About Dr. Mamoo Nakamura,
Interventional Cardiologist

"Mine is a story of self-advocacy. It is a story of two diagnoses, two doctors, and one simple surgical solution that took me to a better place. I knew of my two diagnoses from diligently following up with doctors over the years. I had also done my homework on the internet and by talking with friends and clients I trust. Research would add a layer of understanding that transformed my experience. And as soon as I was aware that I had both an aortic aneurysm and an aortic valve that needed to be replaced — I knew that as long as my aneurysm didn’t require immediate surgery — that I wanted to have my aortic valve replaced without a sternotomy, which means having my sternum cut open and my ribs spread apart. A minimally invasive procedure called a Transcatheter Aortic Valve Replacement (TAVR) makes this possible.

With a TAVR, a small incision is made in the groin enabling the surgeon to run a catheter through my femoral artery and up through the blood vessel in the center of my body — where it can then be guided into place in my heart. Having an aortic heart valve replaced this way takes just over an hour and leaves no postoperative discomfort other than the healing of the small incision in the groin. The sternotomy required by fully open surgery means a sore chest from a cut and separated sternum sometimes results in broken ribs. I had experienced broken ribs from a motorcycle accident years ago, and I didn’t want to repeat the experience of pain with every laugh and cough. The TAVR procedure would make this faster and less uncomfortable recovery possible. Having my aortic valve replaced this way became my goal.

Unfortunately, in my case, arranging for a TAVR wasn’t as easy as I had thought. My cardiologist was great, and promised to send my charts to any surgeon that could perform my procedure. But when I consulted with surgeons at another institution, I was told that I would not qualify for a TAVR due to the shape of my heart and the severity of the calcification of my valve. This calcification is known as aortic stenosis, and they also told me that it would intensify my risk of having a stroke during the procedure. Another warning was that there might be risks from the anesthesia, which seemed odd, because TAVR’s are now so common. For this reason, the other institution said that I would have to have a traditional SAVR, or Surgical Aortic Valve Replacement. I immediately found myself in the “TAVR versus SAVR” debate. But as a CPA with 1000 clients, it was easy for me to find ten who had had TAVR’s. All of them spoke highly of the procedure and handled the anesthesia without incident. The objections being raised by the other institution seemed manipulative and contrived. This is when my self-advocacy kicked into high gear, and I decided that it was time for a second opinion.

All the homework I had done online told me where to go, and the place to go is to Cedars-Sinai and to Dr. Joanna Chikwe, the Director of Cardiac Surgery. Consulting with Dr. Chikwe was a breath of fresh air. She took an entire hour with me to review my diagnosis in detail. Dr. Chikwe has a wonderful patient manner. She is very calming and knowledgeable, putting patients at-ease with her kindness and vast knowledge — which she then shares with great understanding for her patients’ concerns. Prior to meeting with Dr. Chikwe, I had had an MRI and CAT scan at the prior institution. She reviewed both and was able to explain them to me in detail. Dr. Chikwe felt that I could, indeed, be a candidate for a TAVR. She also concluded that my aortic aneurysm, which at 4.5 cm was still half a centimeter below the 5 cm threshold for surgery - could be controlled without immediate surgery through blood pressure medications. This process is called medical management, and its effectiveness must be continuously monitored with daily blood pressure checks and scans every three to six months to ensure that the aneurysm has remained below the 5 cm threshold.

With my aneurysm at a non-surgical point for now, Dr. Chikwe was able to address my aortic valve. She did feel that I was indeed a candidate for TAVR, and she then referred me to Dr. Mamoo Nakamura, an interventional cardiologist specializing in TAVR. My consultation with Dr. Mamoo Nakamura was also a reassuring and calming experience. Dr. Nakamura reviewed my prior scans and also assured me that the minimally invasive TAVR was an absolutely workable solution for me. He also assured me that it was perfectly fine to schedule my procedure in November so that I could take care of over 300 clients with tax filing deadlines. And the timing worked out well with how I had felt. Up until then, I had been asymptomatic. It wasn’t until about two weeks prior to my surgery that I started to feel sluggish, which was perhaps the result of my defective aortic valve not enabling enough oxygenated blood out into my body. It was clear that the time for my surgery had arrived.

