Facing heart failure, Brian Martin made a life-saving decision to get heart valve replacement after reflecting on the final words of his late father.
On January 11, 2021, Dr. T. Sloane Guy performed his first aortic valve replacement using the da Vinci surgical system. As the Director of Robotic & Minimally Invasive Cardiac Surgery at Thomas Jefferson University Hospital, Dr. Guy has performed many mitral valve replacements robotically, among other surgical procedures, but this was his first attempt at using the robot to replace the aortic valve. I am his patient, Brian Martin, I reside in Yardley, PA, and this is my story.
My wife, Kathy, is a healthcare professional—a dietician/nutritionist—without whose constant guidance and support I would rarely see a doctor and certainly would be inclined to eat less healthy meals. As a commitment to her, I see my primary care physician once a year for an annual wellness check. At their urging, I might also see other specialists to make sure I stay ahead of the curve—a urologist for a prostate check or a gastroenterologist for a colonoscopy. Having turned 69 this past September, this strategy has kept me on the straight and narrow and equally as important—has kept my wife in a happy place!
I promised my dad I would take care of my heart health
During my annual physical in December 2019, my primary care physician, Dr. Brad Friedmann of Langhorne, PA, listened to my heart and remarked, “Did anyone ever tell you that you have a heart murmur?” I replied, “Doc, I saw you last year. You didn’t mention anything then, and the short answer is no–no one has ever told me that before.” He urged me to get an echocardiogram done. Since I had no discernible symptoms, I decided not to overreact. I have been blessed with good health over the years and felt that this was likely much ado about nothing. My weight is good; I do a cardio workout at least five days a week for 30 minutes each session; I play golf (my friends might call it something else!) twice a week during the golf season; and I live in a three-floor townhouse, going up and down the stairs constantly. The holidays were coming up, and I just wanted to focus on family time.
To Dr. Friedmann’s credit, he stayed on top of it and called to push me along. I finally had the echo done at St. Mary’s Medical Center in February 2020. Dr. Friedmann called me immediately with the results. He said it was not good—the echo showed severe aortic regurgitation, and he told me to see a cardiologist. I thought of my dad at that moment. Some 20 years ago, I promised my dad, given our family history of heart disease, that I would regularly see a cardiologist. Back then, the cardiologist I saw did a nuclear stress test, thought there might be an issue, and followed that with a cardiac catheterization. The bottom line —unlike my dad, who had coronary artery disease, I did not. Good news. So I made the decision then to stop seeing a cardiologist.
Fast forward a couple of decades, it was now time to add one back onto my care team.
The diagnosis: my aortic valve needed to be replaced
In March 2020, I scheduled a visit with Dr. Richard Hyman of Mercer Bucks Cardiology in Newtown, PA. He looked at the results of the echo—read by one of his partners—and if he was skeptical at first, as soon as he put the stethoscope on my heart, he heard the leaky valve. With that, he scheduled another echo and a nuclear stress test a couple of months out. Of course, the COVID-19 pandemic had just arrived on the scene, and those tests were postponed until after quarantine.
Finally, in August into September, the testing was conducted and confirmed the original diagnosis—severe aortic regurgitation. Dr. Hyman told me that this was not sustainable. At some point, my heart would fail. Not having any symptoms that I could really feel, I pushed back. Dr. Hyman looked me in the eye and said,
Your heart is getting too big. It is compensating for the severe leakage and will eventually fail. It is just a matter of time. —Dr. Hyman
He wanted to do one additional test in anticipation of me seeing a cardiac surgeon. A cardiac catheterization was scheduled for October 1 and his partner, Dr. Dave Drucker, conducted that procedure. Dr. Drucker was great. He was able to perform the procedure through my wrist and had me laughing when he said, “Brian—any surgeon would love the opportunity to work on you given the shape you are in.” I mentioned that I still had visions of my dad undergoing heart bypass surgery in 1997. The open-heart procedure he endured left him looking like the Michelin Man post-op, and I was hoping to find a surgeon that could replace my aortic valve less invasively. Dr. Drucker gave me a few suggestions, one of which was Dr. Guy. On October 23, I met with Dr. Guy at Thomas Jefferson University Hospital.
It was destiny that brought me to this point
In anticipation of our meeting, I did some homework via the internet. Dr. Guy has a very impressive bio, and given his military background, I figured he had seen it all. Regardless of what my specific surgery might entail, I knew I would be in good hands. My face-to-face meeting with him only confirmed that—my search was over, and I was literally ready to put myself in Dr. Guy’s very capable hands. At that point, Dr. Guy was planning to perform the surgery less invasively than performing a sternotomy like my dad had, but not robotically. He planned on using a bioprosthetic or tissue valve, explaining that at my age, this was his recommended approach. It would also preclude me from having to be on blood thinners the rest of my life, as would be the case if he used a mechanical valve.
Following some pre-admission testing in December—CAT scans of the heart and thoracic area down to the pelvis—we were ready to go. On Sunday, January 10, Dr. Guy reached out to me to go over the procedure. After further review of my case and a discussion with a colleague who had successfully replaced an aortic valve robotically in early 2020 in West Virginia, he felt that I would be an excellent candidate for that same procedure. I was all in—it would be even less invasive than what was initially planned, and frankly, I was excited about the opportunity to help medical science go a little further down the road. I had begun my graduate work in biomedical engineering, and although I did not stay in that field, I felt like destiny had brought me to this point, where my God-given valve would be replaced with one born from a joint biomedical engineering and medical technology breakthrough, placed in the hands of a very skilled surgical team.
Severe aortic regurgitation is a thing of the past
On January 13, just two days after my arrival at Jefferson University Hospital, I was discharged. The morning after, I was swinging a six-iron [golf club] in my living room. A week later, I had an appointment with Dr. Friedmann, my primary care physician, who discovered the heart murmur a year earlier. He was blown away by the work that Dr. Guy and his team had accomplished. Better yet, he could no longer hear the severe regurgitation. He gave me the green light to start driving. A week later, I visited my cardiologist, Dr. Hyman, and he, too, was amazed at where I was post-op. He also declared that the severe aortic regurgitation appeared to be a thing of the past. Another echocardiogram two weeks later confirmed that diagnosis.
It certainly is not all peaches and cream. Like I tell my friends, it feels like I was in a barroom brawl. The penetrations made to the chest to give the robot access (near the right breast and armpit) certainly leave you sore, particularly when you try to sleep. You also have an incision in the femoral artery through which you can be hooked up to the heart-lung machine. But regular strength Tylenol has been the only medication I have needed to manage the pain. Compared to recovering from the alternative surgical procedure, a full sternotomy, I am sure I am way ahead of the game. And I may still have a shot at a swimsuit modeling career.
On February 12, a month following my surgery, Dr. Guy and I met via Zoom for a telehealth visit. He felt comfortable declaring that I now had a new lease on life. I will need to remain under the care of my cardiologist, Dr. Hyman, and conduct an echocardiogram at least annually to monitor the performance of the bioprosthetic aortic valve. Should the valve begin leaking more severely at some point down the road, the repair can be done very simply using a catheter.
My wife and I can now turn our attention back to our family. Our 3 children and their spouses have blessed us with 8 grandchildren. And in spite of the impact that the pandemic has had on our family time, I look forward to when the virus is under control, and we can all get back to normal.
In the meantime, I will always be thankful that I found my way to Dr. T. Sloane Guy and his team. Although I could not see the “cliff” I was headed for, he and the rest of my care team did. I have them all to thank for putting this behind me and giving me the opportunity to get back to living life to its fullest.