J Alexander's Guestbook

Richard Munson  For what its worth frank, i had my mitral valve repair and maze roughly 3 years ago at mass general during covid via minimally invasive technique and my surgeon and cardiologist were in my eyes top notch. Everything about mgh is great.

Frank Gianino  Hi Richard, Thanks so much for your input.  Can I ask who was the cardiac surgeon that performed the MV repair at MGH? 

Richard Munson  Sergui melnichauk is fabulous and specializes in minimally invasive which i had. Cardiologist was dr. Dal bianco a mitral valve expert. Both at mass general. Since i had my surgery have passed on their names to other satisfied customers. 

J Alexander Lassally  Hi Frank - Happy to color this for you from my vantage point. I will give you the Fact version and the Soft Fact version. Totally honest...
Fact 1- With health outcomes and data analysis experience as my professional background, I was totally looking at macro facts in my selection. I wanted a high volume hospital. I learned that there are several Mitral Valve reference centers in the the US which have high volume and good outcomes. They are recognized as such. The Boston hospitals were not on this list.
Fact 2 - I learned that the Dr at MGH heavily pushed the manual thoracotomy approach. I considered this heavily at first  -- but then moved away from it - so it made no sense to consider them for a sternotomy. 
The MGH robot approach was new at the time, and their meta analyses data were not good to m y eyes. Super long times on pump. Slow and low on the learning curve. 

Fact 3 - Brigham had lost most of their seasoned older surgeons for mitral and I refused to have a newbie young surgeon there. That made  no sense to me. 

Soft Fact 1 - I had worked in Boston for several years as a consultant and was frequently with Brigham doctors and at Harvard for meetings. I found the arrogance factor super high and it was off putting for me (a west coast native.) 

Soft Fact 2 - I had heard stories of MGH being a "mill" from several folks I knew in Boston, so I just decided to look elsewhere and beyond.  We initiated trials for drugs there and it was always super busy / frantic. Also, I left Boston and sold my place around that time of my journey. 

Soft Fact 3 - For me, the "universal truths" were told to me at places like Cleveland Clinic and Mount Sinai (and Hopkins too) when I had my consults. Some hospitals had a big skew to their stories, and quite honestly, some surgeons were not that impressive on scrutiny. I am only 52, so I was committed to make the best choice I could for myself.  I am glad I did what I did. 

Hope this helps color it. I have no specific bad feedback about Boston choices, I just leaned the other direction for clinical choice reasons, and also gut feelings. Happy to answer questions for you ! 

Richard Munson  Frank: JAL did some very diligent research before his surgery and i respect all he did. His insight is great. My situation was a little different. It was during covid, i was 79, i hate airplanes, no hotel issues, MGH was close by and in the top 10 , plus my heart surgeon and mgh cardiologist went to school with my local cardiologist, and his specialty was minimally invasive. We never met in person before the surgery due to covid but he spent as easy 1/2 hour or more with me on the phone. The staff at mgh was great, and i spent 5 days there with no visitors allowed at that time. My wife was able to drive me there and home so that was convenient. Driving into boston after was a pain but its always nasty. Plus, my follow up visits for the first year were at mgh with the same folks that did the work. I have since had my follow up echos done locally on the south shore. So far, so good. 

Frank Gianino  J. Alexander,  thanks for your time and efforts in providing me the background due diligence you conducted and the findings that lead to your decision.  The information was quite beneficial.  I assume that, given your role as a consultant, you were able to learn much about MGH and other hospitals based on your experience and networks. You were able to research and learn about very important data, i.e., the MGH robotic approach was new at the time, their meta analyses data were not good to the eyes, super long lead times on the pump, etc.
I have been having challenges finding out key data on certain hospitals, i.e., number of MV repairs each year, % of successful outcomes, etc. In the spirit of my efforts to conduct more due diligence, are there specific websites, medical journals and/or other sources of data / information that you could provide that would enable me to obtain certain data such as: 
(i) surgeons / hospitals with a high volume level for MV repairs and a high percentage of successful outcomes using the Da Vinci robotic surgical system;
(ii) surgeons / hospitals with the lowest trending average of days in the ICU post surgery from MV repair or replacement, etc.       

Thanks in advance for any information you can provide. 

Frank Gianino  Richard, thanks for the additional background information that contributed to your decision.  Also I appreciate you sharing about the great experience you had at MGH.  Anytime you would like to get together for a cup of coffee down in the SS, I'm buying.     

J Alexander Lassally  Hi Frank. Not systematically. You'd have to buy huge data sets to get that data.  You have to interview each hospital and then see if they present logical data to you. 

One point: I think the ICU thing is a rabbit hole.  These are just averages and predicated on age and complexity of patients in the series. The thoracotomy patients often move to step down faster so that does not tell you much. What does matter is long term durability and comorbidities from surgery.   Stermotomy patients are in ICU longer because they take longer to come out of anesthesia. Mine was rough - I won't lie. 


