Cayman Islands Man Back at Work Weeks After Heart Surgery in Miami

When Shane Foster of the Cayman Islands needed highly complex heart surgery late last year to replace a leaky aortic valve, the 59-year-old immediately turned to Baptist Health in Miami. For decades, Baptist was where his family had come for treatment when the level of care required was unavailable back at home.

One of Mr. Foster’s brothers even spent three months in Baptist Health Baptist Hospital with a traumatic brain injury following a terrible car wreck. “Baptist has just been there for us in every way,” he says, adding that he could have gone anywhere for his surgery but never considered any place but Baptist.

(Watch now: When Shane Foster of the Cayman Islands needed highly complex heart surgery to repair a leaky aortic valve, he immediately turned to Baptist Health, where many members of his family have been treated over the years. Miami Cardiac & Vascular Institute CME Tom C. Nguyen, M.D., an internationally recognized minimally invasive heart surgeon, was able to get him back home – and back to his active outdoor lifestyle – in a matter of weeks. Video by Steve Pipho.)

The busy executive and active watersport enthusiast was worried about a long and arduous recovery from open heart surgery, which for decades had been the only option for patients like Mr. Foster. It entails splitting open and spreading the ribcage, repairing the leaky valve and then stitching the patient’s chest back together again.

Although he was resigned to having the traditional “chest-cracking” approach, also known as a sternotomy, Mr. Foster was desperately hoping that Baptist Health had someone with the expertise to perform minimally invasive aortic valve repairs. From his research, he knew that the minimally invasive approach greatly reduces the patient’s post-surgical pain and discomfort while speeding up their recovery time. And he had zero interest in being laid up in a hospital even a day longer than necessary.

Tom C. Nguyen, M.D., chief medical executive, Barry T. Katzen Medical Director Endowed Chair and director of minimally invasive valve surgery at Baptist Health Miami Cardiac & Vascular Institute

Thanks to what Mr. Foster calls “God’s providence,” he was able to see Tom C. Nguyen, M.D., an internationally recognized minimally invasive heart surgeon who had just joined Baptist Health Miami Cardiac & Vascular Institute as chief medical executive, Barry T. Katzen Medical Director Endowed Chair and director of minimally invasive valve surgery. Dr. Nguyen was able to perform minimally invasive valve replacement of Mr. Foster’s aortic valve and get him back to his active outdoor lifestyle – not in a matter of months but in just a few weeks.

Enjoying life in and on the water

Mr. Foster describes the Cayman Islands as “one of the most unique and special places in the world” and spends much of his free time either in or on the water. “I love to sport-fish for Marlin and Wahoo, and I’ve picked up fly-fishing now for Bonefish, which is my new passion and love,” he says. “I love to dive with my sons and we also do a lot of boating, water skiing and that sort of thing. During the pandemic, I picked up cycling, too, so I cycle with my boys as well.”

A family history of “heart problems” had Mr. Foster keep an eye on his own health. His brothers have what is called a PFO (patent foramen ovale), a hole between the heart’s left and right upper chambers that exists in everyone before birth but almost always closes up shortly after. In their cases, it didn’t close. Most people with the condition never know they have it until it’s discovered during tests for other health problems, according to experts.

As a result of his brother’s PFOs, even though his own health generally has been very good, Mr. Foster has been careful about his heart health, keeps his high blood pressure under control and follows up regularly with his doctor.

When he told his physician he was planning on doing some deep dives in the year to come, the physician became concerned. Listening to Mr. Foster’s heart, he detected a heart murmur – a distinctive “whoosh” sound – indicating a possible leaky aortic valve. If there was a problem with the valve, diving to any depth could place tremendous pressure on his heart and aggravate his condition.

What is a leaky aortic valve and how common is it?

Mr. Foster had a condition known as severe aortic regurgitation or severe aortic insufficiency, which Dr. Nguyen says can lead to heart failure and even death if undiagnosed or untreated.

“The very last valve that your blood goes through before it reaches the rest of your body is the aortic valve, and his valve was leaky,” Dr. Nguyen explains. “With aortic regurgitation, every time the heart squeezes, instead of all that blood pushing forward to the rest of your body, much of it leaks backward into your heart’s lower chamber.”

When this happens, Dr. Nguyen says, patients start noticing symptoms such as shortness of breath, fatigue and maybe some chest pain. “If left untreated, the heart’s ventricle becomes dilated or enlarged and its function becomes increasingly impaired, leaving patients feeling like it takes more effort for them to climb stairs or simply walk a few steps,” he says.

Leaky aortic valves are more common than many people think, Dr. Nguyen notes. “Some people have a leaky valve or heart murmur and don’t even know it. Others know they have it but don’t seek care because they worry they’ll have to get their chest cracked open via sternotomy in order to have surgery,” he says. “They don’t realize they have other potential options available to them now at Miami Cardiac & Vascular Institute.”

