Aortic Valve Replacement

My most recent heart operation was to replace my aortic valve with a St Jude Medical 21mm bileaflet artificial valve. This procedure was a long-time coming and finally had to be done when I was 16. On 14.06.2007 I underwent an (approx.) eight hour operation, sawing open my ribs, replacing the valve and closing me up again, all while I was being kept alive with a Cardiopulmonary bypass (CPB).

The day before my planned operation, my mum drove me to hospital, getting a speeding ticket in the process, for the routine check-up and to give some blood in case it may be needed the following day. I was not scared, it all felt familiar, after all it was my second invasive heart surgery and I’d had an aortic valvoplasty just 22 months prior. For me, there was somehow the comforting feeling of ‘Ahhhh, this again’, a very strange feeling now when I look back at it.

The small ring in my heart is an artificial St Jude Medical valve 21mm in the aortic position in an x-ray.

Prep Room
The only thing that put me on edge was a value I heard while they were checking the difference in pressure on either side of the valve, also known as the gradient. I knew that all three prior procedures were done when I had a gradient equal or less than 90, as it was too high. I always assumed that it was a percentage measurement, so I was definitely startled when I heard my gradient was 101, but I knew the operation was the next day, so I was in the best of hands.

Being first in the queue, my bed was rolled to the operating rooms where I was greeted by several friendly prep assistants and anaesthetists. I manoeuvred myself onto the operating table trying not to show my bum in the loosely tied back-free hospital gown. Still feeling calm, I noticed that they weren’t used to people taking an interest in them and making jokes in what could literally have been my death bed. They had finished their pre-sleep preparations and told me to count backwards from ten in my head as they inserted a fluid into my veins. ‘Ten, nine, eight, seven, six, fi.., f…, …’

Waking up
‘Voices, voices, who is that?’ I thought. First thing I remember were voices as I came to. I could hear my mother talking to a nurse although I have no recollection about what. I tried opening my eyes. I failed. I tried again and slowly, slowly I could see light seeping through my eye lids. My vision was a bit blurry, but I could clearly make out why I had a strange feeling in my throat. That feeling was a big intubation tube that had obviously been forced into my windpipe and was breathing for me. Disgruntled that I couldn’t swallow, I passed out again due to the strain my body had been through.

I have no memory of whether or not I was awake when the doctors took out the tube, I was definitely still in a very weak state. With my eyes closed, I heard voices again, the same as before. My throat was parched and sore. It was too tiring to keep my eyes open for long and no one saw that I was awake. I couldn’t speak. I slowly moved my hand on the bed by my side and made a slight noise to grab my mum’s attention. My mum came towards me and asked how I was feeling.

Bubbles bubbles
Luckily, due to my grandparents being deaf, I could communicate with her in broken sign language. I don’t mean the thumbs up to the previous question, but more the sign for ‘drink’ that signalled to her that I REALLY wanted some water. I was still so tired that every movement felt like I had lead weights attached to each muscle. The water was poured, but I fell asleep after being told to wait before drinking it. Even in hospitals, Germans decide that water WITH bubbles is the way to go, which is NOT the way to go for any patient that has been through anything similar to what I had.

I coughed from the bubbles and it was painful, more pain than anyone could imagine. My ribs were literally detaching themselves from their counterpart. Later in the evening I woke up and got in my head. Still heavily under the influence of whatever they had been pumping in me, I started to stress out that I was not sleeping. My heart needed rest, but I was having a panic attack. After that incident and my neighbour punching a nurse, things calmed down (stay tuned). The next few days were promising, medicines were reduced and I was put on weaker pain killers; synthetic morphine known as Dipidolor.

No pain no gain
I was out of intensive care and in a room on my own for the start. The numbing chest pain I was going through was intoxicating and I hated being ‘encouraged’ to get up and walk around by the doctors. It hurt but it was important to help recover what physical strength I still had. Now I had this hallucinogenic painkiller at the touch of a button. It was set to inject me with 30 minute intervals if I had pain and pressed accordingly. They took me off it two days later as they thought I was abusing it, but I was consciously just trying to fight the pain. Maybe on a subconscious level it was addicting.

They said I was pressing it nearly 10 times an hour and here the result. **I was a ninja turtle thief, breaking into a rich man’s house, I climbed through the window at night and was snooping around looking for valuables. I jumped over the couch in a ninja fashion. But wait… There was someone on the other couch. I waited. The world I was in transformed.** It was a bed and I too was on a bed. A hospital bed. My head was at the opposite end. I tried to move back but the pain was excruciating. Luckily, the button to call the nurse for assistance was near and they helped me spin myself around, a feat I could not have accomplished alone.

Out and About
The recovery was a long process. I had to wear a chest brace, practically a very long flat-chested bra. I was skinny and weak and pale. It was tiring to walk around but I pushed myself as sitting around wouldn’t help. My chest was sutured together with dissolvable stitches from the inside, but the small ends still needed to be pulled. Just a small prick. I left the hospital with two daily medications that i will need the rest of my life, Ramipril (to lower my blood pressure) and Marcumar (to stop my blood clotting). A decision on the dosage on the second pill, had a BIG impact on my life. (more on that later)

For quite some time I had trouble sleeping and it wasn’t from the pain. It was because of my ticking heart. For weeks… even months I couldn’t stand the ticking clock inside me. It would bug me every night until at some point I just got used to it. And it will be with me the rest of my life, this or its replacement (expected 2035).

Sebastian