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Risk of contracting Corona Virus as Annulplasty Patient

  • 1.  Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-07-2020 15:33
    I had annuloplasty surgery to implant two Medtronics metal alloy rings in my Tri-cuspid and Mitral Valves in Dec 2016 Miami Heart Institute/Mount Sinai Hospital Miami Beach (Dr. Pablo Vivas Cardiologist and Joseph Lamelas Cardio Surgeon).  Surgery went well and without complications. I had a stroke six months later but recovered without lasting effects.   I do not suffer from any underlying problems such as being overweight (5'7" 120lbs), or diabetes, of high blood pressure (my blood pressure is actually in the low range consistently), I lift weights regularly, am not on any meds other than low dose aspirin,  I do not smoke, drink alcohol, or partake of illicit drugs.  I am 63 years of age and in actually very good health.   My question is:
    Does the fact that I have had annulplasty surgery for my Tri-cuspid and Mitrail valves,  place me at a higher risk of contracting the corona virus than I would be - all things considered (I am taking all suggested precautions, i.e. weariing mask when I leave my house, wearing gloves, maintaining social distance from everyone (sans my daughter [20 yoa] with whom I reside) and only going out if absolutely necessary - than I would be otherwise.

    In other words - I am considered to have heart disease for purposes of my risk of contracting the coronal virus.
    Thank you
    George Baraque


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    george baraque
    Accountant
    George Baraque
    Hollywood FL
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  • 2.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 10:41
    ​Hi George,

    I never had annulplasty surgery but, 26 months ago, I did have emergency quintuple bypass surgery after a mild heart attack with no heart damage, complicated by post-surgical pneumonia caught from the ventilator that kept me in a medically induced coma for two weeks with a 50/50 chance of survival.  I also was and still am, at age 69, a lifelong athlete, including former gymnast, wrestler, distance runner, current weightlifter and bodyweight training (e.g. pullups, pushups) athlete.  Other than high blood pressure that was well controlled by low dose medication, I had no risk factors or symptoms.  In fact, everybody I knew was shocked that I, of all people, had a heart attack and nearly died on a ventilator. Of course, none of them knew that I have a family history of left anterior descending coronary artery disease.  They never knew because nobody in my family ever bothered to tell me until after the fact.

    The lesson I learned is that "everything is possible" (a once popular expression with Eastern European Nazi death camp survivors when they told their survival stories).  And so, today, I sit in my apartment bunker, hopefully shielded from outside contact with the pandemic epicenter of NY/NJ, doing stair climbing for cardio and pushup/pullup variations for strength, and I rationalize about all the same types of things you mentioned in your post.  I think about all the so-called expert advice, as reported in the media to the best of their understanding, and I analyze it based on my own knowledge of scientific method and statistical analysis. And I come to the conclusion over and over again that what is being posited as information, even by supposed experts, is mostly speculation without adequate data and without the benefit of controlled, random testing critical to the advancement of scientific knowledge.  I also recognize that the general statements about the dangers posed to seniors like me are based on the average obese, sedentary, free eating and drinking 70 year old, without accounting for individual differences.

    And so I use my intellectual training, including my interest in all things science, to rationalize that I am the exception to the seniors at heightened risk rule...except that I know, in my heart of hearts, that however right my intellectual critique  may be, I am, in fact, at heightened risk from Covid and I am no exception to anything because I also know, through personal experience, that everything is possible.  So I remain a Covid shut-in, willingly, avoiding outside contact with anyone save my wife and my 20 year old daughter that lives with me because, while Death and I are old friends, and I have made my peace with it, I have no desire to put my wife and daughter through anything like they went through the last time that I greeted Death.  At this point in my life, I would like the opportunity to share more of what life really offers all of us and, one day in the more distant future, teach them how to die in a hopefully wider time frame than is likely during this time of pandemic.

    Stay healthy and safe, friend.

    Ira



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    Ira Reid
    Hoboken NJ
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  • 3.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 15:34
    Hi Ira:

    Thank you so much for your response.  I agree with all your points.  I told my daughter recently when she mentioned to me certain inconsistencies in what was coming out from the various medical experts about the virus, that this is 1918 all over again and despite all the modern technology and advances in medicine, it is a learn as we go matter.  We went through this with the 1918 flu, the 1980's aids virus, and more recently with SARS, MERSA, etc.

