The Plan

The next step after finding out you need surgery is to meet with your surgeon. The purpose of this meeting is to talk about what will be done and of course when the surgery will take place. As it stood I was going to need bypass surgery, the valve may or may not be taken care of and there didn't seem to be a great urgency as long as it happened within the next 2 months.

I'm very fortunate to live in a city that has a heart specialization institute like the OHI. That means that the place is jammed packed with heart specialists, researchers, high-end nurses an rehabilitation specialists. Little did I know that the surgeon recommended by my cardiologist was "da Man" when it comes to valves, and heart surgery in general. Our meeting with the doctor was scheduled for late January.

I didn't know much about the surgeon except that he was a valve specialist. As it turns out the guy was the chief of surgery at the OHI and very reputable in valves. As I mentioned earlier the bypass part of the surgery was a given, but the way we were going to deal with valve hadn't been decided yet. For valve treatment there are 3 options: (1) a prosthetic valve, which is completely mechanical and has a life span of 10 to 25 years; (2) a tissue valve, which is made for pig tissue and has a life span of 5 to 15 years; and (3) a transplant valve, which comes from cadaver. The 3rd option is pretty rare given the requirement of a good match and timing of a donor. The doctor explained that the ecocardiogram, the CT and the angiogram indicated that there was significant valve calcification and malformation. He recommended that we deal with the valve at the same time as the bypass.

As each option was explained to me, the big difference comes down to quality of life after the operation. A mechanical valve has a long lifespan and is typically the default choice for people my age however there is a requirement to use blood thinners for the rest of your life. In short, if you're on blood thinners there is a requirement to visit a blood clinic bi-weekly for testing and adjustment of the medication formula as well any time you get hurt (cut or bruise) you may have to go to the hospital to get the bleeding to stop. The tissue valve has a shorter lifespan, but life goes on normally. For me the choice was simple; I lead a pretty active life that includes travel and lots of wilderness activity. The idea of being super careful about cuts and bruises as well as going to a clinic for tests every two weeks was not so popular. I talked it over with M. and tissue valve was the decision. The only drawback with the tissue valve is that with current technology I would be going in for more surgery in 5 to 15 years to change the valve again. I felt that was acceptable especially with some of the improvements being made in heart surgery where they no longer open the chest and some advancements contemplating working on beating hearts. To me, at 37 years old, I wanted to continue living a regular life.

The last big item was the date of the operation. Personally, I was ready for any time, but as it turned out the surgeon was a pretty busy guy and we scheduled the surgery date for March 5. This ended up being ideal for me because it would give me the time to inform people, transition the management of the business over to the team, get my life together and rest a bit before operation.

An interesting sub note is the doctor mentioned, almost in passing, "we'll really only know for sure what we're going to do when we get in there". I figured it was just one of those CYA things doctors say in case its worse than expected.