The Retired CEO: I Got a Pig: Reflections From the Cutting Edge of Cardiac Innovation [Redux January 2025]

(Source: Heartvalvesurgery.com)

“A cat will look down to a man. A dog will look up to a man. But a pig will look you straight in the eye and see his equal.” -- Winston Churchill

Of all the innovations I've been exposed to through the years, from TempTales and modern air conditioning to cotton gins and Hamilton, the one closest to my heart is the 23MM Epic Supravalve.

~~Six months~~ Four years ago today, surgeons at Beth Israel Deaconess in Boston cracked open my chest, switched on their magic heart-lung machine, cut out my wonky, calcified aortic valve, and sutured in a new, porcine Epic Supravalve.

In another place or time, I might have received a bovine valve, or even one taken from a cadaver. Was I a little younger, I might have chosen a valve made out of carbon.

But as it happened, on January 28, 2021, lying on an operating table not far from Fenway Park, I got a pig. I'm delighted to report, after a first year of up-and-down healing, there has been barely an oink. Thank you Beth Israel. Thank you Metoprolol.

Think Mercedes

In medical-speak, I received an xenograft of a bioprosthetic heart valve made from porcine aortic valve cusps matched for leaflet coaptation and hemodynamics.

If it helps, think of an aortic valve as a Mercedes Benz logo, its three leaflets intended to open and close snugly. And think of my valve as having two of those leaflets stuck together, plus six decades of frayed edges.

Again, the easiest description is: I got a pig.

Besides Arnold and Peppa, footballs and bacon, Pulp Fiction, Charlotte's Web, and Lonesome Dove, we like pigs because their hearts are similar to our own in size, weight, and structure.

Likewise, the 23-millimeter valve I was given is correct for my body size and weight, like choosing a comfortable pair of shoes. And the last thing you want is to spend all day in the wrong-sized shoes.

Check that. The last thing you want is to have been diagnosed with a wonky aortic valve before 1965.

Because that was the year that pigs began to fly, or at least flow.

The Arc of Innovation

In September 1965, a team in Paris completed the first xenograft replacement of an aortic valve, and by January 1968, had implanted 61 porcine valves in 53 patients.

Entrepreneurs claim to want to be on the cutting edge of innovation, but the truth is that the cutting edge can be a very unpleasant place. Only 65% of those early porcine valves functioned well at six months, and 45% at a year.

A patient's immune system wanted no part of having a large, interspecies object sutured onto a major organ.

So, medical innovators went to work with chemicals like sodium periodate and glutaraldehyde-buffered solutions. The result substantially reduced the human body’s immune response to animal valves.

The percentage of functioning valves in one year increased to 82%, an engineering miracle. Through the years, results have continued to improve rapidly and substantially.

Today, pushing innovation ahead in many companies means getting a team of software coders to play nice together. At a company like Sensitech, it means encouraging software and hardware engineers to work hand-in-glove.

But for porcine heart valves to evolve, it takes the relentless pursuit of innovation by a combination of cardiologists, surgeons, mechanical engineers, biologists, and biochemists.

It's a complex, high-stakes process where failure is not about cleaning up a few bugs in the next release but the quality of life and sometimes life itself.

The Future

About 250,000 human heart valves are replaced worldwide each year. When I asked my surgeon how many successful implants he had done, he smiled and asked, "This week?"

That's the right answer. One person's major surgery should be another person's walk in the park.

Today’s valves, like the one I received, are harvested from pigs intended for consumption. Tomorrow, researchers may breed pigs with valves genetically altered for human implantation.

The Guardian reported not long ago that adapted pig hearts—the whole thing--could be transplanted into patients within three years.

You first, of course, and please let me know how it goes.

So, if we compare my Epic Supravalve against a healthy native valve, I believe we are about two-thirds of the way to where medicine would like to be.

I would rather be much further along on that innovation arc, but I also know, except for fate, that it might also be 1964.

A 2025 Update from my new BFF, ChatGPT

ChatGPT, how many heart valves are replaced each year?

ChatGPT said: Approximately 300,000 to 350,000 heart valve replacement surgeries are performed worldwide each year. This number includes procedures to replace damaged or diseased heart valves, such as the aortic, mitral, tricuspid, or pulmonary valves. The majority of these surgeries involve replacing the aortic or mitral valves.

In the U.S. alone, over 100,000 valve replacements are conducted annually. With advancements in technology, less invasive options like transcatheter aortic valve replacement (TAVR) are becoming more common, especially for patients who are at high risk for traditional open-heart surgery.

Would you like more details?

No, Chat GPT, but I would note that my cardiologist promised that my subsequent aortic valve surgery (sure to come in about 5 to 7 years), when my current pig gives up the ghost, will be a TAVR (through the groin) procedure that will have me up and out of the hospital in a flash. Having your chest cracked open--as many of you know--is like being in an automobile wreck.

With Thanks

I don’t really like to think about what happened to me on January 28. I have assiduously avoided watching any YouTube videos showing open-heart surgery.

I have joined and unjoined the "Aortic Valve Replacement Group" on Facebook five times. (Soon, I may be banned for life.) Most of the stories are positive, but occasionally, one is so harrowing that I can't help but click the unjoin button.

I may have gotten a pig, but I am still a chicken.

My cough pillow, another brilliant innovation

That doesn't mean I'm not thankful for skilled surgeons and brilliant medical entrepreneurs worldwide, nor am I unhappy to be on an arc of innovation that makes this life-changing operation possible.

I also appreciate pigs more than you can know.

Thanks especially to the folks at BIDMC for pushing forward on cardiac innovation.

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