The heart of the matter

Heart disease is nothing to play around with. So why does its treatment continue to be such a crapshoot?

In a story by the New York Times about the wrongful death of former astronaut Neil Armstrong, Dr. Michael Mack, a heart surgeon at Baylor Scott & White The Heart Hospital — Plano, Texas, said if he had to choose from among the roughly 40 hospitals that do open-heart surgery in the Dallas area, only six or seven would make the grade. “And I would pick the surgeon,” he added.

Why can’t hospitals be listed/ranked by cardiac capability and other capabilites as well? There should be tiers of capability and as soon as a patient is diagnosed then that patient is automatically directed to the correct facility.

My cardiologist is one of the top surgeons in his field. But because I was unaware of his existance, he wasn’t my first choice. That was nearly a fatal mistake. But how could I have known?

He’s one of the very few who can reopen native arteries rather than rely on bypasses, which have high failure rates, particularly when other surgeons performing those procedures are not up to the task.

I speak from experience.

I underwent in October 2018 a triple bypass and a procedure to repair an aneurism in my aorta. I had an extended stay in the ICU after having a seizure in the recovery room. We were never told the cause. When I saw my first cardiologist for my follow-up he sort of shrugged and said, “Who knows? You could have had a heart attack. What does it matter? You’re fine now. And we couldn’t have gone back in, you wouldn’t have survived it.”

I was thinking, yeah, but by retracing your steps, maybe you could discover an error and avoid it next time, or require some tests now to determine it. My guess is that the seizure was caused by one of the bypasses failing — within an hour of me being sewn back up. Do I know that? No. I am left to guess. But it’s a strong guess because 14 months later the other bypass failed. A few days after, when I was put on a treadmill for a stress test, I didn’t last 20 seconds. I used to run marathons. I was working 10-hour days in 100+degree heat as a landscaper. My stamina level now was frightening.

So I went back to the hospital. The young surgeon there was to put stents into the bypasses. After 90 minutes on the table they wheeled me back after an unsuccessful attempt with the surgeon talking about making a serious decision regarding cutting my chest open again.

I sought a second opinion and another surgeon there assured me he could perform the operation. His tone and body language suggested I should have been assigned to him in the first place. I came in more optimistic. Another 90 minutes on the table, another unsuccessful outome. Neither surgeon could insert a catheter into the bypassed vein. As I was in the recovery room, I was left to think that I was out of options.

After being pressed, he referred me to a surgeon at a diffferent hospital. Thank goodness. Bright and confident this new surgeon assured me he could do the job. I told him I had heard that twice before. He was incensed that a hospital would be practicing trial and error on a heart patient. He asked why we went to the nearest hospital. He said he couldn’t understand the reasoning behind why people do that.

I told him that after I experienced symptoms I went to the cardioligist I could see the soonest who was covered under my plan. He was linked to a cardiac team at the hospital that was also covered under my plan and happened to be 5 miles away.

He cited a variety of reasons why my bypasses may have failed. The grafts might have been handled too much, the stitching may have caused a clot. All his reasons pointed to surgical error. He didn’t say they weren’t.

He planned to use me as a model while streaming the procedure to open my native arteries to a class of surgeons gathered to learn how do perform the operation. He wanted them to hear my story and how unacceptable it was for such a practice to be just that, hospital practice. He said that, by the way, the two surgeons who had failed me were to be among those in the class.

The day of my procedure with him came, March 20, 2020, but Covid was in full swing and the gathering of surgeons had been canceled. My procedure, however, was allowed and was a success, as was the next one in June. The failed bypasses were cinched off and my native arteries reopened with stents. A recent CT scan indicated they are working fine.

But in between time I developed stenosis in my aortic valve. The valve that allows blood flow from my heart to the rest of my body was down from four centimeters to one centimeter. Also in between time, my surgeon had disappeared without allowing his hospital to leave any word of where or why he’d gone. He resurfaced at a clinic and hospital about 45 minutes away. And he’ll be performing my TAVR procedure in October.

I was looking up reviews of his work, and aside from being glowing, with countless expressions of gratitude for his life-saving work, there were entries where other surgeons at other hospitals told their patients to go home and get their things in order. And my surgeon, who is now also my cardiologist, got these patients through.

Which obviously leads to the conclusion that heart patients are dying simply because they went to the wrong place! How can such a thing be allowed? It could have happened to me. And it wasn’t an emergency situation where a heart attack victim was brought it with no time to lose. These were procedures planned in advance.

I’ve found that the inequity in quality of service at our hospitals is alarming. And that leads me to ask why aren’t hospitals and, at least their cardiac care teams, prescribed to perform certain procedures at certain levels of their expertise and that’s all. If a patient comes to a cardioligist and the required procedure is beyond that team’s capability, the patient then goes to the correct facility — one with a team that can perform the procedure and restore and prolong a healthy life and never put a patient (not me, thank goodness) through the shock of being told wrongly to go home and put your affairs in order or worse, die under less-capable hands.

I’m one of the lucky ones alive and able to tell about it, and I hope to do so more fully when my own four-year journey through this heart disease medical-care catacomb is finished. Let’s get through October first.