When Broncos coach John Fox went under the knife for aortic valve replacement surgery Monday, he had a procedure that more than 60,000 Americans undergo each year. It's a common surgery, with a high success rate, but that doesn't lessen the seriousness of what he faces.
To explain what Fox has in front of him, The Denver Post spoke with Dr. Carlin S. Long, chief of cardiology at Denver Health Medical Center. Long hasn't treated the coach, but he was able to give a general breakdown of the procedure — and at what point it is deemed necessary.
When Fox was taken to a hospital Saturday, he already knew he needed to have a procedure on what the team called in a statement a “defective aortic valve.” Fox, 58, had chosen to delay medical treatment until after the Broncos' season concluded. Long said such an approach to a valve replacement is not uncommon; plenty of patients know they have a condition but can push back surgery if they aren't presenting the “buzzwords that worry us.”
Those buzzwords — which often prompt immediate surgery — are threefold: angina (chest pain), shortness of breath and syncope (a sudden loss of consciousness). When symptoms such as these are present, patients are rushed to a hospital and usually have surgery soon after.
Patients with aortic valve disease have the condition for one of two reasons: They were born with a congenital defect, or their valve has calcified and stiffened with time. Although Long does not know Fox's specifics, he said that a patient of Fox's age is more often one with a congenital defect.
“When you have someone of Mr. Fox's age, the betting majority would say that he started out with an abnormal valve,” Long said. “He was probably born with something called a bicuspid aortic valve, which means instead of having three (cusps), which is what you and I and the rest of the world have ... he might have been born with two.”
When a patient has just two cusps in his aortic valve, the cusps are subject to more wear and tear over time. Patients therefore have more turbulent blood flow, which causes calcium deposition.
“People with this bicuspid aortic valve typically will present in their 50s with symptoms that require valve replacement,” Long said. “People with three leaflets that are normal that then have calcium deposition over time, those are the people that present in their 70s and 80s.”
Patients are almost always administered an electrocardiogram immediately upon arriving at the hospital, Long said. From there, testing varies depending on the symptoms. Once doctors determine that valve replacement is necessary, most patients are put in a catheterization laboratory to determine whether there's additional blockage that might necessitate clearing concurrently with the valve replacement.
“If they're going to go in and do a valve replacement, (doctors) want to know if there might be a reason to do a ... coronary artery bypass at the same time,” Long said. “You wouldn't want to just replace the valve and then find out a year later that he really needed a bypass, too.”
If such a bypass is necessary, Long said it takes the complexity of the surgery from “straightforward” to “a little more complicated.”
Aortic valve replacement surgery itself involves a few more decisions. Patients are usually implanted with either a bioprosthetic valve (usually made from a pig's aortic valve or another natural substance) or a mechanical valve (usually made of plastic). Bioprosthetic valves endure for five to 10 years, whereas mechanical valves are longer-lasting; the downside to mechanical valves is that patients must remain on blood-thinners, often for the rest of their lives.
Long said that given a theoretical patient of Fox's age with a congenital defect and no other major medical conditions, a mechanical valve would be the most likely option.
After aortic valve replacement, patients can be out of the hospital in as few as five days, Long said, after which they're required to return to the hospital for 2-4 weeks for cardiac rehabilitation. Only after that are they given a rehabilitation plan to continue on their own. Some patients then can return fully to work within 4-6 weeks.
It'll be a long road ahead for Fox, and his family, over the next few weeks, but it should calm them — and Broncos fans — to know how commonplace the surgery is within the world of medicine.