A lot of thoracotomy patients have arrhythmia issues (sternotomy too) but these sorts of things are missed in that  ICU time data. Also, ICU is not scary necessarily.  My best care and comfort were there, so don't  necessarily think of it as "blanket bad."  I think surgeons presented this time data to show non inferiority more than anything. Thoracotomy will always be presented as non inferior to sternotomy. 


If you want robot that is great, just know the caveats that come with it. It comes with tradeoffs. 

J Alexander Lassally  Thanks Richard, I very much appreciate. I intend to write some parts down - bringing some humility and humor and spice to the process. In addition to data, which is actually sorely missing from consideration sets of many! 
We warriors need to fight like hell for what we want and deserve!! 

J Alexander Lassally  Hey Janet - ANYTIME! I am all about realism. That is my role on earth... Happy to answer any questions... 

Sternotomy is tough but somewhat predictable. Around 60% of cases in the is country still. Not really discussed.  Happy to answer anything. 

Deena Z  Lovely, spot-on platform,  prospective President. —Creating a safe &  healing world!!.  (Right up there with Ms. America platforms:)  What do you think about universal canine insurance?! 

J Alexander Lassally  May I PLEASE be Secretary of State? I will proclaim the minimally invasive mantra around the world for you ! 

Richard Munson  There is no question that the 3 of us need a mental evaluation. Possible side effect from heart surgery? Speaking of canine insurance which we have, took shadow for his annual physical and oil and filter change today. He weighed in at 62.5 pounds and was proclaimed to be fit as a fiddle. He is on the upper weight scale for a male siberian husky. 45-60 is the akc range. He was great but got a little crabby when they took blood. Had trouble finding his vein. 

Susan Lynn  Poor Shadow! It's never easy to get bloodwork even when you understand the rationale for it. Hope he received a treat afterward!

Svetlomir Ivanov  But what about this oppininion :
https://www.heart-valve-surgery.com/learning/baby-aspirin/
Moreover,even after 1 year many people report stomach problems, even ulcer?

Marie Myers  Going  to jump in here…I think the take-a-way from this article is that baby aspirin is recommended after valve surgery. If you have side effects from aspirin, you need to speak with your doctor about it. Are you having stomach issues from the aspirin? Have you tried an acid blocker like famotidine? It is non prescription at 20 mg here in the US.

Svetlomir Ivanov  Hi, Marie, but I get the impression that dr.Gedrich said the mitral valve repair is not between the operations, needing this baby aspirin. Famotidine I start to use, but maybe some gastrits already result and it is of no avail. For example, some patients here, stop baby aspirin after mitral valve repair? What is you info about that, do you know other people with mitral valve repair and if they take this baby aspirin, which is not a joke at all

Marie Myers  Have you seen a gastroenterologist about your stomach? If you have ulcers caused by certain organisms,  a course of antibiotics may help you. You would need to see a stomach doctor for that.  
   I believe the article says that baby aspirin provides benefits after valve replacement , aneurysm resection, and bypass surgery. It does not specifically mention mitral valve repair.. Does your cardiologist know you are having problems with aspirin? What advice does the doctor give you?  I hope you find answers soon!

Svetlomir Ivanov  I was 6 month of sintrom, and no problems, but after only 1 month on baby aspirin, stomach pains start, and I stop aspirin, and in some degree this eased the pain. Of course, I told the carfiologist, he recomended to lower the dose, but I just stop it, because even without aspirin, it is still hurting after eating. Helicobacter pylori is possible reason, but just a week ago I was on amoxiciclin course, because ot dental cleansing, that is why it is not very probable reason. That is why I suspect the aspirin. By the way, what is practice after mitral valve repair in US ? One guy told me, that he was 3 months of anticoagulants, and that is all, but here there are patients who taking aspirin long time. And because English is not my native language, I can not understand very well, what this article says in respect to aspirin prophylaxis after mitral valve repair. Because I definetely think that no sense to get ulser, just for this baby aspirin, if it is not must after mitral valve repair. Cardiologysts follow some protocol, and  they will change their practice after years until the cited research by dr. Gerdisch become a popular. To put it shortly one controversial prevention  could cause gastritis or ulcer, and that is why I wonder if this aspirin is important after mitral valve repair. 

Marie Myers  I have also read that many mitral valve repairs get anticoagulants for 3 months, then nothing. But i think that depends on your cardiologist and their own line of thinking and preferences. It can also depend on the individual patient ,their own history, and possibly their tolerance of aspirin. By the way, i think your English is very good! I wish I  was as fluent in another  language!