    Similarly to you, I had my surgery at 59.  (I am turning 63 tomorrow Maundy Thursday - Holy Thursday, regrettably I will not be able to attend Holy weeks services which are particularly special to me, in light of this holy week marking almost 11 years since I lost my dad and almost one year since I lost my mom.  (both went during Mothers day weekends, 10 years apart)  
    I too am staying in, but I go out  to do minor stuff like take a walk and go to post office and get gas etc.  
    SInce age places me at higher risk, I was just concerned that I should be extra cautious because of the surgery, and if so what other precautions I should take.  I too interestingly enough reside with my 20 Y/O daughter.  I have a set of weights at home and thus am working out regularly despite all the gyms having closed.  
    I did managed to speak to someone at the CDC who advised that I would not be considered at greater risk for the Corona virus due to my heart surgery.  The young lady I spoke with indicated that since I do not suffer from or have any of the conditions associated with heart disease, my surgery was several years ago, and I had made a full recovery without complications,  the normal recommended precautions would suffice. I too worry mostly about my daughter, both transmitting the virus, God forbid, to placing her in a position where she has to take care of or worry about me.  
    Although I feel quite confident the virus could not kill me since the folks that hold my student loans would never let me die, at least not until I have finished paying them off.  While I agree that anything can happen, as a People we have been through similar or worse, and as a People we will get through this, and emerge ever stronger.  This too shall pass.  We'll emerge with visible scars from this but they will heal.   May God keep you and you family healthy and safe. 

    Thank you

    George Baraque





  • 4.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 15:51
    Thanks, George, and had you told us upfront that you hadn't finished paying your student loans, I would have cut short my long response and told you that you're guaranteed not to die until they're paid off.

    As for me, l'm just laying low, limited human contact to just my wife and daughter (she's taking the lockdown like a champ), doing bodyweight workouts and stair climbing at home and reading, reading, reading.

    I wish you and your daughter a wonderful Holy Week and know the services that truly matter you will perform in your heart.

    All the best,

    Ira

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    Ira Reid
    Hoboken NJ
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  • 5.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-09-2020 10:08
    Folks,

    The strength of this forum is the sharing of information without the risk of contamination by sources "talking their own book" (the financial industry had vivid expressions) by people who have experienced many of the issues. This virus is an exception in that most of us have no experience. My heart experiences are similar to Ira's although I was able to avoid the ventilator during my emergency quintuple bypass in 2007, but subsequently have months of lung problems. We are similar in our approaches to rehab and life afterwards, including being fortunate in having a supportive wife and daughter. We both are scientifically oriented attorneys. Attorneys do not testify: we search for, and evaluate, witnesses. One of my lessons was that I could control my emotional responses. 

    Using the Ben Franklin method of asking questions: What does this mean for the virus?

    To me (lawyers are big on citing sources)  it means a great deal of uncertainty as the science is still evolving. The political responses will escalate as the objectives vary from fighting the virus to winning the election. The setting is the Tenth Amendment to the Constitution provides that any right not specifically given to the feds is reserved for the states. The right to control behavior during the virus was not given to the feds: it remains with the states. Most of the time this means governors, but sometimes, like in NY, the mayors act. When they do not act appropriately, like in NY, they will look for someone else to blame. Other talking heads, such as the WHO or China, opinions are tainted by their agendas. Ignoring these has greatly reduced the background noise.

    Ira succinctly defined my analysis of the risks factors for society and me (over 70, good shape and health but my heart issues alerted me of the possibility that these may not protect me). My "to do" is shelter with daily exercising. Reducing stress is important so I have established a tentative schedule of continuing this through April and re-evaluate monthly. My target date for returning to something like normal is September, with a hopeful July, although recent events indicate progress by May on treatments but much later for vaccines. Establishing a plan greatly reduces my daily stresses although I still somewhat monitor the situation

    I am resetting my life priorities and remembering that  I will only have one April 9, 2020, and so forth. For fun and profit, I am thinking about what changes will result from this disruption in our lives.

    A bit of rambling that I hope is helpful;.

    Brent Zepke
    Author: One Heart-two Lives: Managing Your Rehabilitation Program WELL    





  • 6.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-09-2020 11:14
    Brent and All,

    I have an addendum regarding the use of ventilators and hydroxychloroquine.  Yesterday I read a news story that doctors are beginning to limit the use of ventilators in Covid cases because there is some concern that ventilators possibly cause an overreaction of the immune response that ends up killing the patient.  There are various reports surfacing that between 50-80% of Covid patients placed on ventilators die without ever getting off the ventilator.

