Nov 4, 2013 11:56 PM by Jordan Mason

Dr. Eric Skipper answers questions about John Fox

Dr. Eric Skipper is the medical director for Carolinas HealthCare System's Sanger Heart & Vascular Institute in Charlotte, where Broncos Head Coach John Fox had his aortic valve replacement surgery on Monday morning. Dr. Skipper was not part of the medical team that performed the surgery on Fox and thus his remarks below are not specific to Fox's procedure or condition.


On the process of an aortic valve replacement surgery

"I speak to generalities. Obviously, not being a part of team-I'm the Medical Director of Adult Cardiac Surgery at Carolinas HealthCare System's Sanger Heart & Vascular-a typical aortic valve replacement is about a 3.5-4 hour procedure. It typically involves an incision on the chest, and in most instances the valve itself has to be replaced. There are some instances where it can be repaired, but typically it is a replacement procedure-either a mechanical or metal valve, or a tissue or biological valve is actually used to replace the day-to-day aortic valve."


On the average recovery period

"Every patient is different. Most patients are in the hospital 5-7 days, but exactly when someone returns to work varies quite a bit between patient to patient-from a matter of a few weeks to 8-10 weeks."


On what goes into the recovery

"Typically getting over any sort of major surgery involves several days to a couple of weeks of just generally getting back to your normal activities. And then on the far end of the recovery, it really depends on when you're released to do heavy lifting. So depending on your profession, depending on your job, you can re-enter the workforce at varying intervals."


On if it's fair to say a repair is a quicker recovery than a valve replacement

"No, it really isn't. It's open heart surgery whether it's a repair or a replacement. And the recovery time between the two for the aortic valve is very similar."


On if this is a common procedure

"Yes, it's a very common procedure, one that institutions like ours do almost on a daily basis."


On what cardiac rehab is involved for Head Coach John Fox

"Well certainly coaching, like a lot of other jobs, involves a lot of stress, however, again, it really is an individual issue. Some people are going to get back in a matter of several weeks. To put a specific time on it is virtually impossible."


On if it's typical to delay this procedure like Fox had planned to

"These cases are often times scheduled on an elective basis. This is not something that occurs overnight so most people will try to pick a time when it's going to be convenient for their schedule, convenient for what other things are going on in life. The average person is able to predict when they would like to have the surgery and schedule it more electively. Once patients start having symptoms, then often times that speeds up the timetable."


On what symptoms would require immediate attention

"The three most common symptoms would be chest pain related to the tight valve or leaky valve, passing out or near passing out episodes. Those are the three things that really get people's attention and typically turn the clock up. The more common symptoms that people will have are shortness of breath with exertion-that typically is progressive over a considerable period of time."


On what happens if the valve is not repaired or replaced

"It's certainly possible to have significant cardiac events. When a valve gets either severely tight or severely insufficient one runs the risk of the heart not being able to meet the demands that are put upon it and in those situations you can have situations where you would have cardiac arrest, bad rhythms and so forth. That's why symptoms such as passing out, near passing out and chest pain get people's attention and kind of move the time table forward because those are warning signs that the heart is really not happy with what it's having to deal with."


On what type of valve is most common with this surgery

"The two general valve categories are mechanical, or metal, valves versus tissue, or biological valves. By and large, there are more tissue or biological valves implanted across the country than metal valves. And there a myriad of reasons behind that. It's a very common operation for people to need and I would say if you look at the numbers, probably more people get a biological or tissue valve than a metal valve."


On whether that valve will work forever or if it has a time limit

"There are time limits on anything that we, as physicians, put in the body. But in general, the valves that we have today are very well-made. They have excellent long-term durability records. But, as they say, it's hard to beat the original equipment."


On whether a patient is more prone to other heart-related issues after this surgery

"Without specifics of his case, as an individual, in general, once you fix the valve pathology, you take care of the problem that the patient has. So patients typically lead a very normal life after something like this."


On tissue valves

"Biological valves come in several varieties. They come in animal varieties-the most common of which are cow versus pig. They come in human varieties known as a homograft. And then there are some unique situations where you'll actually use valve tissues from the patient to reconstruct another valve. So there are multiple options on the biological valve side of the equation."


On the causes of this condition and the preventative measures that can be taken

"Often times, it's luck of the draw. Often times, there is not a lot you can do. Other times, medical conditions such as hypertension or tobacco use can affect the rapidity with which valve disease will progress. But sometimes it's just a predisposition with which you were born, or the way your body handles calcium deposition, and the valve just narrows over time. This is a one-way valve between the heart and the aorta where the heart pumps blood out to the body. You can imagine if that valve that should open fully starts to narrow down, then it makes it harder for the heart to pump the blood out to the body. The heart has to work harder, like having to run uphill."


On doing a procedure like this in Charlotte as opposed to Denver

"I think Sanger Heart & Vascular Institute, much like Denver, is a quaternary care referral center for Carolinas HealthCare System. So it would be perfectly reasonable to have a procedure like this here, especially since he happened to be in Charlotte when he had his problem. I'm sure if he had the problem-or if his symptoms had escalated-when he was in Denver, the folks there in Denver would be more than capable of handling things. But here at Carolinas HealthCare System, we end up with a lot of complex procedures, a lot of cases being referred in. It's part of what we do on a daily basis."


On whether a patient can travel after the procedure

"Patients oftentimes travel very quickly after surgery."


On how quickly that happens

"A matter of a few weeks. You have to keep in mind that patients oftentimes fly into institutions to have procedures. And then they will oftentimes leave and go back home after their procedure. So there really isn't a hard and fast time lime to say, ‘Well, you must stay local to that institution for two-to-three, four weeks.' It really depends upon how the patient is doing and patients very commonly will be able to return to their home environment-be that several hours away, be that an airline flight away-very quickly."


On the benchmarks that patients must meet before returning to work

"It really depends upon your job and what requirements your employer places upon you as far as returning to work. Just speaking in generalities, once you're able to fulfill the requirements of the job, you're able to go back to work. Our general recommendations to patients after cardiac surgery, such as aortic valve surgery, would be that they take it easy for a short time after the surgery and then gradually increase their activities avoiding any heavy lifting for a period of about 10 weeks. But the heavy lifting restriction is pretty much the most stringent long-term restriction."



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