Normally when your heart is broken you go to a shrink, but if you are a glutton for punishment, you join a dating site and start all over again. For some people, it goes medical and you have to turn your life over to a team of surgeons which may destroy any Yoga training you ever had. In the process, you also know the surgeons are going to suck every nickel out of your wallet and the whole orgy is going to cost a fortune above and beyond any insurance Obama ever gave you. But that’s not all… you think, because you heard it online, that all of this is going to hurt more than the original heartbreak. Turns out that’s just not true, that’s the old-fashioned way. Nowadays, its painless, they just stick a tube up your crotch and gently replace the worn out (stenotic) stuff with an almost bionic cow valve—no chest cracking, no stitches, no stabbing, no priests needed on standby, no end-of-life scenarios, nowadays it’s all high tech… the heart just keeps pumping. It’s like a miracle, without the religion…more on this later.
This new operation, called a TAVR, (Trans Aortic Valve Replacement) started in earnest in the 1980s. Maybe you’ve heard of the pig heart transplant… but even that has progressed up the phylogenetic scale, to where now it’s cow tissue, and the move from Porcine to Bovine turns out to be more luxury wristwatch and less barnyard. Oh, they still knock you out, but there’s no chest stabbing, or rib stretching, no bleeding, maybe a trickle, and no life-threatening drama.
Here’s how it works:
First, you have to be healthy. It helps if the rest of your body still functions and you don’t smoke a pack a day. I mean: what’s the point if you get a new Cobalt Chromium heart valve stuck in your chest and your kidneys don’t work? Also, if you have cancer they are not going to waste this Rolex level thing on you…. especially if they just have to go in and jerk it out a month later?
It’s not all easy going. A lot of pre-surgical tests are required. The first step is to have a solid insurance deal…The TAVR ain’t cheap. I was smart, I guess, we signed on to the guinea pig plan at the State University hospital decades ago, but after that yobreu have to be healthy… you have to make the hospital look good… they don’t like to back a loser, and YES, they cheat! They want you to live through the ordeal so they can get paid.
To assure success they give you a massive battery of tests, including MRIs, where they slide you into a big noisy donut imported from Germany, EKGs, and other exploratory probes. The MRI machine is so heavy, by-the-way, that they have to pour tons of reinforced concrete before they install it. and, if you’ll notice, they are never situated on any floor above ground level.
Also, to take blood tests of every kind, they stick a permanent drain in your vein, or maybe two. This allows tests for cancer, anemia, diabetes, hepatitis, AIDS and asthma -— not to mention a COVID test at every turn, even if you’re fully vaccinated — and maybe to see if your allergic to opaque purple dye, and if you’ re going to go into anaphylactic shock after the concert starts. Just in case you might, they give you Prednisone and Tums. They don’t want you tossing up on the operating table…. And, oh yes, they also stick a Foley Catheter…in just in case you need to take a whiz during the festivities.
They also have to check you for allergies. This battery works to get them more money from BIG Pharma and the instrument makers… it’s not corrupt, it’s just good business and don’t forget you are a lab rat on several levels, almost like an unpaid astronaut, and besides, they don’t want to get sued. To be serious, this TAVR procedure cost companies like Edwards Instruments and Boston Scientific billions to develop over several decades and it costs you about 30 thousand for each operation, which includes the Rolex gizmo and the 2-day procedural hospitalization and all the follow-ups.
After all the tests have been exhausted and your ability to pay is confirmed, the next step is into the operating room — this procedure takes place in a special space-age dungeon called a “Cath Lab.” This lab is set-up to allow your surgery team to monitor the procedure on several x-ray and thermography, EEG and mystery screens. An anesthesiologist administers some euphoric concoction, and the next thing you know you’re waking up with a nurse smiling down on you asking you how you feel, and, slightly disappointed, you realize you missed the whole thing.
While you were blissfully sleeping, the surgeon cuts a small hole in your crotch and sticks a catheter up into your femoral artery towards the Aortic arch. Next, they slide and glide a collapsed mesh ring with a tricuspid leaf valve bonded to it into your worn-out heart valve. Once it is safely in place they pressure the device with a balloon to embed into your old aortic valve tissue. This can be done manually or automatically, while the heart is still beating. Now the magical mesh ring, which goes by various names-depending on the manufacturer’s patent, and which has been pre-measured to fit you like a Savile Row suit, starts to pump… no battery, no electric jump start, it just starts on its own. I asked my surgeon about this, a 27 year old Savant like Doogie Houser, only even smarter, and he couldn’t give me an answer except to say, “It’s Theological!”
OK so what’s the prognosis for the future? Those cow-skin leaves, all three of them, are new and no longer stenotic or diseased or worn out or calcified, and like magic you are no longer old and the heart break is gone. Your heart valve is youthful all over again. You’re not 15 but your aortic valve is new. So, your old bones and capillaries still ache, but somehow you have a bunch of new oxygen in your blood, and your old lungs are doing the job as if they have a new lease on life, your old glands feel like they just woke-up from a Rip Van Winkle rehab.
Finally they wheel you into post-op and let you come back to life… literally!… The surgeon comes to check on you and to reassure everyone he did a good job, heck, you’re still alive so it must be true! Your life returns to the mundane: you watch a little bad TV, maybe, take a shower… walk around with two really big nurses right next to you and go back to bed. You sleep. You sleep a lot. No matter how successful the procedure was, your system has still been traumatized, it is still in shock. If you’re OK the next day your spouse or significant other arrives with fresh clothes and they send you home.
You ache for about a week, and you have to modify your old habits. What’s the point if you’re just going to overeat and be crabby all the time? Initially you won’t notice too much of a difference, but gradually, as your body heals, you start noticing amazing things… like you can walk without brachiating on the furniture and you get urges to consume copious quantities of sushi at any price. Meanwhile, you have to return for regular check-ups for a few months.
My brain is still ticking, only God knows how I survived the Haight-Ashbury. Ultimately, your TAVR will give you a new lease on life: the valve makers guarantee 4 billion heartbeats and they can put a new model in about 10 years down the road. They won’t tell you this, but I saw it on YouTube so it must be true — and trust me, to be told at 81 you’ve been given another 10 years to write and be creative is more than a blessing.