When the day of my TAVR came, everything seemed so quick and easy. The entire procedure of replacing my aortic valve with the catheter through my groin took just one hour and fifteen minutes. As I awoke, the nurse asked me how I felt. “I’m ready to play five rounds of rugby,” I joked. I went home the very next day with no sternotomy. My surgery was on Thursday. I was home on Friday. And by Monday, I was already working half days. Within a week, I was out walking around again and going about my normal life. And the few discomforts were relatively minor in comparison what they might have been with fully open surgery. While at first I felt great, there were a few days after the surgery where I felt a bit uncomfortable with the steristrips over my groin incision. But they stayed on in the shower and felt better within days. There was also some bruising on my right side. The nurses said this was normal and that it would also go away within a week, and it did.

Throughout my experience with both Drs. Chikwe and Nakamura, I was constantly supported by their care and scheduling teams. When I first called Dr. Chikwe, her scheduler, Mary, and her nurse practitioner, Vivian, were both incredibly kind and helpful. And Dr. Nakamura’s nurse practitioner, Katherine Brow was just great as she helped me during my surgery and office visits. Dr. Nakamura’s scheduler, Auz, was simply terrific as she called me frequently to check on me. The pride that this team takes in their work really shows - and truly helped me as a patient.

It has now been almost three months since my TAVR. The experience of the surgery itself seems just as minimal as the term “minimally invasive” would imply. Looking back at this point, there isn’t much to say about the actual surgery and that’s the entire beauty of it. My valve was replaced quickly and efficiently with a TAVR and with relatively little discomfort. I was back to my normal routine within days. My new valve works, and I feel as energetic as ever.

But what does stand out in my mind now is what I learned through my own self-advocacy and self-care experiences. I started this entire journey with two diagnoses – one for my aortic valve, and one for my aneurysm. My new valve will last fifteen to sixteen years before needing to be replaced again. As for my aneurysm, I will need to make every effort to medically manage my blood pressure with medications and report for regular scans.

As a self-advocate, I am so glad that I sought a second opinion at Cedars-Sinai with Dr. Chikwe and Dr. Nakamura. I have already recommended both surgeons five times to friends and clients for their own heart care needs. My experience has left me feeling that Cedars-Sinai is the only place to go in Los Angeles for heart surgery. My fifty-year career as a leading CPA and accounting instructor at the college level has taught me to be savvy in reading how behavioral clues relate to competence. As an observer of people — that means that the stubborn hubris unfurled upon me by the rival institution in insisting that a sternotomy was my only option merely turned me off and drove me to seek answers elsewhere. When online research told me that Cedars and Dr. Chikwe was the right “elsewhere” to seek answers with, it was their gentle and straightforward delivery of the honest truth that impressed me immediately and won me over.

Dr. Chikwe and Dr. Nakamura are truly in it just for their patients and are not emboldened by excessive pride in their program or the desire for more profitable, fully invasive procedures when minimally invasive options truly can work. Dr. Chikwe and Dr. Nakamura will do whatever they can to make minimally invasive surgery available for their patients whenever the patient’s diagnostics show that it is possible. The esprit de corps of their entire care teams – their nurses and their schedulers – make an entire culture of their caring and gentle ways. I approached my diagnoses for my aortic valve and aneurysm wanting a minimally invasive solution if it could be done.

Dr. Chikwe and Dr. Nakamura took the time with me to show me that in my case, a TAVR really was possible for my valve, and that medical management for my aneurysm is a good strategy moving forward. In so doing, they gave me a good plan for my future and got me where I want to be with as little discomfort as possible. I arrived in this satisfied place because I found two great surgeons. Doing my homework and advocating for myself really did pay off."

-- Ernest Howard, Aortic Valve, Valve Replacement, 11/07/2024