Svetlomir Ivanov  Thank you, you are very polite, but it is not good enough :) As far as I understood, the aspirin aim is to prevent blood to clot on anulloplasty ring and chords till they are covered with body tissue, i.e. endotheliialized. But as per research and prictice, this happened for 3 months. Let for safety put additional 3 months, in sum 6 months. And, what is the sense to take aspirin after that, just with greater risk to provoke gastritis or ulcer? Of course, if one have no complication, it make sense for let`s say addtional 3-6 months. But if you indefinetely take aspirin, sooner or later result will be a ulcer and another operation (surgery). Ordinary carfiologysts has a tunnel vision,think only for anti thrombosis therapy, but neglect the real risk ot ulcer. Moreover, if one use proton pump inhibitors, symptoms may never appeared, but gastritis to progress to ulcer.

Pamela Gregory  I had my AVR and root replacement at CC last October 2022. I could not lay flat in bed for quite a while comfortably. I bought wedges to prop myself up but slept the best in a recliner for a long time. I would definitely recommend a recliner. I am a side sleeper and it kept me comfortably on my back the best. I did wake up still intubated in ICU and that went on (I am guessing) for 20 mins? They needed some number to get to a certain level. I would drift in and out of consciousness during that time but I was very happy when they took it out. They will take very good care of you at CC. 

J Alexander Lassally  Hi Tim !  I had Dr Gillinov at Cleveland Clinic. And no - no minimally invasive approach was used. It was the full median sternotomy. What is your case? I cannot tell as it says Tim C and there is no clickable link. 

J Alexander Lassally  Hi Isabella - I hear you on all fronts. The intubation was fine on the starting side. I was only aware for the first lines being put in and then was out. 
I won't lie - the extubation phase was difficult. I was partially aware and awake when the line was still in. I had a sensation of wanting to cough or light choking - but they had to keep it in. 
Then, when ready, they pulled it out and all was good. 
A lot of people have no recollections, but I did and still do of the experience.  Just being honest.   Feel free to leave your email if you like... 

Isabella Heart  Wow, I was not aware that they intubate you while you are awake before the operation. I hope I misunderstood!!!

Marie Myers  You are sound asleep when you are intubated. They will be putting in some IV lines while you are awake /and or lightly sedated. 

Rita Savelis  I don't recollect being intubated (I was asleep) or extubated (I was too groggy when waking up to notice anythimg). Extubation is a fear most have, but many patients barely notice. The tube is kept in only as a precaution and taken out as soon as possible. It is very likely you will be too drugged out to notice. An anasthesiologist can usually answer all your questions and fears about this.

Isabella Heart  I hope I will have your experience Rita😜 No recollection of intubation at all. 
I am extremely  gaggy - that's why it really scares me. My survival instinct may just make me rip it off. 

Grace Mason   I barely remember. I vaguely remember the ICU nurse telling me it was coming out, a very slight sensation in my throat and then I think I fell back asleep 😊

Rose Madura  I had mine in when I woke up because it took over 14 hours for me to wake up and i kept setting off the apnea alarm every time they tried to turn it off. I did gag but my nurse Bill and my husband Rick helped calm me. It wasn't too bad once I calmed down but I do remember it all. Just saying.  If you are groggy you still can remember things.

Valerie Allen  Isabella, I’m not being facetious but the way I’ve handled some challenging situations is by learning and using meditation when under duress. I happen to favor TM (Transcendental Meditation). This would be perfect for such a situation if you can take a class.

Jennifer Fuller  I don’t want to scare you, but intubation was the worst part for me. I have no memory at all of having it inserted, but after surgery was difficult. I woke up rather quickly from anesthesia. That was good. However, I was intubated and desperately wanted it removed. Every breathing test I did showed low oxygen levels.  I was awake and intubated for about 10 hours. It was not good. But I survived it. On the plus side, having the tube removed wasn’t painful at all. The nurse and respiratory therapist pulled it out gently while asking me to cough and it just kind of came out. I think my experience is not the norm at all. But know if it happens, you’ll get through it. 

Isabella Heart  Thank you Jennifer for sharing your experience.  It's important to know all different scenarios that might happen and be mentally prepared. I wish that doctors could work on improving  this pretty important detail. I am extremly gaggy, so it is very scary.  I am so sorry you had go through that. I hope you are doing well!

Christine Maiorano  Wow thanks for sharing this information. My surgery for Mitral Valve repair at Cleveland Clinic is 4-10 I’m a bit stressed about being intubated. Hope I don’t panic!!

c w  Ruth, omigosh! How long until the popping stopped? Also, I noticed your name does not appear as a link, so no one can see your profile. I wonder if that is a bug? 

J Alexander Lassally  That is great. They were good cars to work on. I remember helping my dad with starters and water pumps all the time ! 

J Alexander Lassally  Perfect. Will do. That bumpy take off air for about 30 minutes was so uncomfortable, right. I was clutching my jacket. Utilized the wheelchair service at airport which was essential. Could not have yet walked that much. 

J Alexander Lassally  Hi Valerie - It is holding up for me. Like "winter waiting mode" giving me plenty of time to walk and not navigate snow!! 

Deena Z  Me too, J Alexander! Thinking of you! Hoping that you are beginning to get the walks around the unit going well.