Heart valve surgery saves older adults from common, but little-known disease

Decorated Air Force veteran doing great again after double heart valve surgery.
February 17th, 2020

The walls of Bud and Emily Warner’s home in Black Forest are adorned with photos of a safari in Africa.

In one photo, an elephant fills the frame.

“That little guy was heading toward our Jeep,’’ Bud says with a chuckle.

Bud and Emily Warner have been married for 62 years. Photo courtesy of Bud Warner.

Married 62 years, Bud and Emily are now in their 80s. They have raised three sons, have three daughters-in-law and six grandchildren. They live an exhilarating life, traveling the world – Africa, Ireland, New Zealand, Playa del Carmen – and hiking Colorado’s mountains. On weekends, they watch football, cheering for the Ohio State Buckeyes and Air Force Falcons.

They walk two or three miles several times a week in picturesque Black Forest and snowshoe in the winter. On the night before Christmas, they have a giant sleepover with their grandkids.

A Vietnam veteran, Bud was awarded the Distinguished Flying Cross in 1968 while flying as a crew member in the RF-4C photo reconnaissance aircraft. He and Emily are a blend of gift and grit – smart, charming people living their dreams because they earned it through hard work. Staying in shape and having a sense of humor have kept them strong.

“We have lots of funny stories – at his expense,’’ Emily quips, her eyes twinkling at Bud.

It was the spring of 2017, before Bud’s 82nd birthday, Emily begins. Bud had been feeling a little weak and dizzy and even had some coughing and nausea. He and Emily weren’t sure what was going on, so they made an appointment with his doctor who started down the path of discovering what was wrong.

“On his birthday, we went out to dinner with good friends and Bud was sitting there, and he loves Fat Tire beer and ordered one. He was sitting there with his Fat Tire, and he drank only half of it,’’ Emily said.

“We were all there looking at him and afterwards, our friends asked: ‘Is Bud OK?’ That’s when I thought, ‘Oh my, this is worse than I thought.’’’

Air Force physical exam finds heart murmur

The very first doctor who examined Bud back in June 1956, as he was about to enter the active duty Air Force, pressed his stethoscope to Bud’s chest and blurted out: “You’ve got a heart murmur.’’

“What’s that?’’ Bud asked.

“You’ve got a mitral valve problem,’’ the doctor said.

Bud went on to spend 26 years in the Air Force, retiring as a colonel. Emily retired from her elementary school teaching job and they moved to Colorado in 1996. Though Bud had never been stationed in Colorado Springs, home to five military bases including the Air Force Academy, they had relatives who lived here and wanted to live in the Rocky Mountain West.

About three years ago, when Bud started to have shortness of breath, he went to his primary care physician. The Warners weren’t ready to accept that Bud’s symptoms were part of growing old. Initially, Bud had low red blood cells. He got some iron pills but by summer of 2017, he wasn’t feeling any better so he saw a hematologist. In Vietnam, he had been exposed to herbicides like Agent Orange, so doctors explored every avenue.

“We would go down different paths and we kept going down all these routes until our primary care doctor said none of it was adding up,’’ Emily said.

A referral to heart specialists 

The doctor sent him to a UCHealth cardiologist, Dr. J. Russell Strader, who ordered two echocardiograms that revealed that Bud’s mitral valve was deteriorating.

“That ended up being the explanation of why I was having all of these problems physically,’’ Bud said.

Strader sent him to UCHealth’s Dr. Peter Walinsky, a preeminent heart surgeon with extensive experience in complex heart valve disease. The Warners had pages of questions and high expectations.

“We talked, and I wanted to make sure that he understood that Bud was in really good condition. I said, ‘I want you to know that if we go into this surgery with you, we expect to come out and do these things on the other end,’’’ Emily said.

“And he looked at me smiling, and I thought this was kind of his disclaimer,’’ Emily said. “He said, ‘You know, when you go into the body of an 83-year-old person, you can’t change much else that is going on. He’s still an 83-year-old person.’’’

Walinsky encouraged the Warners to make sure to ask questions of the surgeons who might do the operation.

Heart valve surgery

“One of the points that he made when we were talking about this, he said, ‘When you’re talking to someone else about this make sure you find out about how fast they do things. It’s not the speed of things, to do it right, the point is, are you going to be on the heart-lung machine longer than you need to be?’’’ Bud said.

“I had not really thought about that. I’m thinking the machine does its thing and your heart takes a little vacation and it starts up again. It was a critical thing, and he pointed it out. I thought, ‘that’s got to be absolutely correct.’’’

Walinsky, a master at efficiency in the operating room, said he gets people on and off the heart-lung machine quickly, even during big operations.

“That’s important for a number of reasons. If something out of the ordinary happens, you can deal with it and you’re not going to be on the bypass machine all day. The longer you are on the machine the more complications happen. So you can do bigger operations and you can take on bigger operations if you do them efficiently.

“For someone like Bud, who is in his 80s, if you screw around and you have him on the bypass machine for hours, he’s going to go into renal failure, he’s going to be on the ventilator for a week. He’s going to have a stroke – all of those things. If you can get in and out quickly, he’s got a good chance of being OK.’’

Decision time

By December, the Warners were convinced Walinsky should do the heart valve surgery.

Dr. Peter Walinsky said he gets people on and off the heart-lung machine quickly during heart surgery, which is important for a number of reasons.
Dr. Peter Walinsky said he gets people on and off the heart-lung machine quickly during heart valve surgery, which is important for a number of reasons.

