...but it was NOT smooth sailing.

My wife and I drove up Sunday night and got a hotel near the hospital as I had to check-in at 5:30am Monday morning and it's a 49 mile drive (one-way) from Orange County across down-town LA to West Hollywood where the Cedars-Sinai Hospital is located.

We got checked-in on time and I was scheduled for a 7:30am time slot, the first TAVR (Transcatheter Aortic Valve Replacement) procedure of the day. I had no problems in the pre-op and they got me into the cath-lab and everything was running on schedule but when they cut into the groin to insert the cardiac catheter, which would be used to guide the valve into place, the femoral artery 'dissected', which means that one of the layers that makes up the wall of the artery started to tear. Now this is not an unusual situation (occurs in something like 10%-15% of cases) and they were prepared to handle it but it did require that they do a 'balloon-angioplasty' to seal up the tear and to immediately administer blood-thinners to make sure that no clots were formed with could have caused a stroke or some other problems. Now doing this had no real impact on the TAVR procedure itself since, except for the cutting into the femoral artery, there are no other incisions or cutting so the risk of excessive bleeding is generally not a problem, EXCEPT IN ONE SITUATION.

Remember when I said I might only be kept in the hospital for one night, well that option went out the door in a hurry.

What happened is something that happens in these valve replacement procedures, whether it's done by open-heart or the leaser-invasive TAVR method. The electrical circuit that controls the beating of your heart, what they call the 'pacer', has two redundant circuits to the heart, a Left and a Right. Now the Right-hand circuit is not really the critical one, in fact many people are born with only the Left circuit working and the Right one doing virtually nothing and it's not a big deal, as the Left circuit is the critical one. The problem is that the Left circuit runs right next to the Aortic valve, the one which was being replaced, and in approximately 25% of the cases, while installing the new Aortic valve (by open-heart or TAVR method) this nerve bundle becomes 'blocked' meaning that it's no longer able to send a signal to the heart. Now we were warned that this could occur when they discussed the risk-factors of the procedure a couple of weeks ago. In fact, as part of the procedure, even if everything went perfect, they still first hook-up a temporary external pacemaker to the heart to control it while the procedure is being done and to be there in case this critical nerve gets 'blocked'. And if this occurs, they immediately insert a permanent internal pacemaker in your chest as part of the overall procedure and you're good to go, and again we were told all about these possibles before hand.

Well, as you can guess, they 'blocked' that pacer nerve BUT since they had just shot me full of blood-thinner they couldn't start to cut holes in my chest to embed the permanent pacemaker, not without risking a major bleeding event, so what they do is they leave the temporary external pacemaker hooked-up (they simply taped it to my neck where they had inserted the electrical leads to my heart via the carotid artery) and then schedule implanting the pacemaker for the next day, Tuesday, which means that the earliest I could come home would be Wednesday, which is what they said it would normally be anyway. However, the schedule for Tuesday was so full that they had to move this to Wednesday, so now we weren't coming home until Thursday. My wife extended her hotel reservation another day and I was now scheduled for the implantation surgery for 5:00pm Wednesday.

So I had to go all day without any food and only enough water to take my daily medications. But when we got to the pre-op they were running behind and it wasn't until nearly 7:00pm before they got started.

Well everything seemed to be OK, the temporary external pacemaker was gone, I had a big scar on my chest just below the Left collarbone and we were told that everything looked good and that I would be going home on Thursday.

So my wife gets-up in the morning, checks-out of the hotel but when she gets to the hospital my room, it was EMPTY.

