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Heart health warning: Man scheduled for hip replacement winds up with quadruple bypass surgery
February 16 2023, 08:00

A Manhattan man’s discussion with his orthopedic surgeon days before his total hip replacement surgery resulted in a stunning discovery about his heart

David Holland, 57, said his orthopedic surgeon, Dr. Vladimir Shur, PhD and chief of trauma service in the Department of Orthopedics at Mount Sinai-Beth Israel in New York City, decided to delay Holland’s surgery after discovering that Holland had a heart murmur. 

Despite Holland’s assurance that he'd had his murmur since childhood and had no symptoms of heart disease, the surgeon insisted he get it checked out before surgery.

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Holland told Fox News Digital that he was active prior to his hip issue — he played hockey and tennis throughout his 30s. Pain in his hip, not a heart issue, was limiting his activity level, he said. 

"I took statins for high cholesterol, but other than that I had no idea anything was wrong," he said.

"It’s so surreal," he said. 

He added, "I’m happy to be alive."

Holland said that Dr. Shur, FAAOS (Fellow of the American Academy of Orthopaedic Surgeons) was not comfortable doing the surgery without a cardiologist's workup — especially given that Holland had several family members with histories of heart attacks and a history of high cholesterol.

"I thought overkill — just never had any issues," said Holland. "I thought he was being overcautious."

Shur told Fox News Digital that as an orthopedic trauma specialist and joint replacement surgeon, he believes it is important to be thorough. 

"I am not just putting metal into a patient," said. 

"The patient has to be looked at medically," he said — noting that it is "very important to be sure the patient is fit for surgery before it is too late."

Shur sent Holland to Dr. Maurice Rachko, a cardiologist at Mount Sinai Beth Israel Hospital who performed a simple non-invasive test called a calcium score screening heart test.

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A normal calcium score test is less than 10. Holland’s score was 2,060.

That result led Holland to Dr. John Fox, an interventional cardiologist at Mount Sinai Beth Israel Hospital. 

He conducted an angiogram that revealed Holland had four blocked coronary arteries of his heart. Holland shared that Dr. Fox told him that the coronary arteries were so blocked the doctors could not use stents.

Dr. Fox quickly consulted with Dr. John Puskas, chair of cardiovascular surgery at Mount Sinai Morningside Hospital in New York City's Upper West Side, where Holland had the surgery within days of the angiogram. 

"I went in for a hip — and instead got heart surgery," Holland said.

He added, "The teamwork was seamless between the doctors." 

The test that raised the red flag is called a calcium score screening heart test

It is a non-invasive procedure that involves placing an IV in the arm and a quick pass through a CT scan that measures calcium deposits in the coronary arteries of the heart, cardiac specialists told Fox News Digital. 

A higher coronary calcium score suggests the person has a higher risk of narrowing in the coronary arteries and an increased chance of a future heart attack, according to heart specialists.

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Puskas said in an interview that calcium score testing is a "big breakthrough" in terms of screening for heart disease. 

"The latest CT scanners are relatively low radiation, so it's really a very benign, non-invasive test. It has a very strong predictive value in identifying a patient who has important blockages of the coronary arteries even before they become symptomatic."

Dr. Puskas said patients often think they are asymptomatic because they do not recognize the symptoms — and in some cases they even mistake heart pain as heartburn related to gastroesophageal reflux disease (GERD).

"The GERD is actually angina. It's heart pain, not heartburn. It is not coming from the stomach. It's coming from the heart, but it's been treated with Tums or antacids or whatever," he said. 

Puskas added, "The [cardiac] calcium score is a very objective way of identifying those patients and getting them on the pathway toward treatment before they have a big heart attack. It is one thing to have a heart attack and then a coronary bypass operation. It is much better to have the coronary bypass instead of a heart attack to prevent that heart attack." 

He concluded, "That really is the fundamental benefit of coronary surgery. It's to prevent a heart attack." 

Puskas said that CT scanners are becoming more sophisticated. 

"We now have CT scanners that will tell us not just how much calcium is in the coronary arteries, but how tight the blockages are in the coronary arteries." 

Puskas also said Holland underwent a unique type of open-heart surgery rarely performed in the United States. 

Holland underwent an "all arterial, no aortic touch, off–pump, quadruple bypass surgery," he said. It's a surgery performed in less than 1% of patients in the United States, according to the cardiovascular specialist.

The heart is not stopped during the surgery, he said. There is no use of a heart-lung machine, and the aorta (a big artery in the chest near the heart) is not clamped during the procedure. 

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By avoiding clamping the aorta during surgery, the risk of stroke is reduced, the surgeon explained to Fox News Digital. 

Puskas also said this type of surgery actually rewires arteries from the patient’s chest and one from the arm to help provide blood flow to the heart, instead of using veins stripped from the legs. 

"It's sort of the latest and greatest way of doing coronary bypass surgery. Quite different from a surgery that was designed in the '70s and which is still the most common way of doing it," he said.

The heart surgeon explained the benefits of using artery vs. vein grafts to do a coronary bypass, especially in a younger patient.

"We know the arteries will last longer than the veins. Arteries are designed for a high-pressure environment. Veins are designed for a low-pressure environment. When we take veins from the legs and attach [them] to the heart, they are now in a high pressure situation — and they don't last as long as arteries." 

The vein grafts tend to wear out in a decade, said Puskas.

"Half of veins will have closed in 10 years. That's OK if you're 77. But [this patient is] 57. So we want to give him an operation that's going to last decades."

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Holland said he is recovering well since his surgery this past November. "I went in on Monday and [was] home Thursday," he said. 

Within a week, he was "able to walk a mile and a half without stopping," he proudly said. 

He credits Dr. Shur with potentially saving his life, thanks to his thoroughness. 

Shur, the orthopedic surgeon, said that surgery places stress on the body and "so anything, murmur or shortness of breath — I take it seriously."

He added, "The safety of our patients is our first priority."

Shur credits his keen sense and thoroughness to his training with trauma patients at the University of Maryland in Baltimore’s Shock Trauma Center.

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As for Holland, he hopes his story will raise awareness for others that it's important to get checked for heart disease, even if people don't think they have any signs or symptoms. (He has not yet had hip replacement surgery.)

Coronary artery disease is the no. 1 killer of humans, said Dr. Puskas. He suggested that those who have classic risk factors for coronary artery disease — including a family history of heart disease, diabetes and high cholesterol (being overweight and being a smoker are also risk factors) — to ask a physician about the calcium score test. 

Diet and exercise are important in preventing heart disease, he also noted. 

"Diet and exercise — there’s no substitute. No pill will replace that," he said.