demand for its On-X mechanical valves for mitral valve and aortic valve replacement.

"We continue to experience increasing acceptance of the On-X heart valve in the United States and around the world," said Clyde Baker, On-X LTI president and CEO. "The relocation of our operation to this larger facility will permit us to expand our manufacturing capacity to meet this demand."

Great news regarding the launch of our heart valve surgeon database!!!

I'm very excited to share that our new, FREE database already has over 273 surgeon profiles uploaded! In less than one week, patients from around the world - including the United States, the United Kingdom, Australia, India, Singapore, Malaysia, Mexico, South Africa, Thailand, Israel, Canada and Mauritius - have uploaded their surgeon information and their feedback.

Thanks so much for your help everybody!!! I know this very unique, heart valve surgeon database is going to help many future patients and caregivers for years-and-years-and-years-and-years to come!

As I wrote earlier, the FIRST STEP of this process is to upload as many surgeon profiles as possible to the database.

That said, if you are a former valve surgery patient and would like to add your surgeon profile, please click here!

The SECOND STEP will be making the database available to everybody for use. This will happen next week when we officially launch our own version of "Google" for heart valve surgeons.

Keep on tickin!
Adam

I'm not sure if you followed the cardiac news coverage of Robin Williams's heart valve surgery.

But, it was confirmed that Robin Williams, prior to his passing, had double heart valve surgery at the Cleveland Clinic in Ohio. While initial reports suggested that Robin Williams would only need aortic valve replacement surgery, the Oscar-winning actor and comedian also had his mitral valve repaired.

Robin Williams (Aortic & Mitral Valve Surgery Patient)

Tammy wrote me earlier today asking, "Who was Robin Williams surgeon?"

I don't know if you like the television show Brothers and Sisters, Sunday nights on ABC. But, Robyn (my very pregnant wife) and I really enjoy watching the trials-and-tribulations of the Walker family.

"Why is Adam writing about Brothers and Sisters?" you may be scratching your head and thinking.

Well... On Brothers and Sisters, Rob Lowe plays the role of Robert McCallister - an eager politician striving to balance the demands of running for governor, fatherhood and his wife, Calista Flockhart (aka Kitty Walker). Recently, Lowe's character had an unexpected heart attack and cardiac bypass procedure.

Rob Lowe After Heart Surgery On Brothers And Sisters

I could not resist posting this very, very, very interesting note from Erik. I never knew that certified dog therapists existed!

Adam,

I just created a surgeon profile for Dr. Vib Kshettry, Minneapolis Heart Institute, in your surgeon database. I would also give kudos to my cardiologist, Dr. Kevin Graham at the Minneapolis Heart Institute. They have a heck-of-a-team and clinic there. I just don't have enough positive adjectives to describe these two physicians.

As a "young" patient at the age of 37, open heart surgery was very scary. It gave me peace-of-mind to know I had the best-of-the-best. It was a year ago and I feel great.

Erik, With Dyno, The Dog Therapist, After Heart Surgery

Just for fun......I attached a photo of my first day out of ICU. Our dog, Dyno, is a certified animal "therapist" and my wife takes her to several hospitals and visits. This visit was personal. She actually stayed a couple hours and just slept with me.

Hope all is well with you.

Erik

Earlier today, Kerrigan and I exchanged emails about the recovery from open heart surgery. Specifically, we discussed the physical healing of the broken sternum and the heart. In one of his emails, Kerrigan wrote, "I was wondering how long after surgery is the heart considered "healed" as far as the incisions and reattachment of aorta? Thanks, Kerrigan"

While I have some pretty good thoughts, research and experience on the healing time required for a stitched heart and broken sternum, I am ALWAYS APPREHENSIVE about issuing estimates for patient healing and recovery.

Any guesses as to how much blood your heart pumps each day?

Need a hint? It's more than 10 gallons.

Need another hint? It's more than 100 gallons.

To find out how much blood your heart pumps each-and-every day of your life... Scroll down below the beating heart animation.

According to The Texas Heart Institute, most healthy hearts can pump up to 2,000 gallons of blood during each twenty-four hour period. Isn't that incredible?

I just did the math. During the time you just read this blog (I assumed one minute), your heart pumped 1.38 gallons of blood through your body!!!

Why am I writing about this? Well... This is exactly why our heart valves need to function properly. If our valves do not open-and-close tightly, the heart needs to pump even more blood which puts additional strain on the heart. If the heart "works overtime" for long periods of time, the cardiac muscle can thicken, dilate and, ultimately, fail.

Related Links:

• Heart Valve Anatomy: What Should Patients Know?

• Human Heart Diagrams: Side & Top Views

• How Does Blood Flow Through Your Body?

Keep on tickin!
Adam

Here is an insightful, patient story about Josh from Oregon. As you can read below, Josh offers a unique glimpse into some of the common challenges and opportunities patients experience during early heart surgery recovery. I say "early" because Josh had his operation less than two weeks ago.

Adam-

Hey there! Just dropping you a note that the "hardest" part is over.

