The Perfect Valve Job: Reflections on Open Heart Surgery

As I write this, I am eight weeks post-surgery. I’m still taking a lot of meds, but not the kind that prohibit me from operating heavy machinery. Or laptops. Since I can't quite handle full-time work just yet, I’ll take this opportunity to pass along a few nuggets of advice that you can apply to your next rebuilding project, be it automotive, or something more … personal. So here we go … five key components to a successful outcome. Are you ready?

Diagnose the Problem. Many engine problems are betrayed by noxious odors, external leaks, or odd vibrations. Unfortunately, those are often late-stage evidence of an expensive issue. If you want to catch a problem early and avoid unnecessary damage, you have to look for symptoms that are far more subtle. You need to develop the discipline of following a preventative maintenance plan. Let’s use the analogy of the annual physical, and one of the simplest procedures – use of a stethoscope to listen to the heart. Sure, you could skip the annual physical, why not, you’re busy! Or … you could see the doc and find out that you have something called a “heart murmur”. That’s interesting … now what do you do? Just live with it? Or do you take the next step and determine the root cause? You’ll need more sophisticated tools, like an echocardiogram, but the benefit is now you discover … oh my! … you have a congenital birth defect! A defective aortic valve, which is finally leaking sufficiently to be detected by a stethoscope. And … bonus … you also discover an aortic aneurysm!! Whoa … that’s a ticking time bomb … aren’t you glad you took care of that routine maintenance?!?!

Create a Plan. It’s usually best to repair problems as quickly as possible. But it’s never good to rush into a repair job without a plan. Once you’ve collected your data, review your options. Maybe your air filter is a little dirty … but the pressure drop is still well within acceptable limits. Or perhaps, yes, you do have an aneurysm … a weakened and enlarged blood vessel … but the enlargement is within safe parameters. Do you rush ahead with surgery? Actually … no. You create a plan. The plan says “no heavy lifting, take these meds daily, and repeat the echocardiogram every year”. Year after year. For ten years. Until finally the data says, “um, the valve is leaking more, the left ventricle is starting to enlarge, and the aneurysm … ain’t getting any smaller”. This is a heart that needs an intervention. Check the calendar, schedule the surgery.

Quality Parts. Are you going to throw an inexpensive, white-box, potentially counterfeit fuel injector into a $10,000 13L diesel engine without doing a little research first? Probably not. Take your time, check out the facts. Yes, a mechanical heart valve is a good option in “younger” patients, because the valves never wear out. Tissue valves on the other hand might only have a 15-year life before replacement is required. Are you 80+ years old? Go for the tissue valve. Are you in your mid-fifties? Mechanical, baby! Or not ... did we forget to mention the blood thinner you’ll need to take every day? Are you going to be comfortable with that? A lot of things can happen down the road that make blood thinners unattractive. Think it through … perhaps you’ll want the “Medtronic Freestyle Aortic Root” (i.e., “pig valve”) after all. And when you’re 75 and need it replaced, they won’t have to open your chest again; they’ll just open up your femoral artery, and slide a new valve right inside the old one. Slick, huh?

Expert Team. Remember when you could stand inside an engine compartment and work on everything yourself? Those days are (mostly) gone. Complex systems require expert technicians. But you get to choose the specialist, and that is very, very important. In heart surgery, that team includes a cardiologist, a cardiac surgeon, a cardiac rehab provider, your local pharmacist, and the staff that supports each one of them. Choose wisely! Reputations are earned through hard work, and outcomes are publicly available. Do your research! Keep in mind, a facility with a high volume of patients probably follows a disciplined, repeatable process. Unless your diagnosis is highly unusual, you probably don’t want to go to the research hospital at the local university. Personally, I was very satisfied with the services of Eastside Cardiology in Kirkland, and the surgical care provided by Swedish Cardiac Surgery in Seattle. Oh, and a shout-out to the boys at Bellevue Station #2 that responded to 911 calls (twice) and the care I received in the ER at Evergreen Hospital on Easter Sunday. Amazing people.

Support Network. Service providers are awesome, but they are not the same as a support network. Service providers are there to fulfill a contract and provide expertise; your supporters are there with a totally different mission in mind. They want to see you happy and whole, thriving and fulfilled. They are looking for more than project completion … they are prepared to make sacrifices so that you can prosper.

These are the people who love and care for you, who offer their prayers and drop off flowers. A quick text, a card, a phone call or a visit … they find a way to let you know that you’re still connected to them and a part of their life. And if you are blessed with family members that will link their arm inside of yours and walk alongside you on the path to recovery, you know the greatest support network of all.

I don’t know the state of your support network … but if you’re reading this, I want you to count on me to be in your corner, no matter what kind of project – or procedure – you are facing. As for me, I have been richly blessed these past two months by the extensive support and affection of family, friends, and colleagues. My support network came through big time, and I am forever in debt to them.


Eight weeks out, I’m ready to say that my procedure was a success. Sure, full recovery will require another thirty days … or ten months, depending on your definition. Hopefully you can take my rudimentary keys for success, combine them with the right YouTube videos, and create your own successful outcome. Let me know so I can be praying. Cheers!!            - John

PS … for the nerds:

“Bicuspid aortic valves and ascending aortic aneurysms often occur in the same person. At one time it was thought that stress on the aortic wall from the abnormal blood flow through the bicuspid valve damaged the aorta, causing it to enlarge. However, in some people the bicuspid aortic valve has been replaced and an aortic aneurysm still developed years later, even though the aorta was no longer subject to the abnormal blood flow pattern. It has been found that the aortic tissue itself may be weak. This weakness is due to connective tissue degeneration in the wall of the aorta, making it prone to aneurysm formation.”  (www.cedars-sinai.edu)

In case you’re wondering, a bicuspid aortic valve is a birth defect that occurs in 1-2% of the population. An accompanying aneurysm happens maybe 20-25% of the time. We’ve been aware of my condition for over ten years. The plan is to have my valve and aneurysm replaced with an “aortic root bio-prosthesis”. It’s tissue (from a pig), not a mechanical valve. Tissue valves aren’t expected to last forever, but I won’t have to go on blood thinners, and replacement, if necessary, should not require a repeat of open-heart surgery. Recovery is mainly the process of allowing the sternum to knit itself back together while being weaned off pain-killers, not, as some have suggested, watching every minute of the NCAA Tournament. (JA)

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    Its difficult to stay positive during such hard times. I appreciate you for being so strong and your message in the post is surely inspiring the future generation.
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    Response: www.rxrefill.ca/
    Numerous motor issues are double-crossed by poisonous smells, outside breaks, or odd vibrations. Sadly, those are frequently late organize confirmation of a costly issue.

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