Cyclist Not Stopped By Heart Valve Surgery

Every fall for nearly 30 years, Martinsville resident Dan Rhoden has headed to Bloomington to ride in the Hilly Hundred, Indiana's longest running cycling event. About 2,000 cyclists participate and ride the back roads of Owen and Monroe counties. Even after he was diagnosed with lupus and a heart murmur in his late 50s, Dan continued to exercise regularly and show up for cycling events year-round, feeling fit and enjoying the sense of accomplishment after each race.

But in 2021, Dan noticed changes in his race performance. After his first race that year in March, he was beat. His breathing while cycling was heavy and labored. And he experienced unfamiliar fatigue. With some resignation, he accepted that he was getting older, after all, and that could be the cause of his fatigue.

Still, he continued to ride during the summer and fall, including the Hilly Hundred.

"It felt different, but I was still riding," he said.

In November 2021, Dan went to his regular appointment with cardiologist Michael Barron, MD, at Franciscan Physician Network Indiana Heart Physicians in Indianapolis. Dr. Barron had monitored Dan's aortic valve and associated heart murmur for several years. The valve had showed some calcium buildup, or stenosis, but not enough to greatly impact heart function.

When Dr. Barron reviewed Dan's new echocardiogram, however, he realized Dan's aortic valve had dramatically deteriorated in a short amount of time. What had started as a mild narrowing of the heart valve opening now was a valve whose leaflets were severely restricted in their movements.

"A patient with a heart murmur can go for years, even a lifetime, without experiencing serious issues," said Dr. Barron. "But certain valve conditions can change quickly. Heart murmurs need to be re-evaluated regularly so that treatment can take place in a timely manner and before patients start experiencing symptoms such as shortness of breath with exertion, and before they go into heart failure."

Dr. Barron referred Dan to the structural heart program at Franciscan Health Indianapolis. Team members Marc Gerdisch, MD, cardiothoracic surgeon at Cardiac Surgery Associates, and Sunil Advani, MD, cardiologist at Indiana Heart Physicians, determined that heart valve surgery to replace the diseased heart valve was Dan's best long-term option. Dr. Gerdisch, who focuses on replacing and repairing heart valves and lectures extensively on heart valve care, would do the surgery.

Referral notwithstanding, Dan went online to read about Dr. Gerdisch and found many glowing patient testimonials. "I saw right away that this was the guy for me," said Dan.

"Because there are now many options and devices for patients with heart valve issues, the key to finding the best treatment is to consider the patient's health holistically," said Dr. Gerdisch. "Dan's lupus certainly played a role in our surgery plan, but so did his lifestyle and family history."

Many times, lupus reduces a person's blood platelets. According to Dr. Gerdisch, this made a mechanical valve a less-appropriate choice for Dan.

"Although mechanical valves typically last a lifetime, they require patients to take blood-thinning medications, which could be a challenge for someone with low platelets," said Dr. Gerdisch. "On the other hand, autoimmune disorders like lupus can lead to a more aggressive immune and inflammatory response to a valve made of animal tissue. In balance, though, we felt the composite risk was lower with a tissue valve."

Because patients with heart valve disease are more apt to eventually develop atrial fibrillation, increasing their risk of stroke, Dr. Gerdisch insert an AtriClip device during heart valve surgery to close off the left atrial appendage in Dan's heart. The device helps to reduce a patient's risk of stroke by blocking this space where dangerous blood clots commonly form if the heart's beating becomes irregular.

Dan had one other issue: his aorta, the largest artery in the body, was slightly enlarged near the aortic valve. While not at a critical size, the enlargement was a sign that the artery wall was thin there and could later develop into an aneurysm -- or worse, rupture. Two of Dan's brothers had had aortic aneurysms, indicating the condition was hereditary and thus more in need of attention. Dr. Gerdisch decided also to replace the abnormal section of the artery with a synthetic graft during Dan's heart valve surgery as well.

Dan had open heart surgery in March at the Franciscan Health Heart Center Indianapolis and was in the hospital for only four days. "During that time, I was pain-free," he said. "I was taking other medications, but none for pain. The staff was tremendous, too -- I couldn't have asked for better nurses or therapists."

Dr. Gerdisch credits Dan's easy recovery from heart valve surgery to the advanced protocols refined at Franciscan Health Heart Center Indianapolis during the past several years. By refining their approach with anesthetic techniques, minimally invasive surgeries, new sternum fixation devices (to replace traditional wiring of the sternum bone after open-heart procedures), nursing and physical therapy techniques, "we create an environment that supports restoration of health and mobility in short order," said Dr. Gerdisch. "Our approach has reduced patient's need for pain medication by more than 90 percent, and patients return to normal routines very quickly."

For Dan, that "normal" routine meant getting back to cycling and cross-training.

"A few days after surgery, I went to the gym to walk, and I felt fine," he said. "Since high school, I've been active every day - it's important to me."

Just 17 days after surgery, Dan felt good enough to get on a rowing machine. He had his brief workout filmed and showed it to Dr. Gerdisch's staff during a post-op visit.

Dan's recovery, especially when compared to others he's talked to who had a traditional wire sternum closure, has been better than he could have imagined.

"After seven weeks, I didn't feel like I'd had anything done," said Dan.

"Dan is a great example of what individualized heart care looks like," said Dr. Barron, "from timely monitoring to diagnosis to treatment plans that best suit the patient and ensure the best outcomes. That is at the core of the multidisciplinary care Franciscan provides for heart valve disease."

Franciscan Health Indianapolis was named No. 1 in Indiana for medical excellence in cardiac care by CareChex®, an information service of Quantros, Inc. For more information about our services, visit FranciscanHealth.org/heart.