Glenn Karpf
July 16, 1999

Glenn Karpf here, reporting from sunny California. It's day 2 at home and I thought I would sit down and provide more details regarding the aortic valve replacement (AVR) surgery I had on July 7.

Let me start by saying I feel GREAT. Except for some minor soreness around my sternum, there is no pain. I am not even on any painkillers right now.

Where to begin? I guess I should start with the fact that I had a homograft. During my initial consulutation with Dr. Vaughn Starnes (USC

Universtity Hospital, Los Angeles) he reccomended doing a freehand method homograft which would leave my aortic root and coronary arteries unmolested. At the time he did not specify why he wasn't reccomending an RP except to say that, in his experience, there was too high a resurgery rate (4%) and that he was being a little more selective on who he advised RPs for. He did not like ending up with a "2 valve problem" on his hands if the RP went wrong. His words kind of threw me for a loop given that I thought I was the ideal candidate for an RP based upon my age, health, etc. Instead of getting more details as to why he felt I wasn't an ideal candidate, I spent a lot of time asking questions about the homograft. I have since learned that he didn't recommend an RP because he could already tell my aortic root and aorta were dilated and it was unlikely that that my pulmonic valve would fit. In any event, I went with his recommendation for the homograft. After all, when the guy who has probably done the most RPs on the West Coast (over 140) says he doesn't think its a good idea, what am I going to do, argue? (Note: I had also consulted with Dr. Hillel Laks of UCLA prior to seeing Dr. Starnes. Dr. Laks also felt an RP was not for me.)

So onto surgery day. Date: 7/7/99 Time: 5:00 a.m. (What, what, what!?) Place: USC University Hospital, Los Angeles CA State of Mind: Amazingly relaxed. I even managed to sleep 4 hours the night before. Age: 33 Height: 6' 1" Weight: 176 lbs Entourage: My Mom, Dad, Brother, Girlfriend, Stepmom

As soon as I enterted the Surgery Prep Area they got down to business. Off came the clothes and on went the hospital garb including those cute little booties. Then onto the fun stuff. They shaved my entire front side from my Adam's apple to my you know where. The Treasure Trail has been erased. Call me man child. I was laughing so hard I made the nurse stop and crack up. They also shaved the inside of both legs in case they had to "harvest" a vein. Then a nurse inserted an IV line into my left arm (virtually painless). While they were doing these things my family was allowed to visit me one at a time.

Around 5:45 a.m. my anesthesiologist visited and told me what to expect. He was very friendly and eased what little nervousness I had. He told me that at 6:30 he would give me a sedative to relax (via the IV that was now in place) and then I would be wheeled into the OR. Once in the OR I would be given the anathesia that would put me to sleep and they would spend about an hour inserting some monitors for use during the operation. They would insert a blood pressure monitor via an insert into an artery in my right wrist. They would also install a line via a vessel in my neck that would lead directly into my heart. From this line they would be able to inject drugs directly to the heart if it became necesary. They would also insert a TEE (trans esophogeal echocardiogram) line down my throat so they could get a clear image of my heart before and during surgery. All these lines would be inserted while I was asleep and I wouldn't feel a thing. As far as the anasthesia went, because of my good health and young age, he was going to primarily use gas as opposed to an IV drug. His whole demeanor was very friendly and it made me feel like he really cared what happened.

Around 6:15 a nurse came in to say "Hi" and introduce herself. She was more than a nurse but I forget what her title was. She was basically the person providing primary support to Starnes and the other surgeons in the room. Like the anasthesiologist, she was very friendly and made me feel cared for.

At 6:25 the curtains swung open and my anasthesiologist, the nurse and two others in full surgery regalia came in and said it was showtime. That was the only point where I got really frightened. It lasted for about 30 seconds. The anasthesiologist said he was gong to give me the sedative and a short moment later I was in la la land. My family gave me pecks on the cheek as I was wheeled down the hall and next thing I knew I was in the OR.

It gets hazy from this point on until I woke up some 10 hours later. I remember looking around the OR and thinking it looked more like a physics laboratory than an OR. There seemed to be nothing but equipment, monitors and keyboards. The anasthesiologist later told me that we talked for several minutes before I was put out. I don't remember a word of it. I don't remember the oxygen mask. I don't remember him asking me to count backward from 7000 using only prime numbers (apparently I tried). It was lights out.