    There also is speculation that these deaths are being caused by the extended periods of time Covid patients spend on ventilators (one to two weeks) and may not have anything to do with a Covid immune response.  After all, as I learned two tears ago,  two week stint on a ventilator reduces your survival odds to just over 50% (although my extended ventilator stay was related to pneumonia caused by the ventilator normally used for a few hours or a day after heart surgery).

    In short, I was originally concerned about potential ventilator shortages for Covid patients in places like NYC and NJ, even while I knew from personal experience that ventilators are not some benign life saving device and actually are quite risky.  Having heard this new report, though, my concern has decreased significantly as I realize now that ventilators not only are not a magic bullet for fighting Covid complications, but also may possibly exacerbate those complications.

    With respect to hydroxychloroquine and Z-pack, I read another article that some doctors were surprised to find that certain Covid patients, including some with no known history of heart disease, and without any significant lung impairment, were going into ventricular fibrillation and dying of cardiac arrest.  The author and, apparently many doctors, were perplexed by this but I immediately recalled that there are longstanding studies showing that hydroxychloroquine and Z-pack, though safe for most people, can cause vfib and cardiac arrest in the subset of patients that have abnormally long LZ values on an EKG.  So I think it's fair to speculate whether these supposed wonder drugs for treating Covid may also be responsible for the cardiac arrest deaths, rather than the virus itself.

    Stay healthy and safe, folks.

    Ira


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    Ira Reid
    Hoboken NJ
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  • 7.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-09-2020 13:33
    Wow Thank you.  As we discussed it's a learn as we go.   I'm going to check out those studies online.

    George





  • 8.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-09-2020 13:04
    Hi Brent:

    Thank you for your response.   I am in agreement with your points. I am adhering to the CDC recommended precautions, but out of an abundance of caution, I put it out to the group as well as contacting the CDC directly, to find out if as consequence of my surgery I might be at a greater risk.  (which by the way was a congenital heart defect, not discovered earlier - according to my cardiologist - probably because I have always taken good care of myself, and thus I was asymptomatic until age caught up with me - the surgery was planned and that made a huge difference both in the process but in the recovery).

    I was concerned not just for myself but for exposing my daughter to the virus if I become infected.  And watching news reports, particularly Chris Cuomo's experience with the virus, its apparent that unlike contracting the flu or even recovering from open heart surgery, fighting this virus is a journey in pain and suffereriing without any guarantees on a the denouement.  Fortunately, both of us are asymptomatic and fear and concern has kept us on the straight and narrow about this virus.   

    Thanks again for your response and may God keep you and your family safe and healthy.

    George Baraque







  • 9.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-10-2020 09:59
    If you cannot get to the link I posted, You can find the whole article at Live Science Health posted this morning.  
    I too like it when articles are cited so I can read further.

    Here in a nutshell is what I found most interesting about the article. 
    _________________

    Both heart cells and lung cells are covered with surface proteins known as angiotensin-converting enzyme 2 (ACE2) - these molecules serve as "doorways" for the virus to enter cells. But this enzyme is a "double-edged sword," she said. On one hand, the ACE2 molecule acts as a gateway for the virus to enter the cell and replicate, but on the other hand, it normally serves a "protective" function, Michos said.

    When tissues in the body are damaged - either by an invading virus such as SARS-CoV-2 or by other means, the body's natural healing response involves releasing inflammatory molecules, such as small proteins called cytokines, into the bloodstream. But paradoxically, too much inflammation can actually make things worse.  The ACE2 enzyme acts as an anti-inflammatory, keeping immune cells from inflicting more damage on the body's own cells.

    But when the virus latches onto ACE2 proteins, these proteins get knocked out of commission, possibly reducing the anti-inflammatory protection that they give. So the virus may be acting as a double-whammy by damaging cells directly and preventing the body from protecting tissues from inflammatory damage.

    "If the heart muscle is inflamed and damaged by the virus, the heart can't function," she said.

    The novel coronavirus might also indirectly damage the heart. In this scenario, the patient's immune system winds up "going haywire," Michos said. This scenario has played out in some really sick patients who have highly elevated inflammatory markers - or proteins that signal high levels of inflammation in the body.

    This is called a "cytokine storm," Michos said. Cytokine storms damage organs throughout the body, including the heart and liver, she added. It's not clear why some people have such an elevated response compared with others, but some people could be genetically prone to it, she added.

