Jeff's Journal

It’s been a while since I’ve visited/posted on HVS.com! I had a mitral valve repair (MVP) via full sternotomy in 2014 by Dr. Gosta Pettersson at the Cleveland Clinic. At the time the MV condition was moderate/severe. Secondarily, my bicuspid AV was under evaluation for a possible replacement. In the end, the AV condition was determined to be mild and the surgeon elected to leave it alone as he advised that it might be another 10-20 years before intervention would be required. Well… after almost 12 years, it’s time to replace my AV as the condition is now severe. I’m returning to the Cleveland Clinic at the end of April for two days of tests and then scheduled for SAVR on the third day with Dr. Anthony Zaki… however, I am also meeting with a TAVR team in case it is determined that TAVR is recommended. I’m 62, in good shape so all things being equal, SAVR or Mini SAVR would typically be the first line approach. Since I am a redo, I am in a higher risk pool primarily because of scarring so all options are open. These matters will all be dialed in following tests. I must admit, the TAVR recovery is very appealing but if SAVR gives me a more durable and longer lasting result, I’ll be inclined to endure the longer recovery and discomfort though considering another SAVR is a daunting prospect. My first-round surgery and recovery went very well and I expect a similar experience. At least this time, the overall anxiety level is much lower if SAVR is required because I now know what to expect afterwards… and I can tell you, my imagination ran off to some dark places prior to the first surgery. Thankfully, Adam and his website were a fantastic resource for keeping things real and providing me with great support! I will now lean back into the HVS.com network for support and guidance! Thanks again, Adam for all your amazing work! Jeff V., MVP 2014 & pending AVR April 2026, Cleveland Clinic!

Has anyone heard who performed Henrik Lundqvist's surgery at the Cleveland Clinic...? https://heartvalvesurgery.us5.list-manage.com/track/click?u=7522a89b5cec760c765e5d6ed&id=09d3ddc0c2&e=fceea8c0e4

Has anyone in the community talked to their docs about the new Foldax Tria valve? The first in-human use was completed last year and it sounds like a promising next-generation technology using biopolymer material... potentially meaning no repeat surgery or blood thinners. The Tria valve is not available yet, but AVR feasibility studies are underway now so perhaps it will be an option in the near future...!

I went back to work last week following my 4th week post-op and clearance from my cardiologist. I have a desk job and had no problems transitioning. Energy levels are as good or better than pre-surgery. I am considering a 6-week session (3X’s per week) of cardiac rehab and had to baseline with a stress test, echo and 24-hour Holter to get into the program. I passed the stress test with no symptoms and my MV regurgitation was >1 during the echo… so far, so good on the repair! I am debating the rehab program but think it will kick start me on an exercise routine. When I asked my cardiac nurse practitioner and cardiologist about rehab they both agreed that it would be beneficial. However, I guess I pressed my luck when I asked if they thought I could run my snow blower in lieu of rehab… they were not happy with that question. They looked at each other and then back at me and the cardiologist said, “Jeff, it is great that you think you are feeling well enough to run your blower but have you noticed that 9” incision on your chest? Do not touch that machine until I tell you it is OK!”

My recovery continues smoothly, aside from some minor issues dialing in my INR. After 3 weeks, my GP is getting closer to figuring it out but I seem to be very sensitive to low doses of Coumadin. I will be on the med for ~60 days because of a 5 hour A-fib run on day 3 of post-op. I just traveled 16 hours by car to Kansas City with my family to spend New Years with my in-laws. The trip was no problem physically and it sure has felt great to get out of the house! Happy New Years to all!