What happened is that at around 6:30am, right after they had done my daily EKG to check the new heart valve and now the pacemaker, I had to go to the toilet and since I had already been up and walking around for two days, they let me use the commode in my bathroom. However, when I sat down I grabbed the sink with my left-hand to help steady myself and as I sat down it caused one of the two leads to my heart to come loose and I almost passed out as my heart-rate suddenly dropped, but it was only for a second or two and I was on the room monitors the whole time. Anyway, this happened three times in about 10 minutes so they called the pacemaker team in, took some more X-rays and decided that one of the leads didn't have enough 'slake' in the wire so that it wouldn't get pulled-loose, so they decided to schedule another session in the cath-lab to re-position the leads. So they got a gurney to move me back to pre-op and had just disconnected me from the room monitors and while I was moving from my bed but before they hooked me up to the portable monitor attached to the gurney, I had another 'attack', only this one lasted a lot longer. I almost blacked-out and was lucky that I was caught by my nurse and the people who were there to transport me to pre-op so I never actually hit the floor but for a moment there I thought I was dying. Before they got me stabilized they say that I went for about 12 seconds where my heart was not beating sufficiently to sustain life. In fact, my nurse, who everyone said was one of the best in the hospital, immediately started slapping me on the back with all her strength to try and keep my heart beating (she couldn't hit me on the chest since I had that big fresh incision where they had implanted the pacemaker). Anyway, they got me on the gurney and the pacemaker started to work again but now it was a very fast trip directly to the cath-lab where the surgical team was waiting. Flying out of the room, going down the halls of the hospital, into an elevator, up one floor and then into the OR was like out of a movie, with people yelling to get out of our way and literally pushing the gurney as fast as they could run. I was awake for all of this but under a lot of distress and I have to admit, I was praying like I had never done before in my life.

They got me onto the OR table, started me on oxygen and knocked me out. This was around 9:00am, just about the time that my wife was walking back into the hospital and of course, by the time she got up to my room I was no where to be found. They explained what was happening and rushed her down to the OR but all she could do was wait in the family lounge until about 11:00am when I went to recovery, for the THIRD time in four days.

Of course, this meant that I was NOT going home on Thursday. My wife decided to stay in my room for the night and they set-up a cot for her. Anyway, I was feeling pretty good and had a good night and after talking to all of my doctors, either Thursday afternoon/evening, or in the morning (Friday), having another EKG and X-ray, they decided that they had gotten it right this time so they discharged me about 2:00pm.

Thank God I didn't have the procedure earlier in the day on Wednesday as they said that I might have been sent home that evening. If this 'lead' had come loose while at home or when driving those 49 miles back to Orange County, I probably would not have survived.

Anyway, we're finally home now and things are looking much better. So now I have to be careful for the next 6 weeks, not raising my left arm above my heart or pulling on anything, I'll be fine. In fact, the doctor said that after 6 weeks you couldn't pull those leads out if you tried as by then they would have been fully locked into the heart muscle.

Now I have to see my regular cardiologist next week, and in 30 days and 90 days, go back up to Cedars-Sinai for follow-up visits and to have my pacemaker 'tuned'. It's amazing since they do it using a wireless link in the office. In fact, I'll be getting a monitor that I place next to my bed and at night it downloads the days data about what was happening and then 'phones' it to my cardiologist in the middle of the night so that if there's any problems they can spot them before they get out of control. The unit is portable so I can take it with me when I travel and stay connected (this service, including the bedside unit, is all included in the cost of the pacemaker and is covered 100% by our Medicare Parts A and B and our supplemental).

I don't have to take any blood-thinners after about 30 days and then I'll just need to see my cardiologist every six months where a technician will be called in to link-up to the pacemaker and make adjustments to the program. Over time they can 'tune' it for maximum effectiveness. The battery is good for 10 years after which they'll simply open up the little pocket in my chest and replace the entire unit with whatever is the latest technology (the leads will never need to be replaced) and this is all done as an out-patient procedure.

Here's a short video (only about the first half needs to be watched) showing how the TVAR procedure is performed. Note that since this video was produced 18 months ago, the criteria for who can have the TAVR procedure has changed to where patients with even minor or intermediate-risk factors (which was my case) for open-heart surgery now can qualify for this procedure.

http://www.youtube.com/watch?v=JBuoz_kgdtY