Benefits of minimally invasive valve surgery

Mr. Foster was fortunate, according to Dr. Nguyen, because his condition was caught early enough for treatment to make a real difference. “Even though he had severe aortic regurgitation, he was right on the cusp of early symptoms where we still had an opportunity to intervene and really help turn his life around,” he says. “With many cases of valvular heart disease, if intervention doesn’t occur early enough the damage can be irreversible.”

Dr. Nguyen points to data showing that patients who have minimally invasive surgery are less likely to need blood thinners and have shorter stays in the Intensive Care unit (ICU). In experienced hands, the procedure also is extremely safe, affirms Dr. Nguyen, whose patient outcomes score in the top 98.7 percent in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) – the largest database in North America dealing with congenital cardiac malformations.

After initially consulting with Dr. Nguyen via telehealth until he assumed his new post at Miami Cardiac & Vascular Institute, Mr. Foster and his surgeon met in person for the first time on the day of his surgery, which took place Nov. 13 at the Institute. In a procedure Dr. Nguyen has performed thousands of times, he made a small incision in the upper right part of Mr. Foster’s chest and deftly removed the leaky aortic valve, replacing it with a bioprosthetic tissue valve.

Mechanical or tissue replacement valves?

According to Dr. Nguyen, bovine valves are medical-grade aortic valves from a cow’s heart and have been used more and more in recent years as an alternative to mechanical valves. “Bovine valves typically don’t require the patient to take blood-thinning medications, which is a benefit for people like Mr. Foster who spend a lot of time being active outdoors. Also, bovine valves last on average 10 to 15 years, although your actual mileage may vary,” he says with a smile.

Mr. Foster says he was reluctant to get a mechanical replacement valve because that would require taking blood thinners. “When I go bone fishing, I’m stepping through all kinds of flats and water, sometimes barefooted,” he says. If he were on blood-thinning medication, slicing his foot on a piece of sharp coral could easily cause him to bleed to death if not treated quickly.

Mr. Foster’s new valve is also big enough that, when he needs a replacement in 15 years, Dr. Nguyen can simply insert a new, slightly smaller valve into the larger one, much like a stent. “If I’m lucky enough to get another 15 years in life, Dr. Nguyen’s got me all set to go and it will be less invasive surgery,” he says.

Up and running the day after surgery

Even though minimally invasive valve surgery is considered major surgery, the difference between it and traditional open surgery isn’t just in the approach or the technology but also in the recovery, notes Dr. Nguyen, who is highly trained and skilled in both techniques. “Because it involves far less trauma to the chest, minimally invasive surgery has been shown to speed the patient’s recovery time, among other benefits,” he says.

Mr. Foster says he was eager to hasten his own recovery so he could get back home and back to work as soon as possible. On the day after his surgery, he was already walking laps around the nurses’ station in the ICU. “I was up and running pretty much right away and was immediately on my way to recovery. By the third day, I was out the door and on my way home,” he says, referring to the Miami apartment his family keeps for times like this.

Shane Foster, center, with his family at home in the Cayman Islands, spends much of his free time on or in the water with his two sons

“I started walking every day around our apartment complex and also taking daily walks around Baptist Hospital’s lake,” recalls Mr. Foster, who was cleared to return to the Cayman Islands just four weeks after his surgery. A month after his return home, Mr. Foster reports that he’s feeling great. “I feel very strong. I’m walking 40 minutes on the beach. I’m going to start doing some light weights now and I’m fully back to work every day.”

Blessed to be an example of what Baptist can do

Dr. Nguyen is pleased with his patient’s progress. “Now that his valve isn’t leaking anymore, his heart function is back to normal,” he reports. “Mr. Foster can expect to have a normal life from here on out but if he ever needs another intervention or more complex care, he knows that we’re always here for him.”

Mr. Foster says the care he has received at Miami Cardiac & Vascular Institute has been “nothing but fantastic” and that Baptist Health is fortunate to have someone with Dr. Nguyen’s expertise.

“You guys are very blessed at Baptist because now you are state of the art as far as heart surgery. You now have the finest facility there is, you have the best surgeons, the best nurses and the best staff,” he proclaims. “I feel tremendously blessed to have had this surgery there and to be an example of what Baptist can do.”

In addition to his patient’s excellent outcome, Dr. Nguyen is particularly pleased with the ease in which Mr. Foster was able to access the care he needed from Baptist Health, even when at home in the Cayman Islands.

“Thanks to telehealth technology, it was a seamless experience for both of us. I was able to monitor his condition from afar in the weeks leading up to his surgery and then again once he returned home,” Dr. Nguyen says. “It goes to show that people can receive excellent care from Baptist, no matter where they are.”