I had my aortic valve replacement and ascending aortic aneurysm repair done on Thursday, March 5th at Providence St. Vincent Medical Center in Portland, Oregon. I just filled out your online surgeon database questionnaire so that I could highly recommend my surgeon, Dr. Storm Floten of the Starr-Wood Cardiac Group.

Josh Receives Kiss Following Heart Surgery

I'm happily at home and have been since Monday, March 9th. That's right... I left the hospital 4 days after my surgery.

I just received a great question from Wayne. He writes, "Adam - At the ripe age of 62, I'll be having my mitral valve replaced due to severe regurgitation from prolapse. I know a woman who was in the hospital for 9 days. Is it common for valve patients to be in the hospital for that long? Thanks for all that you do! Wayne"

There are really three answers to this question. The first answer I'll provide is based on patient data I collected during a survey. In that survey, I asked over 75 former surgical heart valve patients the question, "How long were you in the hospital?" As you can see on the chart below, the average response was 5 days. At the same time, there are patients who undergo less-invasive operations, including robotic mitral valve surgery, that may go home in 3 days.

Patient Days In Hospital Following Valve Surgery

The second answer is for patients who have catheter-based heart valve operations. Those patients may go home between 1 to 3 days. That's right. Patients who receive minimally-invasive therapies including transcatheter aortic valve replacement (TAVR) are in the hospital for a much shorter time because there is no incision to the patient's chest or ribs. In addition, transcatheter patients do not go on the heart-lung machine and many of them do not go under general anesthesia. That said, transcatheter therapies are not available and/or recommended for all patients. So, please discuss this with your doctor.

Lastly, I'll provide a third answer t0 Wayne's question which is, "It depends". As I have learned over the years, every patient case is unique. In some situations, I know patients that have left the hospital after two days. In other cases, due to heart surgery complications, I know patients who stayed in the hospital for more than three weeks.

I hope that helps Wayne (and perhaps you) better understand how long heart surgery patients stay in the hospital.

Related Links:

• Leila's Patient Success Story: Back To Work In 7 Days

• Rapid Recovery Protocol 2.0: What Should Patients Know?

• Robotic Mitral Valve Surgery Patient Education Center

• Mitral Valve Prolapse: What Should You Know?

Keep on tickin!
Adam

There is nothing better than waking up in the morning, putting on my robe and slippers, grabbing a cup of coffee, turning on my computer and reading an inspirational, patient story like the one below. Plus, Jarrett's thoughts about the "waddling penguins" and the "Adam Tinmen" made me giggle. That said, I thought you might like to read about Jarrett Roberts. He writes:

Hi Adam,

Valentine's day - with the emphasis on love and hearts - has taken on a new meaning to me and my wife as I am on day 22 of my "second chance at life" as I had my bicuspid aortic valve repaired by Dr. Bruce Lytle at the Cleveland Clinic on January 23, 2009.

Jarrett Roberts - Arctic Marathoner And Valve Repair Patient

I found it interesting (at the Cleveland Clinic) to be one of the younger patients in for surgery. The nurses were all excited that a 6' 7" marathoner - I've done 83 including Antartica in 2005 - was in for surgery (as they normally get the unusual heart valve cases that other clinics won't touch).

My bicuspid aortic valve was accidentally discovered less than two years ago during a routine cardiac calcium CT that was misdiagnosed as an aortic aneurysm. The follow-up tests showed that the radiologist had flipped the numbers and I didn't have an aortic aneurysm. However, I did have a bicuspid congenital defect of my aortic valve.

What a week for those interested in the topic of heart valve surgery!!!

First, we learned that Barbara Bush was recovering from aortic valve replacement! Then, news reports started buzzing about Robin Williams' need for heart valve surgery on his aortic valve.

As a result, my email inbox has been flooded with interesting questions about all types of heart valve surgery - especially aortic valve replacement.

Aortic Valve Replacement - Positioning A Prosthetic Valve

Yesterday, Barbara Bush, at 83 years of age, joined a long list of public figures to have undergone successful heart valve surgery.

The former first lady, Barbara Bush, underwent open-heart surgery Wednesday to replace her aortic valve, a family spokesman said. Barbara Bush's heart surgery took place at Methodist Hospital in Houston, Texas and lasted about two and a half hours.

Barbara Bush - Heart Valve Surgery Patient

Bush, like many patients, was suffering from shortness of breath due to aortic stenosis. This valvular disease results from a narrowing of the heart valve which may occur due to congenital factors, calcification or infection.

Interest in minimally invasive procedures for heart valve surgery is increasing for both medical device manufacturers and patients. As we learned last week, Medtronic spent over $1 billion to acquire CoreValve and Ventor Technologies, two companies that specialize in non-invasive valve replacement technologies for diseased aortic valves.

From the patient perspective, the advantages of minimally invasive surgery are (i) less post-operative pain, (ii) faster recovery and (iii) lower mortality. As you have read in this blog, several of my readers have had such procedures including non-invasive robotic surgery for mitral valve repair.

Over the past few months, I've been receiving additional comments about minithoracotomy for aortic valve replacement and mitral valve replacement. In this type of cardiac surgery, the patient does not have a median sternotomy in which the sternum is broken (as discussed previously in "Vicki's Thoracotomy Versus Sternotomy").

