The Patient’s Voice: Valve Replacement for Bicuspid Aortic Valve Mark Mercola, PhD Professor, Cardiovascular Medicine, Stanford University

Disclosure Statement of Financial Interest I, Mark Mercola, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. All TCT 2018 faculty disclosures are listed online and on the App.

History Diagnosed late December 2017 Echo, early January 2018 AVR, January 31st Discharge, February 8th Return to work, gradually March to May Return to exercise routine, gradually February to present Currently I feel about 80% recovered at 8 months post-op

Diagnosis Severe AS with mean gradient of 44mmHg (SSN) and AVA 0.6 cm2 Visual impression of valve function was very sobering – I wonder if patients would benefit or not by seeing the echo videos?

Mechanical vs Biological Prosthetic Valve Excellent discussion with Joe Woo, MD, Chair of CT surgery on pros/cons. For me, quality of life outweighed durability issues. Although mortality in AVR is very low, the decision might resemble other device/therapy decisions for which quality of life is weighed against mortality. I felt good about making the decision – I wonder whether others would want to be as involved?

Hospital stay, 8 days Very attentive staff, outstanding feeling of being looked after well – I cannot emphasize how much the attentiveness mattered since I was largely unable to help myself much the first few days. This includes physicians, nurses and especially the physical therapists. The PT visits had the greatest impact on my feeling of recovery. My wife, however, felt out of the decision loop. Perhaps this is a consequence of attention to patient; perhaps unique to my case because of connection to the staff. Nonetheless, attention to family members seems to me to be very important since they might be bearing an even greater emotional burden than the patient, who sees daily progress.

Recovery of Physical Activity Time estimates: Cardiologists: 3-4 months Blogs: 10-12 months My experience: on track for 10-12 months (I am currently at 8 months) And, this is for bicuspid AV!!!! Why the discrepancy? I believe the reason is that it depends largely on the patient’s expectations & degree of athletic activity prior and post surgery

Residual Problems Feelings of being frail/damaged Worry about the next AVR and how I will tolerate it because of age

3 Major Aids in Feeling a Positive Recovery Trend Wife & dog motivate me to exercise every day Family taking me on walks – Walking the Dad Wrist GPS to track activity This makes me consider the importance of: Consultation for families The role accessory devices can play in recovery