Atlanta, Heart Valve Surgery

Mom has been feeling more and more lethargic and short of breath over the past 6 weeks. This is due to the heart-valve calcification condition she was diagnosed with several years ago. The prognosis was that the condition would continue to get worse over time, leading to congestive heart failure where breathing simply becomes more and more difficult until total heart failure.

Up to 6 weeks or so ago, the situation has been getting slowly worse, but not to a point where life was very seriously curtailed. In the past 6 weeks, however, the situation has become precipitously worse. It has gotten uncomfortable enough for her that when mom heard about a heart-valve replacement study at Emory hospital in Atlanta, Georgia that involved using a catheter to do the replacement rather than full blown open heart surgery, she decided to go for it. So she and Julie packed the car and they drove up to Atlanta.

I spoke to my boss about taking time off to go to Atlanta, and he agreed. I spent as much of the weekend as I could with Pam, and then drove down to Atlanta Sunday to meet Julie and Mom at the Emory Conference Hotel about 3 blocks from the hospital.

We all three spent the night in the hotel, Julie and I had a pleasant dinner outside the hotel restaurant, and in the morning went to the hospital.

Plan was to get some tests to evaulate if she was a good candidate for the Study's catheter-from-groin surgery. Turned out she was not. Calcium buildup in her aortic arteries in her groin was too excessive and the arteries were too small to support the size catheter needed for the replacement procedure.

This was disappointing, and we had to evaluate what next to do. There were three options offered: (1) valvoplasty - temporary (4 to 6 months) fix using a balloon inflation to clear the valve of calcium buildup; (2) full open heart surgery; (3) Trans-Apical procedure - enter through lower ribs with catheter tool.

Because option (3) was also part of the study and not FDA approved, the choice between options 2 and 3 had to be randomized.

Long discussions and deliberations ensued. Chosen stragegy: If option (3) was selected, she'd do it. If option (2) was selected, then do option (1) and go home to think on what to do.

Doing the latter makes sense from a "don't rush foolhardy into something" perspective, but makes for rather an emotionally stressful decision process that needs to be made going forward.

As luck would have it, the randomization selected option (3), the TransApical procedure. Mom seemed somewhat relieved about this, as were we all. Now the sweat of decision making was basically resolved.

Numerous tests followed this afternoon to ascertain Mom's fitness level prior to surgery. It seems that other than the heart valve problem and the congestive heart failure that it brought on, her health was really quite good.

The various doctors on the surgical team, one by one, showed up for introductions and pre-surgical consultations. Questions and answers. Getting to know each other personally and get comfortable with the physicians involved.

Surgery is scheduled for Wednesday. She is the 2nd patient of the day, and they said she'd probably go in at around Noon time. Probably she'll get taken for 'prep' an hour or so before that.

I asked the cardiac surgeon (Dr. Babaliomos) various technical questions regarding the heartvalve and replacement procedure:
o) The new valve is bovine valve (bio-material).
o) The old valve is simply pushed out of the way.
o) The new valve is inside a stent. This is how the old valve is pushed out of the way. The stent is placed inside the old valve and then 'sprung' open, pushing the flaps of the old one to the edges.
o) The new valve is not sutured into place, but rather stays in place by heart-action/blood-flow pressure. The new valve is slightly larger than the aortic artery aperture. Pressure of blood flow holds it pressed against the aortic exit.
o) The stent/valve combo are compressed very small, placed inside the catheter tool, and fed through the incision on the lower chest, and to the heart.
o) The heart is not stopped for the valve insertion. Rather, it is "galloped" up to 200 or so beats per minute for 15 to 30 seconds. This results in 0 efficiency in pumping, therefore 0 blood flow, and therefore no pressure to get in the way of the insertion. Once in place, the heart resumes it's normal rate and blood flow/pressure take part in holding the valve where it belogs.


The anesthesiologist stopped by earlier this afternoon while Mom and I were away on a test, so we missed him. He left message that he'd stop by in the morning. I'd like to speak with him to specifically ask "how will they know that she isn't doped and unable to move but still conscious"? Usually these days they have some kind of monitor (brain activity monitor or something) to see the expected brain-wave pattern of unconsciousness.

I may not be in yet when the anesthesiologist shows up, so I'll tell Julie to ask about this in my stead if that's the case.



Tomorrow is a big day. Many people are offering prayers and well wishes.