Given this topic, I just received a very interesting patient story from Jim Engelmann. Jim, as pictured below, recently had aortic valve replacement via mini-thoracotomy.

Jim's Mini-Thoracotomy Scar After Valve Replacement

Managing anxiety before heart surgery can be quite challenging for patients and their caregivers. However, Rochelle just asked me an interesting question about dealing with anxiety after heart surgery. Here is what she writes:

"Adam - I had aortic valve surgery 4 months ago. Everything went well but I am suffering from anxiety. I have been taking Ativan... one milligram. I also go to cardiac rehab once a week. My question is, "How many patients suffer from anxiety after heart surgery? Does it ever stop? Thank you, Rochelle (P.S. Your book has helped me alot!)"

Here is my response to Rochelle:

Like you, I also suffer a bit from anxiety. However, I don't think my anxiety increased after heart valve surgery. To counter the anxiety, I do my best to exercise, to write and to share any anxious thoughts with those around me.

After surgery, I also entered individual counseling. While some patients enjoy support groups, like Mended Hearts, I chose a more personal setting to enhance my mental well-being following the challenges of my recovery.

So you know, I'm not the only patient to seek therapy following heart surgery. In a 2007 study, 9% of patients acknowledged that they saw a therapist post-operation to help with the emotional and behavioral changes after cardiac surgery. From experience, I can tell you that therapy really helped with my anxiety and sleep issues.

Here's the funny part... It was my brilliant therapist who suggested I write a book and blog about my heart valve surgery journey to help future patient and caregivers. Without her thought, you would not be reading this right now.

I hope this helps you better understand anxiety relative to heart surgery.

Keep on tickin!
Adam

On November 27, 2007, I posted a blog titled, "Will Heart Valve Manufacturers Consolidate And Gobble Up Each Other?". In that post, I rambled-on about the possibility that the heart valve industry would consolidate to create advantages for both patients and manufacturers.

Guess what?

Earlier this week, Medtronic spent over $1 billion to acquire two heart valve manufacturers - CoreValve and Ventor Technologies.

In the first deal, Minneapolis-headquartered Medtronic acquired CoreValve, developer of a transcatheter, transfemoral aortic valve replacement product. The deal calls for an initial payment of $700 million plus additional payments contingent upon the achievement of agreed milestones.

CoreValve Transcatheter Aortic Valve Replacement

Barbara, a 57-year old patient from Georgia, just asked me a very honest question about heat valve surgery and hospitals.

She writes, "Hi Adam - I've been diagnosed with severe stenosis of the aortic valve. I got a second opinion to confirm the diagnosis. Now, I'm mentally preparing for what lays ahead of me. I'm overwhelmed. Just the thought of heart surgery keeps me up at night. Also, I have an aversion to hospitals. I've never had major surgery so I don't know what to expect. Sometimes my brain focuses on the negative reality of spending several days-and-nights among sick people. This may sound like an odd question, but... What is the worst thing about staying in the hospital after surgery? Thanks, Barbara"

As most of you know, I consider heart valve surgery to be a medical miracle. With this belief, I started this blog and wrote my book with a single passion - to help transform patient fear into patient hope. However, this passion is not oblivious to the fundamental concerns that confront both patients and caregivers as they transition through each phase of cardiac surgery - diagnosis, pre-operation, the surgery and recovery.

I could be wrong but I think the cliche goes something like, "A picture is worth a thousand words." While I'm not a fan of cliches, I am a fan of this one - especially when it comes to understanding heart valve surgery.

Before my surgery, seeing pictures and diagrams helped me digest (i) my diagnosis and (ii) my need for aortic valve surgery. I've always been a visual person but understanding the structural problems of aortic stenosis was very helpful.

That's why I really appreciate the email I just received from Tanya. She writes, "Hi Adam - My dad is scheduled for mitral valve prolapse surgery on Tuesday. I think I understand what the problem is. He's had valve regurgitation symptoms for years. But, I was curious to know if you had any diagrams that show the physical defect of a mitral valve prolapse?"

I guess Tanya and I are somewhat similar - seeing things helps. With that said, here are two pictures which illustrate the challenges when mitral leaflets do not open-and-close properly. The first diagram shows a side-view of the heart and mitral valve prolapse.

Here, in the second diagram, you can see a top-down view of a mitral valve prolapse:

Considering the two pictures above... I guess, according to the cliche, I just saved myself 2,000 words. Phew!

Keep on tickin!
Adam

I just received a very, very, very interesting question from Debbie about stroke and heart surgery.

Debbie writes, "Adam - My mom is having open heart surgery next week due to severe regurgitation from a mitral valve prolapse. I have heard that stroke is a risk for patients during cardiac surgery. Is that true?"

Diagram Explaining A Stroke

So you know... Debbie's question brings back a distinct and touching memory for me as I prepared for my own heart valve surgery.

It was December 20, 2005, the day before my aortic and pulmonary valve replacement surgery. I was at USC Medical Center in Los Angeles, California. My pre-operative tests were almost complete when it came time to discuss the surgical consent form.