The first time I had open heart surgery.
There was little time to waste.
May, 1998
“What now?” I asked. Dr. Stanley, my new cardiologist, who I had just met today answered, “You have what appears to be a congenitally fused aortic valve which is no longer working. You need to go to the hospital- now.”
The first cardiologist who saw me at St. Francis Hospital in Roslyn, New York, was Dr. Maffiotti. He was perhaps, the gentlest man I had ever met — certainly the most gentle doctor I had ever met. My wife, Shelley, would tell me how amazed she was at how focused Dr. Maffiotti was as he listened to my heart, actually resting his head on my chest to listen. He would need to perform an angiogram, he told us, which is a diagnostic test that uses fluoroscopy (x-ray) imaging to take pictures of your blood vessels. I was mildly sedated as I tried to see what Dr. Maffiotti was seeing on the screen. “There are no significant blockages,” he continued, “ You have collateral vessels which are compensating for some minor blockages and so you will not require coronary artery bypass, just a valve replacement.”
My heart surgeon, Dr. Carson, was a very tall, handsome guy, with a serious demeanor. The thing I will never forget though, was something I still find unsettling. As I sat nervously in my hospital bed, he brought over a large book with pictures of all the different replacement valves he could use to replace my now useless aortic valve. This was 1998, the year Google was first introduced to the world, before most people used the internet to inform their decisions on medical treatment. “Which one would you want if you were in my position,” I asked. “Well, the first consideration is whether you want a mechanical valve (a valve made of titanium or carbon) or a bioprosthetic valve (a valve created from the tissue of animal donors),” Dr. Carson said. “What’s the difference?” I asked. The decision made regarding the class of replacement valve was particularly significant for me. The mechanical valve will likely last a lifetime. Does that suggest that these are better for younger people like me?? A mechanical valve will usually last for the rest of the person’s life while the tissue valve has a “shelf life” of about 10 years. This seemed like a “no-brainer”. However, blood clots are more likely to form on the hinges of mechanical valves and prevent the valve from working properly. That can be an imminently life-threatening situation as those clots may break off and travel through the bloodstream. If a clot blocks an artery to the brain, that causes a stroke. As a result, nearly all people who get mechanical heart valves must take warfarin (Coumadin), an anti-clotting medication for the rest of their lives. Warfarin increases the risk of bleeding, which can show up as bleeding from the nose, gums, or minor injuries. Bioprosthetic valves, on the other hand, do not require the patient to take blood-thinners. “Strokes? Excessive bleeding?” I asked myself. “I’m forty-two years old with two small boys and practicing restorative dentistry!” I thought. Besides wanting my brain to stay intact (who wouldn’t), dentists nick themselves all the time in the laboratory as they use rotary instruments to carve temporary crowns and cut wax for denture trays. “I can’t be darting out of the office to the emergency room every time I sustain a little cut,” I wrestled in my mind, now understanding that someday down the road I would need to go through the surgery again. As far as the particular brand of tissue valve, I asked Dr. Carson to make the choice.
In recent years, there’s been a trend toward using tissue valves in people at younger ages with the theory being that by the time those people need a second valve, it can be replaced using a minimally invasive procedure. But in 1998, a mid-chest or median sternotomy (splitting the breastbone) was the “state-of -the art” for all valve replacements.
There was little time to waste and I was headed for my first open-heart surgery. For the first time, I realized that my life could end at any time- — at this time. “Take care of Mom while I’m away,” I told my ten year-old son Matt, as I looked gently at his worried face. “Your the man of the house until I get back —okay?” I told him, smiling as best I could, working to hold back the tears. “A young dad at forty-two years old shouldn’t be in this position,” I whispered to myself. Yet here I was.
