Larry Anderson
In 1984 I became a patient under the care of a Los Angeles cardiologist for a badly calcified, bicuspid aortic valve. I was fifty-one years old in the summer of 2002 when my valve finally started to fail and needed replacement. I began researching my options on the Internet and quickly learned about "minimally invasive" surgery. The advantages of this procedure seemed obvious and I decided this was the route I wanted to take. Through my research, it was evident that there were three facilities in the U.S. that ranked as the "cream of the crop" for such a procedure. However, I also learned that the term minimally invasive encompassed a number of fundamentally different approaches (more on this later).
I informed my cardiologist of my research and the choices I was considering, but he was very traditional in his approach and, not surprisingly, had quite a different view. In his opinion, such a narrow incision provided too little exposure to the heart and would "tie the hands" of the surgeon. To him, it seemed unnecessarily risky. He also thought that there was no reason to make a cross-country journey to receive exceptional care and urged me to consult with a prominent heart surgeon in Los Angeles.
I acquiesced and, to my surprise, the surgeon he recommended did not share his concerns. However, although he'd performed thousands of conventional aortic valve replacements, he had only done a dozen or so of these procedures using minimally invasive techniques.
As a layperson, it is difficult to know how much weight to put on this "inexperience" factor. It was obviously easier and more cost-effective for me to do this in my own backyard than travel to the East Coast for several weeks. Nonetheless, I decided to assume any inconvenience and added expense to be in the most experienced hands possible for such a delicate and critical operation.
I contacted cardiac surgeons at the three prospective facilities and sent my medical information for evaluation. As hoped, it was unanimously affirmed that I was a suitable candidate for minimally invasive AVR. But which hospital and which minimally invasive surgical technique were right for me?
To aid in my decision, I arranged a four-day excursion to check out each facility and interview the trio of surgeons who were in the running. Most importantly, I wanted to clarify and evaluate the distinctly different minimally invasive approaches they employed:
- the "mini-sternotomy" (as performed at two of the facilities) where the heart is accessed by cutting through the sternum although to a lesser extent than a full sternotomy and
- the anterior thoracotomy - where the sternum remains intact and the procedure is performed through a three-inch incision between the ribs (the primary technique employed at NYU).
Of the three interviews, my visit to NYU was most satisfying and reassuring. Dr. Greg Ribakove was so engaging, confident and remarkably willing to address all my questions and provide any information I needed to make an informed decision (he spent two hours with me), that it pretty much cinched my decision. He addressed the pros and cons of both surgical techniques and, unlike the other surgeons I met with, having performed both personally, was able to speak from a point of view none of the other candidates had.
With my decision to have the surgery at NYU, I arrived at the hospital two days beforehand for my pre-op tests and to meet again briefly with Dr. Ribakove (mostly for a pep talk). All insurance matters were taken care of and I was briefed on what to expect each day of the recovery process in the hospital. By the time I left, I felt very much at ease and confident I had made the right decision.
The night before surgery the hospital provided a lovely hotel room nearby, and very early the next morning I reported to Patient Admissions. There, I was readied for surgery by a friendly staff of administrators and nurses. Clad in my surgical gown and hairnet, I was then escorted to the operating room where I was greeted by a smiling Dr. Ribakove and his outstanding surgical team. As I was being prepped on the table, they introduced themselves and gave me an assuring word that I was in the finest of hands.
The very next thing I knew I was in the recovery room, being greeted by my dear friends who had accompanied me and had waited anxiously in the visitors' lounge for nearly four hours. Immediately after surgery, Dr. Ribakove had fully briefed them and answered all of their questions as to results of the operation.
Over the next six days I was attended to by a superb and conscientious nursing staff and was visited regularly by Dr. Ribakove and other physicians on his cardiac team. Frankly, I'd be lying if I said that the recovery process was fun, but the compassionate care I received and the desire of the hospital staff to make it as easy and comfortable as possible was, and still is, much appreciated.
One week after surgery, I was released from the hospital a new person. On Ribakove's directive, I remained in New York another twelve days to ensure that there were no complications before returning home. The healing process with this type of procedure is typically much faster than with a full sternotomy. My friends and I often marveled, as we dined in Manhattan eateries and walked through Central Park and various museums, how incredible it was that only days earlier I was undergoing a "valve job" on some operating table.
It's been over a year now since the operation and I feel fantastic. I can safely say that since then I've become the West Coast's most vocal advocate of minimally invasive cardiac surgery. Whenever I'm in a situation where the conversation turns to cardiac care or I meet someone who is facing the ordeal of open-heart surgery, I can't help but jump in, show off my scar (what little there is), and enlighten him or her about this incredible procedure that might have otherwise been overlooked. I just thank my lucky stars I had the good sense to do some research on my own and seek out a number of professional opinions.
"My "heartfelt" thanks, Dr. Ribakove, for your passion, your grace, and your amazing talent."