I presume the actual surgery started at 7:30 a.m. Starne's discovered that my aortic root was very dilated (43mm I believe) and the valve area diameter itself was 29mm. An RP was ruled out since my pulmonic valve could'nt even approximate these numbers. In addition, the tissue of the aorta near the root had thinned. In the end Starne's decided to go with a full root replacement homograft. The freehand method of homograft would not have been a good option because of the lack of support structure in the tissue surrounding the valve. My coronary arteries were in good shape and therefore there was no need to harvest a leg vein. Though shaved, my legs would remain unmarred. Also, though my Mom and brother had donated blood for the surgery, there was no need to use it since I didn't lose enough blood during the operation.

At around 10:30 am Starnes came out of the OR to say the operation went fine and that they were just closing me up. He said my heart was in good shape and did not appear to have suffered any damage. My bad valve was indeed bicuspid and regurgitated 30% of the volume it pumped out.

At 11:30 I was wheeled out of surgery and into the Intensive Care Unit. I was still out cold. I wavered in and out of wakefulness starting at about 1pm. I would begin to come out of the anasthesia and the staff would sedate me back under. This is what I was later told, I don't remember a thing. I do vaguely remember one instance of trying to wave at my girlfriend. Anyway at 5 pm I woke up for good. I opened my eyes briefly but closed them to try and relax. The breathing tube was very uncomfortable. I tried to see if I was breathing on my own by taking breaths at staggered intervals. I was which made me very relieved. The anasthesiologist and someone else were debating whether to take out the breathing tube and at one point I heard them say in half an hour. I thought to myself, "OK Glenn, just a 1/2 hour, you can do it." It was torturous. Either a half hour went by very fast or they changed their minds and pulled it a couple minutes later. They pulled the breathing tube out which didn't hurt a bit. Right after it came out they pulled a hose that ran through my nose which I wasn't even aware was there. Again, no pain with that one, just relief. Hoses out, they quickly made me cough to get up some fluid. That hurt. But the pain was mitigated by the joy of having that breathing tube out. They asked me what my pain was on a scale of 1 to 10 and I said a 7. The pain was a rough soreness which made it moderately bearable as opposed to a sharp pain. Anyway, they gave me some morphine and that took care of that.

Once in ICU I took stock. 2 drainage tubes coming out about 3 inches above my belly button. They didn't hurt. 2 pace maker wires I believe in the same inscisions used for the drainage tubes. Painless. 1 catheter coming out my penis (no chuckling). Painless 1 blood pressure monitor in my right writst. Painless. 1 IV line directly to my heart in my upper left chest just below the clavicle. Painless. 1 IV line in my left arm. Painless 1 10" scar down the middle of my chest. A little tight and sore. About 5 EKG monitoring leads placed around my chest

I was in the ICU until the late afternoon of the following day. My resting heart rate began to climb so they put me on Digoxin to bring it down. In ICU you get about 2 hours sleep at any one time because of the constant monitoring the nurses are doing. I slept on and off all day. Of the tubes and things which came out in the ICU, the most unsettling was the catheter and the pace maker wires. I thought the pace maker wires were worse because they are pulled out slowly and you can feel them moving inside you. It wasn't painful, but it was unsettling. They also took the blood pressure insert out which didn't hurt at all.

I was moved into my own room late Thursday (much to my surprise) and settled down to recover. Vicodin took care of any pain which was only a soreness. On Saturday, an xray turned up a 20% collapsed right lung. I suffered the same thing in the same lung when I was 16. However, the degree of the earlier collapse was much greater, around 80%. So they had to put in a chest tube. I wasn't very happy about this since the operation for the earlier chest tube had been a very painful process. For those of you who haven't had one of these you are awake when they put it in. I told the doctors I was really jittery about this and they made a special effort to make sure I would'nt feel any discomfort. They were great. The lung forced me to stay in the hospital until Tuesday. Otherwise I would have been released on Sunday. I'm actually glad I stayed in the hospital 2 extra days. A 4.5 day stay seemed too short to me given the type of surgery I had just undergone

As time wore on, all the other tubes came out. By Monday night the chest tube for my lung was all that remained. The two drainage tubes came out with a queasy feeling but no outrageous pain. It did sting a little as they cinched up the stitches. Then the chest tube came out Tuesday morning and it was the same drill. Just some queasiness and some stinging as the stitches where cinched.

All in all it was much, much, much easier than I thought it was going to be. All the nurses who took care of me were absolutely fantastic (by the way Mark D. you were right). They were friendly, patient, and gladly answered all of my questions. The doctors were great and if I had to complain I would be hard pressed to come up with anything. The only prescriptions I took home with me were for Aspirin, Digoxin (heart rate regulator), and Vicodin (which I only take at night for sleep).

Thanks to everyone on this list for their support, letting me know what to expect, and educating me. I will happily answer anyone's questions. Mail me on the list or via my personal e-mail which is ridergk@earthlink.net

A very happy person,

Glenn Karp