Heart surgeon tells stories of his patients. ‘You must listen to patient’s wishes well.’ 10

Heart surgeon tells stories of his patients. ‘You must listen to patient’s wishes well.’ 10

Heart surgeon tells stories of his patients. ‘You must listen to patient’s wishes well.’ 10

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So I will tell you two stories about my patients. They are very, very short stories. You know, I have hundreds of stories. But the first story I have in mind is a story of a patient who came to me with functional mitral regurgitation and heart failure. This patient underwent the MitraClip procedure. We are in the year 2008. We are at the very beginning of the MitraClip development. At that time, we divided patients into Everest-like or non-Everest-like [treatment selection criteria based on Everest clinical trials]. He was a non-Everest. He had an ejection fraction below 20% or 18%. We have been debating whether MitraClip was a good idea or not.

When we were treating these patients, we didn't know yet what to expect from them. Today we will say this patient was in a 'non-coaptation' risk category. This patient had functional mitral regurgitation, and so a patient would probably not respond to therapy. Well, this patient died one year ago. He survived for more than ten years after the procedure, for 12 years, actually. I don't know if we prolonged this length of his life. I don't know. This is not a part of a randomized clinical trial. But for sure, he lived 12 more years.

But what is more important for me is this. What do I have at my house, office, and room? I have a picture of the dream of this patient. This patient came to me when we were discussing the opportunity of doing or not doing the heat treatment procedure. I said, what do you want? What do you expect from this procedure? He said, you know, I would like to breathe. I have a dream that I can walk again. And if I can walk again, I will go, and I will do the Santiago walk. I will walk to Santiago de Compostela [Way of St. James] to thank God for the miracle. I was laughing. You know, this guy was in NYHA Class 4, and he was unable to walk 20 meters. Okay, listen, if you go there, send me a picture. Well, we did the procedure.

Mitral regurgitation was reduced, but it was not a tremendous reduction. But it was a pretty good reduction. And then, one year later, the patient came to me for a follow-up visit with a passport of the Santiago de Compostela walk [120 to 800 km, depending on route]. You know, for these people, they walk 100 kilometers, and they get stamped at every station they pass, they get a stamp. He brought me a full passport with full of stamps. What this story tells me is that when we do our job, we need to help people. Again I don't know if I can prolong the time of life. I don't know if I prolonged the time of this guy's life. But I was able to fulfill his dream. So with new technologies, we can fulfill dreams which we're not reachable without them.

The other patient's story is the opposite. There was a patient who came to me because he wanted a MitraClip. He knows I'm a MitraClip expert. He comes to me. This guy is an entrepreneur, he has offices in Monte Carlo. He has a flail A2 - A3 mitral valve. He comes to me and says. You know, I was to another colleague of yours, who is very famous, who was cardiology leader in Monte Carlo. He said he could operate on me but only to cut me open [open heart surgery]. I cannot stop. I have a lot of business. I need to have a non-invasive procedure. So he said, can you do me a MitraClip? I see that this is a treatment method after which I can work on the next day. I said, so let's see, let's watch your Echocardiogram. And I started watching the echo. And as I watched the echocardiogram, I thought. Oh my god, this is a flailing of half of the mitral valve. And I'm not sure that I'm going to be able to really solve your problem. Probably today, it would be possible [to do MitraClip] because today we have longer clip arms. But at that time, we had only the initial, the original MitraClip with shorter arms. This patient had Barlow's mitral valve disease with a flailing of half of his mitral valve. This I cannot really do that.

You know, think about your health. I understand you are a businessman. But I will do whatever I can to make you up and running as fast as possible. I will do your heart surgery minimally invasively. So I did it. And the guy one week after the procedure is fine. He discharged himself from a hospital against my will. But he went back to work with a completely competent mitral valve. It was a very good result. He had an active life. This story tells you another aspect of our profession, my personal pathway. Being able to provide the full spectrum of therapy allows me to inform the patients without any bias and also to be credible. Because if I say to the patient, 'it is better to do something else. It's not because I want that something else. But because I know I can do both and I know it's better for you. So this patient also is another lesson - that we need to adapt to the patients. But also we need to provide good information, unbiased information, so that the patient will decide correctly together with us.

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