One Heart, Many Hands
A young father’s life is saved at age 33
Thirty-three-year-old Bradley Ferstein of Buffalo Grove, Illinois thought he would spend most of his life not worrying too much about his heart. He was born with a common heart defect, but it rarely requires treatment before age 65. Then things began to change.
Ferstein was born with a congenital defect of the aortic valve, in which he has two functioning heart valves instead of three. (Often referred to as a bicuspid aortic valve.) Most people do well without treatment until they reach the fifth or sixth decade of life. A few years ago, Ferstein did develop atrial fibrillation (A-fib), an abnormal heart rhythm, but it was successfully treated with a non-invasive procedure called cardiac ablation.
Surprised by Symptoms
In 2011, Ferstein’s annual echocardiogram showed moderate progression of his valvular disease, but he did not feel ill. Then in December of that year, the symptoms hit: Ferstein began having trouble breathing, and he felt tingling pain and lightheaded.
The symptoms became so severe he went to the Northwestern Lake Forest Hospital Emergency Department and was evaluated by Ian Cohen, MD, FACS, FSCAI, medical director of cardiology. Ferstein learned that his heart valve—the one that was not supposed to trouble him until he was older—required replacement as soon as possible. Without heart surgery, he was at risk for life-threatening cardiac complications.
“Suddenly the valve defect was hanging right over me,” he recalls. “I thought, I have a job, two small kids, and I’m only 33—how can this be happening? How do you replace part of your heart? I had a week to take care of everything: make out a will, arrange for long-term leave, figure out what to do about our kids. It was scary.”
Two Problems, One Fix
Luckily for Ferstein, the expansion of Northwestern’s Bluhm Cardiovascular Institute (BCVI) to Northwestern Lake Forest gave him convenient access to cardiac care ranked No.1 in Illinois and No. 16 nationally.* The BCVI has been at the forefront of heart research and interventional cardiology for many years. They have developed treatments and procedures for complex cardiac diseases, including a Program for Atrial Fibrillation and a Bicuspid Aortic Valve Program. Dr. Cohen arranged for Ferstein to see cardiovascular surgeons and heart rhythm experts at BCVI.
Under the leadership of Patrick McCarthy, MD, BCVI provides the most advanced approach to treating patients like Ferstein: surgically correcting A-fib at the same time as another surgical procedure, in this case a valve replacement.
A recent study conducted by Northwestern Medicine® researchers and published in the Journal of Thoracic and Cardiovascular Surgery indicates that atrial fibrillation should be surgically treated when a patient is undergoing another cardiac surgical procedure. Currently, only 38 percent of patients with A-fib receive simultaneous treatment at the time of cardiac surgery. At BCVI, 90 percent of patients with a history of atrial fibrillation are treated when they undergo cardiac surgery.
On the Cutting Edge
For the valve replacement, Ferstein’s physicians recommended a bioprosthetic tissue valve—made from porcine or bovine heart valve tissue—instead of the traditional mechanical valve. These tissue valves are now known to be durable and long-lasting. Another advantage of tissue valves over mechanical valves is that they do not require long-term blood thinners. By using these valves, the patient avoids the complications that often accompany lifelong blood thinner use.
“I decided that I couldn’t manage the side effects of blood thinners because I’m pretty active with my kids,” Ferstein says. “I also learned from my physicians that if the bioprosthetic valve wears out, in the future an even more advanced replacement technique will likely be available.”
At the time of the valve replacement, Ferstein also received a Maze procedure to treat the A-fib. In a Maze procedure, carefully placed incisions and scar tissue created blocks—like the dead ends in a maze—force the heart’s electrical signals to move along a specific path, restoring normal heart rhythm.
“Electrical signals trigger the heart muscle to contract in a sequential fashion, like throwing a rock in a pond with concentric waves,” explains Dr. Cohen. “With A-fib, it’s like throwing a hundred rocks in the pond, simultaneously creating multiple chaotic waves. Maze provides a more permanent, surgical solution by restoring the normal wave pattern. By fixing Brad’s A-fib during his valve surgery, he would no longer face complications from his heart arrhythmia.”
Ferstein’s surgery was successful and free of complications, aided by visits from a Northwestern Home Health nurse. The fatigue and pain often caught him by surprise, but after six weeks he regained his strength and returned to work.
He believes the convenience of having BCVI expertise close to home made the difference in his overall recovery. He went to Lake Forest for all preoperative and postoperative testing and care and only traveled to Chicago once, for the actual surgery.
“At first, I had to see my medical team several times a month, but I was able to do that in Lake Forest,” he says. “It would have been very difficult to keep finding a sitter for our kids and then drive an hour into the city. After the surgery, Home Health arranged for a home nurse to take care of vitals checks and wound care.” Northwestern Home Health is one of the oldest licensed home care agencies in Illinois.
Heart Surgery Expertise
Ferstein notes that although the majority of his care was in Lake Forest, his experience at Northwestern Memorial also eased the anxiety associated with surgery.
“The private room and the care by the nurses downtown was great, too,” he recalls. “They were very attentive to pain management. And the coordination between Northwestern Memorial and Northwestern Lake Forest was seamless. I didn't have to do a thing.”
Dr. Cohen attributes Ferstein’s positive outcomes and overall experience to the expertise at both hospitals, as well as the patient’s positive attitude.
“BCVI is very good at these multi-procedure heart surgeries,” says Dr. Cohen. “That’s what happens when you perform thousands of procedures and have nurses who only work with heart patients. They can also draw from a huge network of experts and research. Northwestern Lake Forest’s connection with BCVI is great for local patients—there’s really nothing quite like it.”
All About the People
Ferstein knows that having access to BCVI physicians in Lake Forest had a lot to do with his recovery and good health. But he believes the people who cared for him are just as important.
“I liked Dr. Cohen right away,” he says. “He connected me with the right physicians—knew everyone and just called them up from his cell phone. I’m keeping him as my cardiologist going forward. And the team downtown was amazing, not at all what you’d expect from high-profile heart surgeons. They were really nice and very accessible. I felt informed and confident throughout the process.”
Ferstein is also grateful for his wife Jamie, who supported him through unexpected heart surgery while caring for their children and working.
“Getting through major heart surgery has a lot to do with my wife,” he says. “She carried the load during those months and there was a lot of stress. If she ever broke down, I didn’t see it. Our friends and relatives helped out, too. Between my physicians and my family, I feel truly blessed.”
*U.S. News & World Report, "Best Hospitals" metro-area ranking, 2012, usnews.com/besthospitals.