I am doing well 2 weeks after surgery. Because of the 5 hour A-Fib session I had 3 days post-op I will be on Coumadin for up to 60 days to prevent any clotting. My local GP is managing my INR and it has been a slow process dialing into my therapeutic range of 2.0-3.0. My first INR result on Mon. was 6.5. My doc temporarily stopped the med (including baby aspirin) and requested that I come in daily until we get things figured out. My Tues. result was 4.5., Wed. 3.3, Thurs. 3.5 and today, my PT was 1.7. I am now waiting on instructions on how to proceed over the weekend and will have to go back on Mon. for another check. I understand that this is a fairly normal routine in initially adjusting one's blood clotting levels. My GP of 30 years was very impressed with the MV repair. He has followed me closely for a long time and was very familiar with my very loud and distinctive MVP. I was always told that my murmur was loud and could be heard clearly from my left side and radiating around to my back. My GP said that my heart now sounded completely normal and he could not hear my mild AV insufficiency (1+) at all. At the time of surgery, my MV regurgitation was found to be severe along with moderate dilation of the LV. My MV regurgitation is now classified as "trivial" and the LV is "normal" size. I have been home for one week and feel very good. I am walking for 30 mins. with no discomfort or shortness of breath and could go longer, I am sleeping comfortably in bed and on my side, I am doing laundry for the household, I have been off pain meds for a few days and only taking Tylenol (650 mg) twice a day... I am motivated and everything appears to be going in the right direction. Thanks for everyone's input and support as I am convinced that Adam's Club was the key piece of the puzzle that prepared me best both pre and post surgery! Jeff

I was discharged from the hospital on Tues. but stayed in Cleveland for two days for some final appts. today. I had some lab work, EKG, X-ray and then a meeting with my surgeon's nurse practitioner to go over my final tests of this morning and to conclude my plan. Aside from a nasty snowstorm on the ride home which tested my BP, my wife and I made it safe & sound and I am resting comfortably! Best wishes to all for a happy and healthy holiday season.

I had my first good nights sleep. Though I was awakened at 3a and 6a for routine vital checks, I slept like a rock and had a great morning with walks and doctor visits. I met with 3 cardiologists today who have been monitoring my progress. I have had a couple of brief runs of AF since yesterday but they are not concerned. The pacing wires were pulled around noon today and I have been told that I will be released tomorrow, 12/9. The pain management has been very good and I never really suffered from any severe pain. I wouldn't have believed it had I not just been through it, especially since I received a full sternotomy! I might have the longest incision on this website (sounds like a new contest, Adam?) Believe me, the ICU experience is no walk in the park but they are really on top of their game and incredibly attentive. I went popsicle crazy while in the ICU once I got the OK for liquids. They start you off very slowly with liquids once off the vent... small wet sponges, then ice, then sips of ice water, then popsicles/ice. They are closely monitoring your fluid intake to prevent nausea. My throat was very irritated and I found the popsicle (cherry) to be most soothing. My nurse practitioner kept the ICU team (and me!) on point and if you didn't know her background, you would swear she was ex-military. Since the wires have been pulled, I can now take a full shower and plan to do this later today. Keep a couple of sets of pajamas (short sleeve top with button front), underwear and light to medium weight robe handy as it is nice to drop the gown ASAP. Also, bring your favorite slip on sandals, otherwise, you will get socks with treads. I also have worn compression socks provided by the hospital for my entire stay. I have worn them for years for work related flying as they have been very helpful in controlling ankle/foot swelling & DVT. Even if you haven't had ankle swelling you may want to try them just to prevent this common complication. Regards to all... Jeff V.

I am watching the Browns/Colts game in my room. I feel good and better by the hour. I have yet to speak directly with my surgeon but learned of the surprising change in plans shortly after awakening in the ICU. I really did not foresee my end result and was fully expecting an AVR and the strong possibility of an MVR if the MV could not be repaired. I will share more info. about Dr. Pettersson's change in plans after I speak to him. I am into Day 3 of Post-Op and experienced A-Fib for several hours today. In just speaking to one of my cardiologists this afternoon, I learned that A-Fib often develops in day "3" of recovery because of the procedure and related inflammation. It is a frequent and possible reoccurring complication and did not bother me too much. My BP stayed about the same both in and out of sinus rhythm, however, the rate increased any where from 30%-70%. I began walking yesterday but stopped until I got the green light to proceed following the A-Fib episode. A decision will likely be made tomorrow about whether I will go on a short-term Coumadin regimen for 6 - 10 weeks. The team wants to huddle and in the meantime I am being treated with rhythm meds. Thanks to everyone for their encouragement and support! Jeff V.

