Friday, February 10, 2017

Post Op, Part 3

Surviving cardiac surgery permits ongoing hair loss!

Today is the one-year anniversary of my aortic valve replacement surgery, and this is my third "post-op" instalment about that experience (part 1, part 2). I'm happy to say that I feel completely normal again. I'm glad to have so far avoided endocarditis (an infection on my prosthetic valve), the risk of which is highest in the first post operative year. Anticoagulation with warfarin has been going well, with my time in the therapeutic range hovering around 90%, and no significant bleeding or clotting complications so far. Hopefully, I'll achieve a personal best in the Calgary Run for Water this summer, training for which is already underway.

I'm also happy to answer the question I've been asking since I started wrestling with my diagnosis of aortic valve regurgitation: when is the best time to intervene and replace my valve, and did I miss it?

The jury's still out on the first part of that question, but a reasonable response to the second part is 'no'.

My heart has returned to completely normal size and function. Here are the most recent values:

LVESD: 30 mm (Normal = 25-40mm)
LVEDD: 46 mm (Normal = 42-58mm)
LVEF : 0.62 (Normal = 0.55-0.70)

It's amazing how well the heart can recover despite years of volume  and pressure overload. But the best time to operate is not just the time that maintains heart size and function; it's the one that maximizes survival. I don't think that we have good data on that outcome - perhaps the mother of all outcomes - but a recent study suggests that I might have been better off to operate sooner. Of course, that's just one observational study that didn't exist at the time, and so I still feel that, prospectively, at least, good decisions were made. Heck, even retrospectively, I still think the timing of my surgery was good since my pre-op ejection fraction (EF) was not below the cut-off value at which increased long term survival was diminished in that one study.

Hopefully, I'll beat the published odds, which indicate an average life expectancy of about 15 years after aortic valve replacement. There are a few good reasons to think that I might: (1) I am younger than most patients who've had this operation and who've generated the statistics, (2) I am  meticulous about my anticoagulation and dental hygiene, (3) I have ready access to excellent quality medical care, and (4) I recognize the importance of that care and the gravity of my situation.
Ok, so I have to skate with a goofy helmet now.

One more big hope: the cause of my valve regurgitation, non-infectious aortitis, will not return.

A big thank-you to all who supported me, including my colleagues, who smoothened my absence from the hospital and clinics, my in-laws, Mark and Diane, who looked after my kids while I was in Toronto, my friends Nick Lagopoulos, Tamara Kolber, and Candice Silversides, my parents, Hans and Mary, my sister, Carla, and her husband, John, and especially, my wife, Jan, who amazed me with her devotion to my well-being. As I look back upon the time of my surgery, I do so fondly not just because all went well, but mostly because of all of the love and care that I received. I feel like a pretty lucky guy.


  1. Warfarin is probably helping with the hair loss.

    1. Huh. Even in retirement, you're still teaching me medicine ...

  2. It's been great to see you doing so well. I don't think anyone can fault your decisions regarding valve type, timing, anticoag etc. You had a critical and thoughtful approach from the outset and your current health proves your good decisions.

    I suspect your post-surgery life expectancy will be a multiple of the average, not the average. We can drink a beer to "outliers" some time. :)

  3. I strongly beleive (indeed i use this verb on purpose) that you will beat the odds by the tender loving care your surrounded with (and off course because you have an academici degree and enough financial resources ;-))

    1. Wise words, as always. Surely some Belgian beer can't hurt either...

  4. My EF today was measured at 0.65 by cMRI!