FIRST SUCCESS OF 2012

Our first day of surgery and post op recovery was a huge success in the CICU. This is Tanya, Bryan (KFH RN), Ashley and Dr. Atul tucking in our first patient - Angelique. I will use her as an excellent example of the difficulties that arise from choosing patients for HHNW surgery and then choosing valve types for each patient.

Our Screening Team (Cardiologist and Echo Tech) travels to Rwanda in February/March to perform Echocardiograms on 100's of patients. Then they narrow this list down to 40-60 patients. Dr. Hal Goldberg, our HHNW Medical Director, has set down excellent ground rules for patient selection, but our surgical team must narrow down this 40-60 patient list to 18 candidates and 5 alternates. You can imagine the difficulties they face - how sick is the patient?, would they tolerate the surgery?, do they have access to follow-up care?, etc.

Then, based on the Echos, the surgical team decides which valves need repair or replacement. Repairs happen with rings and replacements happen with either tissue or mechanical valves. (By the way, a big "shout out" to Edwards Life Sciences, Medtronic and St. Jude who donate all these rings and valves.) If a patient has a tissue valve they do not need to take Warfarin (Coumadin) post operatively, but they may need another valve surgery in the future. If a patient has a mechanical valve they will need to take Warfarin post-op to make sure their blood is thin enough not to form clots around the valve. Warfarin leads to several other decisions - will they be able to obtain Warfarin?, do they have a clinic nearby to perform their INR lab draws to determine Warfarin levels?, are females done with childbearing?

Which brings us full circle to Angelique. She lives in a Congolese Refugee Camp and has 3 young children. Angelique stated she was finished with childbearing - but was this because she felt so awful because of her mitral valve disease or was this her true heart's desire? What happens after we fix her Mitral Valve and starts to feel better?, will she want more children?, will she be able to obtain Warfarin?, will she have a clinic available to her in a Refugee Camp?

In the end we try and educate patients as much as possible so they can make an informed decision. This begins weeks before we arrive, thanks to the groundwork of the 3 Kigali cardiologists who manage our patients before and after surgery. Angelique chose a Mechanical Mitral Valve and is Post-Op Day 2 here, we will give her the first dose of Warfarin, per her decision. Then she will move from the CICU over to Telemetry. We wish her all the best, our first patient of 2012.