This morning Jeff has reached many milestones. Probably most importantly, he is now taking pain medicine in tablet form. This provides much more long-lasting pain control than the iv product. Important advice: Figure out a system for managing the iv pain meds. The patient has a push button that can initiate a dose of pain medication, but because the relief is only about 15 minutes worth, the patient ends up falling asleep once relief is achieved, only to be woken minutes later in pain. This cycle results in inconsistent relief. We started prompting Jeff every six minutes to press his pain med button, the maximum allowed frequency. This is making sure he is getting consistent pain relief. Also, keeping track of the time interval allowed with tablet meds can improve your loved one's pain management! The staff wants patients to be pain free, but pain meds are given by patient request so it's good to keep track of those things! Jeff has had his chest tubes removed, is sitting up, and now doing routine breathing exercises, which we are also keeping on a time-table. His x rays did show some fluid in his lungs so he will be working to get rid of that! We are now just waiting for a bed in the step-down unit. It is amazing how many surgeries are performed here every day! We were told approximately 40 open-heart surgeries a day. We are so gratified to have such incredibly wonderful nurses, and nurse practitioners tending to Jeff's care. We have all noticed that it seems EVERY SINGLE PERSON that works here at the Cleveland Clinic is friendly and helpful and ready with a smile!! Amazing! And very comforting.

After talking with Dr Pettersson post-surgery, we had to wait for Jeff to be set up in his ICU area, before we could see him. He was still sedated at that time, but it was great to hold his hand and see him resting peacefully. We had been prepared for that to be a brief visit, and went out to the family waiting area until we received a call letting us know Jeff's ventilating tube had been removed. He could talk! And he was able to tell us about his discussion with the anesthesia team before surgery. Patients are required to be able to share their name and confirm the procedure that was to be performed. Jeff told them that he was in for waistline liposuction and a "nip and tuck" on the eyelids. He had us laughing. The ICU nurse was pleased with Jeff's condition, noting that not many come into the ICU able to joke! Jeff of course had no idea how the surgery came out yet. Since I had no idea what Jeff ultimately had decided on ( he planned it as a surprise for me) I wasn't sure if he was expecting a new aortic mechanical or bio valve. I shared the info that he ended up needing just a mitral valve repair and he was stunned like us, but very happy. He is still dealing with pain, but able to drink, and is eating popsicles as I write this. The liquids and ice are helping his sore throat. I learned from an ICU nurse that it is not that uncommon for the surgeries to change course once the surgeons get a look at the real deal. Understandably, no imaging can give the picture that the surgery provides.

Jeff and I arrived bright and early to the Cleveland Clinic, but the check-in area was already full of families also scheduled for the early morning surgeries. Jeff having chosen his cheery bright tropical shirt for his morning check-in, remained relaxed even to our last kiss and hug before they rolled him in for surgery. I placed our belongings in the lockers provided to the waiting families, and settled in to wait. Our check-in was 5:15, and Jeff was escorted right in to begin the process of surgery prep. I was called to go in after he was dressed in his gown and hooked up to monitors and I got to stay with him for quite a while. It seemed that all the patients scheduled for the early surgery were rolled into surgery at the same time in a kind of caravan of surgery gurneys. The families in the waiting area were each given a beeper. We were informed that it could be some time before we receive our first communication which would let us know that surgery had actually begun. The waiting families and friends were all then led to a conference room and given information on what to expect for the day. My beeper went off during that presentation, around 9:30, letting me know that "the major portion of the surgery has begun"-meaning-Jeff was now on the heart-lung machine and the surgeon was at work! Surprisingly, the beeper went off again at 11:00. This was unexpected and a little unnerving, since we were all told to expect that second communication would be 4-6 hours later. I was informed the surgeon was ready to talk with the family. Dr. Pettersson explained right off that he ended up doing a different surgery than planned. He did the mitral valve repair, but said he reassessed Jeff's echocardiograms, and other info after seeing the aortic valve, and "couldn't convince himself" that the aortic valve needed to be replaced at this time. Dr. Pettersson shared that he expected a number of years left for the aortic valve, and also chose not to work on the aortic dilation because he said any work like that can affect surrounding areas and could complicate the next surgery. Well we were very happy to know Jeff was getting settled in ICU. We've gotten to see him, although he wasn't out of sedation yet, and still on the breathing apparatus. We are looking forward to seeing him awake and celebrating the great news!! Thank you all for your wonderful support as Jeff has been preparing for this day. I can speak for Jeff, this forum has meant so much to him and has helped him go into surgery with a great outlook! I'm sure it will be just as helpful at the next stage of recovery!! Bridget V