“He does about 300 operations (a year), and Emily and I looked at each other and said, ‘Who could we find that would be more qualified than Dr. Walinksy?’”

Heart valve disease

An accomplished surgeon, Walinsky believes heart valve disease is one of the most significant public health issues facing the U.S. Heart valve disease occurs when a heart valve narrows, blocking the flow of blood from your heart to your body, or the valve leaks because it does not close tightly. Eventually, valve disease limits how much blood the heart can pump. Over time, the heart muscle can weaken and if left untreated, the risk of death and the need for hospitalization increases.

Walinsky said that in people over age 70, more than 10% have moderate or severe heart valve disease. This is an independent risk factor for major morbidity and mortality. In the case of severe aortic valve stenosis, half of symptomatic patients will die within two years. Nearly all those patients could be saved with surgery.

Soon after deciding to have mitral valve surgery, Bud came down with an infection in the pulmonary valve of his heart.

“Here I was going to have the mitral valve either repaired or replaced and then all of a sudden, we are facing two valves,’’ Bud said.

It was time to proceed, and on Jan. 16, 2018, Walinsky replaced Bud’s mitral and pulmonary valves in four hours.

“We thought that was really impressive,’’ Bud said.

Before each heart valve surgery, Walinsky reviews the patient’s medical record, lab work and images at least three hours before surgery. He said Bud’s case was unusual.

“Most of the time, you don’t replace the pulmonary valve in adults unless they have had previous congenital surgery. He just got unlucky. He had endocarditis, so he had an infection in his heart valves and the valves that it happened to infect were the mitral valve and the pulmonary valve.

“It’s a lot of surgery for someone his age – two valves – but he did great.’’

A note to the family of his donor

Because the pulmonary valve came from a donor, Bud sent an email to the family thanking them for his new heart valve. He wanted the family to feel good about their gift.

“You can’t connect with them directly unless you have permission to do that, so I wrote a nice little email and, I have to admit, I exaggerated how good I was: ‘Outstanding career in the Air Force. Wonderful father and person. Volunteer who does church work.’ By the time I was done, I hardly recognized me,’’ Bud said, tongue in cheek.

Bud said his story is not dramatic or unusual. Many people in their 80s have heart valve disease and many have surgery. Still, Bud has high regard for the people skilled enough to perform such heart valve surgery.

“It’s kind of a miracle. I have a lot of admiration for a guy like that,’’ Bud said. “What makes him tick? Guys like that, how does he do this? What is he thinking about? Does he do it just as a routine thing?

“When you consider what can happen to the heart and how he can replace these things, I think it’s a miracle,’’ Bud said.

Walinsky is a perfectionist who prepares for surgery with discipline and attention to miniscule details.

“When you are doing heart surgery, you can’t just go into the operating room with one good plan and a bunch of mediocre plans. You have to go in with three or four good plans. … And you have to make decisions very quickly,’’ he said. “So I think about that a lot.’’

On a recent Wednesday, for example, Walinsky began preparing for a surgery scheduled the following Tuesday.

“I’ll start looking at their records a week before. I’ll look at their catheterization, their echocardiogram, and their labs. I’ll review everything again over the weekend and I’ll do it again the morning of surgery so by the time I go into surgery, I’ve reviewed their films at least three or four times before we get into the operating room.

“It makes me more comfortable that I’ve gone over it, have done multiple reviews, and I know what we are doing.’’

If it’s a complex case, he reviews literature from medical journals, watches videos of the surgery and consults with other master, high-volume surgeons to learn what they might do. Walinsky and his colleagues, who also call him for advice, are always on the same page.

The recovery from heart valve surgery

Following surgery, Bud felt good. He was in the intensive care unit for four or five days and said he “didn’t feel a thing.’’

Being in good physical condition before surgery paid dividends. All those years of living an active lifestyle – running cross-country in high school, marathons as an adult, and hiking Pikes Peak with Emily – had paid off.

When he got home and began his recovery, he knew what he could and couldn’t do physically.

“Because I walked all the time, I was used to listening to my body. I think some people, when trying to recover, are trying to prove something. I didn’t fall into that problem because I was used to really being attuned to by body and I think that helped,’’ Bud said.

By March 2018, a couple of months after heart valve surgery, Bud and Emily would go down to Discovery Canyon High School and walk around the track. He walked slowly at first, went as far as he could go – about a quarter of a mile in the beginning – and gradually built up his strength.

Bud said it took about a year to get back to full strength and he and Emily now walk about two to three miles most days in Fox Run Regional Park.

“I feel great and I am very thankful for the overwhelming support of family and friends before, during and after my surgery, I am very humbled by it,” he said.

The holidays

Last Christmas, the Warners celebrated as they have with their kids and grandkids for years and years.

“When the grandchildren were small, we’d have them sleep in our room with us,’’ Bud said. “The kids are now in college or graduated from college and a few years ago, we thought, ‘they don’t want to do this anymore.’ We thought about modesty and privacy and the bathroom – all that.’’

Bud and Emily set up the blow-up beds in the family room and when the grandkids showed up, they were dumbfounded. They wanted to have their slumber party. So Bud and Emily, and six grandkids – all adults – slept in the master bedroom, as they always had on Christmas Eve, and waited for the sound of the reindeer.

They enjoyed the holidays together and took walks together. Afterward, Bud popped open a Fat Tire.

 

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About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.