Science and Medicine

The day after surgery while still in the CVICU, I got a visit from the top surgeon, Dr. McCarthy. This guy is a rock star at Northwestern, incredible credentials, international reputation. The university hired him away from Cleveland Clinic to head their heart institute. So, even as a patient I don't get much of his time: he only stayed for a minute or two. Fortunately it was during one of the better parts of that day for me so I was able to understand what he said and ask a few questions.

During surgery they both repaired my aorta and replaced my aortic valve. The first gave the urgency to the whole project, so it was no surprise. But the second was McCarthy's call once he got in there and saw what he had to deal with.

My gimpy aortic valve had been the source of a heart "murmer" for decades and the assumption for years was that it would need to be replaced eventually. Before surgery, McCarthy held out hope that it might be repaired rather than replaced. When he looked at it in surgery, he found a tricuspid (three-leaf) valve rather than a bicuspid (two-leaf) valve that is often the source of aortic regurgitation (the technical name for my murmer). A tricuspid valve offered the possibility of repair, but alas he said that one of the leaves was misshapen and smaller than the other two. Given that, he decided to go for replacement.

Thus I'm now the proud owner of an Edwards bovine-synthetic aortic replacement valve. Part cow (moo!), part high-tech polymers. So now between the Dacron aorta and the high-tech valve, I now have about 1/16 of an artificial heart.

McCarthy's only other comment about the surgery itself was that the aortic wall was "very thin." In other words, we caught it just in time and it is a good thing I didn't vacation in Hawaii instead of having the surgery. Good to know.

I was curious about some surgical details that might relate to long-term outcomes and when McCarthy visited, I had my first chance to ask. My first question was time on the heart-lung machine. He said I was connected for 88 minutes, just less than the 90 minutes that he had predicted. Second: how many units of blood had I been transfused with? Surprisingly, none. I guess they collect and recycle your blood during surgery these days. Pretty wild.

Other than these details, Dr. McCarthy simply reassured me that everything had gone very well. And then he was gone.

* * * * *

Removal of the breathing tube (see previous post) on Tuesday night set a pattern that would continue for the next four days as various catheters, probes, monitors and infusion ports would be removed from my body in preparation for discharge. In total, I can remember 10 such items:

- Left wrist IV

- Right wrist arterial line

- Neck catheter (arterial)

- Swan (arterial monitor of heart function inserted in the neck catheter)

- Urine catheter

- Major chest fluids drain (connected to a large collection vessel that was kept under the bed)

- Minor chest fluids drain (connected to a plastic bulb)

- Pacemaker wires (directly touching heart), and the pacemaker itself--the size of a box of rice!

- Incision painkiller infusion lines (two, very fine), attached to a portable infusion pump.

- Another IV in my left arm (they needed a bigger line for some test right before discharge)

I was also connected to a full set of EKG sensors with a radio-transmission box so that no matter where I went on the floor or in the hospital they could chart my every heartbeat.

Each item had a removal point on the recovery timeline but criteria had to be met before they could actually come out. The details aren't worth discussing, but the effects of all this hardware could be vexing and occasionally humorous. I felt like some half-finished Ragedy Andy doll with bits of stuffing, yarn and accessories clinging to me by threads.

My first morning after surgery, while still in the CVICU, they wanted me out of bed and sitting in a chair. I didn't much feel like it, but that was the program. Overall it turned out to be a pretty rough day. My blood pressure seemed to be swinging around--low at one point and high later--and that left my head spinning. As a result, I was pretty oblivious to my visitors, the nurses and most other activity in the room, which turns out to have been a good thing given other family events that day.

Fortunately, by the end of Wednesday--less than 24-hours after I regained consciousness from surgery, they had me stabilized and ready for transfer to the "step-down" unit--a regular ward floor. I was off to the next phase of recovery.