I arrived at 9:30a for pre-op and anesthesia clearance. Before my appt., I was approached by research staff and asked if I would consider participating in a 7-day post-surgery A-Fib study. The purpose of the research is to compare two strategies for treating AF after cardiac surgery by Rate Control (beta or calcium channel blockers) vs. Rhythm Control (amiodarone). Per the Clinic, AF is the most common complication of cardiac surgery with 30%-40% of patients experiencing short-term AF in the first week following surgery and for patients undergoing compound heart procedures, 40%-60% will experience AF. About 470 people will take part in this study at 25 different hospitals. I met with a nurse tech and anesthesiologist to review my surgical plan for tomorrow. I was shown a 15 minute movie covering tomorrows activities. Once done, I went to the surgeons check-in desk for my 12:30p meeting with Dr. Pettersson. My wife and I discussed my options and procedures for approximately one hour. My valve preference going into the meeting was an Edwards bovine tissue valve for the AV and repair of the MV and possible repair of the mildly dilated Aorta and left pulmonary arteries which are mildly dilated. Dr. Pettersson wanted to know why I wanted a tissue valve and I explained. He said OK, we can do that or we can do a mechanical valve as it makes no difference to him... as I pressed the matter further, it became clear that he believed an On-X aortic mechanical valve and a repair of the MV was the best way to go. The likelihood of ever having another heart surgery was extremely low for the mechanical AV (1% range) and 10% for the repaired MV vs. a 100% chance to replace the AV in approx. 15 years. He explained that sure, there are risks of being on blood thinners but they are very low and in his opinion, the benefit of not having another heart surgery and taking Coumadin for life outweighs a re-surgery in 10-15 years. When I was about to leave Dr. Pettersson's office I asked when he needed to know my choice, he said with a smile, tomorrow when we are in the OR just before you go to sleep. Needless to say, confusion has ruled my afternoon and evening. I have been on the phone with family, friends and doctors trying to lock in my plan. I was so set on an Edwards tissue valve but the doc got into my head and I will sleep on it and tell the doc just before go time. I have to report at 5:15a so it's time to sleep on it! My wife Bridget will try to update over the next couple of days.

Arrived at the hospital today at 7a for a right/left heart cath. and surgery check-in. At 7:30a, went to the cath. lab and was immediately brought in for prep. I changed into a gown and got prepped by 2 nurses... IV port and connected to monitors. Just prior to moving on to the OR, a doctor met with me to explain the procedure and release sign-off. This process took about 45 mins. before being rolled into the OR. Once in the OR, a nurse prepped both left and right groin areas for surgery (the left side as a back-up). The IV was administered and I again was told more about the procedure and asked if I had any questions... I had several thanks to HVS.com. The procedure went smoothly and though given two doses of "relaxation" meds., I remained awake through-out with no discomfort and was able to observe the monitors and ask questions about what I saw on the screen. The process was actually very cool (aside from the 4 hours of recovery time flat on your back.) Upon completion, Dr. Hobbs immediately told me my coronary arteries were clear and chamber pressures were normal but slightly elevated because of my dual valve problem. Dr. Hobbs then left the OR and met with my wife to explain his findings and also added that I remained awake for the entire procedure and was very inquisitive. Do not be afraid to ask any and all questions! Tomorrow, I have a preoperative clearance appt. and then end the pre-op stage with my surgeon, Dr. Pettersson, to discuss the plan.

Arrived in Cleveland at 8:45a for an 8:50a blood work appt. Had blood drawn, EKG and chest X-ray done by 9:15a. This place is efficient! Met with the Director of Electrophysiology at 10:30a to discuss some random rhythm issues I have had through the years. They believe I have benign SVT and advise that I could consider an ablation procedure in the future but do not recommend until I have recovered from my Thurs. valve surgery as there is a possibility that the rhythm problem will improve by the surgery. Unlikely, but possible. My final appt. was with my cardiologist/Med. Professor, Dr. Stewart and a fifth year medical student as the doctor has used me in the past for teaching purposes. I guess it sounds like an accordion in my chest between the MVP and BAV! Cath. tomorrow!

My surgery has been scheduled for 12/4/14 at the Cleveland Clinic with Dr. Gosta Pettersson. Preop testing will begin on 12/1 so I will stay in Cleveland until I can go home. I am advised to be prepared for a 12 - 13 day stay in OH... 3 days for preop, 5-6 days in hospital and 2-3 days nearby.