About Me (In My Own Words)
After several years of not seeing a PCP and now retired for 2 years, I had decided it was about time to do something. I chose Dr. Tanya Arvan, who is absolutely charming, of the TMH Physician Network as my new Internist. I went to see her on August 2nd for a BP check and she said, "You have a murmur." I said, "I had a functional murmur years ago," and she said, "Go see the Cardiologist" which I did. Dr. Ram Reddy told me I had a murmur and to get an echo. At this point I knew this was bad news, so I went home and got out my stethoscope, put it to my chest, and said, "Oh, Shit." It was plainly obvious to my ears that I had AS, and, given my age, gender, and medical history, that it was Calcific Senile (don't you love that word) Aortic Stenosis.
The results from the echocardiogram were not reassuring. The stenosis was severe, with a flow across the stenotic valve of 5.5 m/s where less than 1.0 is normal, 2.5 to 3.0 is mild, 3.0 to 4.0 is moderate, and > 4.0 is severe. The obvious conclusion right off the bat was that I would need a new aortic valve. The main diagnostic test left to do at this point was a coronary angiogram. Dr. Salam Azam, also of COR Healthcare in the South Bay, did this at Torrance Memorial on October 10th and it showed some coronary artery disease as well, which was not too surprising. What was a bit puzzling was the collateral circulation with a connecting vessel that seemed to have flow in both directions, if I understood Dr. Azam correctly.
Then, the search for a cardiothoracic surgeon and a hospital began. I went to see Dr. Stoneburner at Torrance Memorial Hospital as my first consult since he has many years of experience and this is my local facility. He was very gracious and made plenty of time for us in his busy schedule. He explained the procedure and options in detail and had me make arrangements for the necessary follow-up tests needed before the surgery. I had also scheduled a visit with Dr. Bethencourt out of Long Brach Memorial Hospital because of his training in robotic surgery with less invasive options for aortic valve replacement. But the need for bypass bypassed this as an option, so I elected not to see him for this reason. And, in the meantime, we had visited with Dr. Alfredo Trento of the Cedars-Sinai Heart Institute and really liked his approach to my situation. When he asked when would I want to have the procedure done, I said ASAP, and so the date was fixed. Given his extremely busy schedule, research and travel to give presentations, and his responsibilities as head of Cardiothoracic Surgery at Cedars, I was surprised that the surgery was scheduled as soon as it was. Perhaps it was the severity that might have helped prioritize my case to 5 weeks. No one wants to lose a patient before they have had a chance to fix him.
I feel confident in the choice of Dr. Trento and Cedars-Sinai for AVR and CABG. Dr. Trento’s CV is very impressive and his experience in doing aortic valves incredibly extensive. To quote him directly, “Hello! My name is Dr. Alfredo Trento and I am a cardiac surgeon having graduated from University of Padua, Italy in 1975. To date, I have performed approximately 7,500 cardiac surgeries, of which 4,000 involved heart valve procedures. I regularly perform surgery at Cedars-Sinai Medical Center. I believe my greatest strength is superb surgical outcomes.” Cedars is highly ranked by several well-known sources as among one of the best centers for Cardiothoracic Surgery in the country.
As a physician and by virtue of a somewhat obsessive bent, I felt the need to research my situation. A review of the literature was just the ticket to try and answer several questions that I had. For example, what valve would be optimal for someone my age (66). A bioprosthetic over mechanical valve seems to be the trend and a better choice. Even if I were 5 or 6 years younger, I might have made the same decision to avoid lifelong anticoagulation. But what about short term (for the first 3 months’ post-op) anticoagulation? There it seems some anticoagulation might be good, even with a bioprosthetic valve and no risk factors, like atrial fibrillation. It is a bit controversial but taking 325 mg of aspirin as opposed to the 81 mg daily that I take now does not seem like a big deal. Dr. Trento will implant a third generation Carpentier-Edwards valve, the Edwards Perimount Magna Ease, which turns out to be an excellent prosthetic choice with a good clinical record. How long might one expect the new valve to last? Fortunately, one of the very few advantages of older age is that bioprosthetic heart valves last longer than at younger ages. And given that we older folk don’t last as long either, it is a race to see which can outlast the other. Structural valve deterioration is a concern in all bioprosthetic heart valves but advances in materials and design have improved this over time. From the Annals of Thoracic Surgery (Ann Thorac Surg 2015;99:831–7) one article states, “With a low rate of valve-related events at 20 years, and particularly a low rate of structural valve deterioration, the Carpentier-Edwards Perimount pericardial bioprosthesis remains a reliable choice for a tissue valve in the aortic position, especially in patients over 60 years of age.” It appears that 15-20 years of valve lifetime is not an unreasonable expectation.
More Info About Me & My Heart
More About Me
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I am from:
Rolling Hills, CA
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My surgery date is:
December 1, 2016
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I was diagnosed with:
Aortic Stenosis
Coronary Artery Disease
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My surgery was:
Aortic Valve Replacement
Coronary Artery Bypass Graft
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