    And then you have patients who have underlying heart disease who are at higher risk of developing severe symptoms of COVID-19 - and higher risk of mortality. "You can imagine, if their heart already has difficulty working ... they don't have the capacity to meet this challenge" of not having enough oxygen because their lungs aren't working as well.

    So COVID-19 can "exacerbate" underlying heart disease, Michos said. A new study, published April 3 in the journal Circulation, described four cases of heart damage among COVID-19 patients in New York, some with underlying conditions. (Michos is on the editorial board for the journal Circulation.)





  • 10.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-10-2020 10:20
    Thanks, Mary.  I did read something yesterday, though, that the enhancement of ACE2 molecules caused by ACE inhibitors for hypertension, such as Lisinopril, may either have a positive or negative effect on the molecules' anti-inflammatory response. In fact, the three leading cardiology groups in the US state that there is no hard evidence one way or another whether the use of ACE inhibitors adversely or positively effect Covid outcomes, but clearly do help heart and kidney function.  They therefore recommend continued use of ACE inhibitors unless directed otherwise by tour cardiologist.

    Best,

    Ira

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    Ira Reid
    Hoboken NJ
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  • 11.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-10-2020 12:21
    Thank you for the excellent explanation.

    George

    Virus-free. www.avg.com





  • 12.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 12:14
    Edited by Victor Fabry 04-08-2020 12:14
    George,
    The question you have asked is a complicated one.  The good news is that he chief of cardiac surgery at Mount Sinai Medical Center is Dr. Steve Xydas.  I knew Dr Xydas when I was a heart patient and later a visitor at Morristown Medical Center. He was was a leading member of the Mid-Atlantic Surgical Associates team until he took the position with Mount Sinai to 2017.  He is an outstanding leader and heart surgeon.  I would contact him or his assistant with your question.
    ATB,
    Vic

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    Victor Fabry
    Short Hills, New Jersey
    fvfabry@gmail.com
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  • 13.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 15:05
    Hi Vic:

    I would contact Dr. Xydas' office or Dr. Vivas' office but it really isn't that urgent in light of how busy these folks must be with much more serious matters at the moment.  Since I am taking very good care of myself, I have a full set of weights at home, so I am still working out eventhough all gyms are closed, and I am staying in and away from pretty much everyone save my daughter (20) with whom I reside, as much as possible, I don't consider myself to be at any greater risk and thus don't really have an important matter to be occupying them with. 
    I did however contact the CDC (as an aside, it is a tribute to this country that I was actually able to get through readily to someone at the CDC who was able to answer my question personally) and I was told that since I have had a full recovery and do not suffer from or have any of the other underlying conditions associated with heart disease (in fact once I left the hospital I was taken of all medications, save low dose aspirin) and the surgery was several years ago, I would not be considered to be at any higher risk for the Corona virus due to the heart surgery. I was just trying to be extra cautious that was all.

    And, yes although I have never met Dr. Xydas he was the one who took over for Dr. Lamelas.  Dr. Lamelas left to teach the procedure -  Minimally invasive open heart surgery (I believe he was the one who pioneered the procedure or at least one of the countries experts) and in fact my surgery on Dec 20, 2016 was the last such surgery he performed before leaving for Texas.  He has since returned to teach at the Univ of Miami Medical School.
    As for Dr. Xydas he signed one of my two implant ID cards I carry around as a medical alert id.  Dr Lamelas signed the other one.
    I know Dr. Xydas is very highly regarded here in So Fla and in the entire country and we are fortunate to have him.  I owe my life if not the quality thereof I have enjoyed now going on 4 years to the wonderful personnel from the physicians, to the staff, nurses, etc at Mount Sinai/Miami Heart Institute @ Miami Beach. God bless them all.

    Thank you for your response my best to you and your family. May God protect all of you God Bless
    George Baraque





  • 14.  RE: Risk of contracting Corona Virus as Annulplasty Patient

    Posted 04-08-2020 16:07
    George,
    I'm glad you discussed your concerns with the CDC.  I had thought that since you don't have any of the other underlying conditions associated with heart disease, that you would not be at higher risk.  Since I'm not a professional, I was reluctant to give you any advice.  When you meet Dr. Xydas, please give him my regards.
    Enjoy a memorable Easter holiday,
    ATB,
    Vic Fabry 


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    Victor Fabry
    Short Hills, New Jersey
    fvfabry@gmail.com
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