The “Procedure”

Choices, research, Ross &……Thank You.  
To everyone who messaged, read the blog, commented or sent love.  It’s been really heart warming (pun intended) and I’ve been quite overwhelmed by it.  
My plan was to write for me; I never expected so many people to take interest.  My heartfelt(!) thanks for all the love and support.

*HEALTH WARNING* – This one, particularly the end describes the surgery in detail and is not for the squeamish; the rest is of course, hilarious.

My issue was diagnosed pre-internet. I therefore have had since Tim Berners Lee casually typed three Ws next to each other to scare myself silly googling “heart surgery”. Knowledge is power, but too much knowledge can make your pants smell. Thanks largely to the internet though (and Doctors) I do fully understand what’s going on under my bonnet.

My experience of hospitals is that you get choices.  These are presented to you, with a recommendation, and you either consent or not.  Normally, you pretend you understand and say ‘yes’, however, this is a biggee, so I wanted to understand and be involved in the decision.

In my last blog post, I said that my choices were between a shit option and a fucking shit option, but that’s not strictly true as there are actually four main options which I summarise the pros and cons of below.

Option 1 – do nothing – The doctors say don’t do this;
–  I feel OK & enjoy a good life.
– The whole NHS could be lying to me in some elaborate prank (I have genuinely thought this) and soon everyone is going to jump out with balloons and say it was all a joke.  I’m still waiting.
– If the condition worsens, I will have aortic insufficiency, potential heart failure from which time I get a life expectancy of about 5 years, the quality of which is ever-decreasing

Do something options
Option 2 – Aortic valve replacement – comes in two flavours:

(i) Biological – Cow or Pig valves are specially treated and inserted.
Pros – No anticoagulation medicine (Warfarin – aka commercial rat poison); you become part-animal.
Cons – They last 10 – 15 years max, meaning re-operation and another boring blog

(ii) Mechanical – Plastic / Metal valves
Pros – They last forever ever; you become part cyborg.
Cons – Rat poison for life (see above) / more likely to form clots / thromboembolism risk (bad)
 
Option 3 – Pulmonary Autograft – aka The Ross Procedure;

• Take your own pulmonary valve and replace the aortic valve with it.
• Add one valve of a dead person and replace the now missing pulmonary valve.
• The idea is that your own valve is best placed to deal with the high pressure business end of the heart.

Pros – No rat poison, in fact no drugs at all and good longer-term outcomes.
Cons – Single valve disease becomes double valve disease. Technically more difficult/dangerous.

• Can be done with or without fruit options – see below.

All options come with the bonus options of increased risk of stroke, reoperation, clotting, pulmonary thromboembolism & endocarditis. Joy. More on longer term outcomes and chances of life/death in a later post.
  
So back to discussing options with the hospital, I had done the research, read the journals and was fully prepared to meet the surgeon – a professor, no less.  He was slightly older than I expected, but his hands appeared steady, so I was happy.

He asked me about my condition (they always test my understanding before starting – it’s extremely annoying).  I said, what about option 3, and he said “Yes, I think the Ross Procedure would be an excellent choice for you.”  

Bam! Smashed it.  All that research paid off. But wait, he then says “you also want pears”.  

I was dumbstruck, in my months – nay years – of frenetic googling of heart surgery, I had found no reference to pears, apples or any other kind of fruit and I was certainly not hungry.  

The moments that followed were a blur as I was overtaken by my dear mother discussing her calcium cholesterol scores with my heart surgeon.

I was only prepared for shit options 2(i), 2 (ii) and 3, not 3 + fruit.   I was disheartened (sorry, last time I promise) and I couldn’t choose; my research had failed. I put off the decision in order to better consider how greengrocery was connected to cardiac surgery.  

But wait! There was to be a further curve ball in the form of a suggestion to see another surgeon – a lowly “Mr”, as opposed to the professor – as this other one was the most experienced in the fruit department.

PEARS it turns out is an acronym, “Personalised External Aortic Root Support”which sounds much more medical and is a 3D printed personal support structure for the aorta.  This is the semi-experimental bit. It’s placed around the new aortic valve to prevent it dilating, and the hope is to improve on the 15-20-year expected outcome. I will be the 19^th person in the UK and about 25 worldwide to have this specific implant, this makes me both nervous and excited.

My research led me to contact the inventor of PEARS, Tal, who created the graft for himself and convinced a surgeon to implant it, as he did not like his options for aortic root replacement – impressive.  This happened 15 years ago – a good start.

On the basis of a life without medication and the best long-term outcomes, I have gone with option three plus the fruit shop.  Initial indications for patients 1-18 are good, says Mr new surgeon.

So the order of operation events (may be slightly jumbled) is: 

1. CT scan to prepare PEARS implant – already done in October.
2. General Anaesthetic
3. Breast bone incision to access to heart
4. Clamp arteries and onto heart lung bypass machine – this breathes and pumps blood for the duration of the operation – (3hrs or so)
5. Stop heart (does this make you dead temporarily, I wonder?)
6. Remove diseased aortic valve – will they let me keep it or see it?  I want to see what all the fuss is caused by.
7. ‘Harvest’ pulmonary valve from my heart
8. Insert harvested valve into the aortic position
9. Insert human donor valve into pulmonary position
10. Insert 3D printed cyborg fruit graft
11. Restart heart with electricity – yikes
12. Close up
13. Catheter in and off to ICU to recover

Total is about 5-6 hours with 1-2 days in ICU after followed by 5 days recovery and then home for the harder task of getting well properly – 3/4 months off work, 12 back to full strength.

Ending on the positives –  I am buoyed by the fact that the new surgeon is an extensively skilled, world leading cardiothoracic surgeon who performs Ross operations on babies (he has steady hands – steady hands are important), and is teaching his methods worldwide. 

I get to sleep through the whole thing, but I feel terrible for those who must wait outside..

I am fortunate to be having this done privately at a world-class hospital in London Bridge.  I will wake up, part someone else, part cyborg & remainder me.  

I am blessed to have received an absolute whirlwind of support.

I think that’s enough for today.

Much love

Howard

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