On-X AAP Recipient
Shortly after his heart valve replacement surgery, Dan Schafer was reminded of his West Point Class of ’86 motto, “courage never quits.” It was this spirit that kept him moving forward in the face of his diagnosis, through surgery and beyond.
Dan has always been physically active. As a young man, he was on the wrestling team at West Point, a rugby player and an Army Airborne Ranger. Later, as his career developed and his family grew to include a wife and four kids, he found another outlet for his competitive nature and became an avid CrossFit athlete – even participating in CrossFit Open events in his 50’s.
“I was pretty active. I felt like I was going to live forever,” he said.
So it came as a shock when, after a routine heart scan, he learned that he had a congenital bicuspid valve and a mildly dilated ascending aorta, which would require valve replacement.
“Things got real right about then,” Dan said. “For me, having open heart surgery, it really was surreal, at least initially as I came to grips with the fact that I had to have it.”
Working with his cardiologist, Joseph Horstmann, M.D., and cardiac surgeon, Mark Bodenhamer, M.D. at the Oklahoma Heart Hospital, Dan had some initial big decisions to make.
Making a Decision: Mechanical vs. Tissue Valves
“Initially, I had to decide am I going to go tissue valve or mechanical valve, The American Heart Association and American College of Cardiology guidelines for valve replacement say that mechanical valves are reasonable for patients 70 and younger, while tissue valves are reasonable for patients 50 and older.1
Tissue valves typically last up to 15 years, and often less in younger patients. Some tissue valves fail after 4 to 6 years in patients less than 65 years old. Some tissue valves fail after 7 to 10 years in patients greater than 65 years.2 Over time, tissue valves will likely degenerate to the point of requiring replacement. The primary advantage of mechanical valves is that they will typically last a patient’s lifetime. Because of this, mechanical valves are often selected for patients with life expectancies beyond 10-15 years.
and that was an easy gate to clear for me. What I discovered is that, since I’m only 53, if I had a tissue valve I could expect more than one open heart surgery in my lifetime.”
Based on this, Dan and his doctors decided a mechanical valve was the best heart valve replacement choice for him.
“My decision to go mechanical versus tissue was absolutely 100 percent based on my expectation that the mechanical valve will outlast me. I will be one and done for open hearts.”
After deciding on a mechanical valve, Dan began researching which would be the best selection for him. He learned more about valve choices by visiting the major valve manufacturer websites, including the CryoLife website, where he read the story of Fred Hoiberg, the Chicago Bulls coach who also faced a life-threatening aortic aneurysm and opted for an On-X Aortic Valve.
After doing a good deal of additional research on his own, Dan decided to ask his heart surgeon to use the On-X AAP The On-X Ascending Aortic Prosthesis (AAP) is indicated for the replacement of a diseased, damaged, or malfunctioning native or prosthetic heart valve in the aortic position in cases that involve an ascending aortic aneurysm3. The On-X stands alone as the only mechanical valve with 90-degree leaflets3 that promote laminar flow, a smooth pyrolytic carbon surface to reduce thrombogenicity4 and a flared inlet designed to prevent pannus and conceal pledgets..
“My recommendation for patients considering or facing a valve replacement – work with your doctors. They’ll know your options in terms of mechanical and tissue. But then also don’t necessarily just take for granted what the doctor says. You need to investigate all the outside factors that are going to impact you,” he said.
When it came time for scheduling his surgery, Dan was hoping he could get in around the 20th or 21st of December in hopes that he could be home with his four adult children who were coming home for Christmas. As it turned out, he had his surgery on the 22nd.
“Christmas was unconventional, if you will,” he said. “All the kids and my wife were in the room with me. But the good news was that we would have other Christmases to celebrate, because if I hadn’t had it (the surgery), this probably would’ve been it.”
Getting Back to Normal
A day after surgery, Dan was up and walking laps, slowly, around the hospital. His recovery progressed well over the next several months, and he gradually has returned to his normal routine, including his regular workout regimen.
“The type of exercises I’m doing today, four months post-op, are quite honestly the same exercises I was doing pre-op – the same exercises I’ve been doing since I was maybe two or three weeks, maybe a month post-op,” he said.
His workout routine includes circuit training incorporating cardio, strength training and yoga.
“It hasn’t really changed much. I’m doing the same kind of stuff I did before.”
Blood Thinners – No Big Deal
Like all patients who receive mechanical valves, Dan has also had to adjust to using blood thinners, but said the effect on his daily life has been minimal.
“My experience taking blood thinners and managing my INR has not really had a big dent in my life and not really changed my lifestyle much,” he said. “I mean, I’m still recovering from having my heart worked on, but I’m ramping up fast. Initially, I went out and bought an electric razor and that lasted for a month. Now I’m back with my regular razors and I’m just careful.”
The main drawback of mechanical valves has been their requirement for using blood thinners. However, with properly managed anticoagulation therapy, rates are low for both bleeding and clotting.
“Taking blood thinners and the effect on my diet – the effect has been minimal, despite what I heard up front and what a lot of people tell you,” Dan said. “I mean, there are a lot of things I take that affect my INR, things like fish oil or glucosamine, kale, leafy lettuce, those kinds of things – but the impact it’s had on me – is that I need to be consistent.
“I’m going to live my life the way I want to, within reason, and I’ll let them manage my dose and then we work it. If things change then, sorry, we have to fix it. I’ve not changed – I mean, I’m not a knife juggler and that’s probably a good thing even if I didn’t have blood thinner, but it hasn’t changed anything.”
Now that his heart valve surgery is behind him, Dan has not only returned to physical activities, but also traveling to spend time with his kids who are spread out across the country. He also enjoys participating in online forums for people facing heart surgery, offering advice and insight based on his own experiences. And he will no doubt continue to inspire and motivate them with the reminder that “courage never quits.”
Note: This story reflects one person’s experience. Talk to your doctor about your situation and possible treatment options.
- Nishimura R et al., 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2017;135:e1159-95.
- Wang M et al., Ann Thorac Surg 2017; pii: S0003-4975(17)30266-7.
- On-X Ascending Aortic Prosthesis Instructions for Use.
- LaGrange L et al., Compatibility of carbon and blood. Hegyeli RJ, Editor, Proceedings, Artificial Heart Program Conference, Washington DC, June 9-13, 1969, 47-58.