The 62-year-old Crabb had quadruple heart bypass surgery Tuesday at FirstHealth Moore Regional Hospital in Pinehurst, the same procedure Clinton successfully underwent the day before at a New York City hospital.
Crabb expected to be released from the hospital Saturday. Although he’s a Republican, Crabb wishes Clinton well and is certain to follow the 58-year-old former president’s recovery.
Crabb’s surgeon, Dr. John Krahnert, took parts of a vein in Crabb’s left leg to create new detour arteries to restore the blood flow to his heart.
“I’ve got a better doctor (than Clinton),” Crabb joked in his hospital room Friday morning.
The bypass surgery should prevent Crabb from having a heart attack. Coronary bypass surgery is a 30-year-old method of treating heart patients with multiple blockages.
Crabb pulled up his pajamas to show the huge metal staples running vertically along the center of his chest and holding his 12-inch incision together, supported underneath by wires that will be removed before he goes home.
In a couple of weeks, the staples will be removed at Krahnert’s office, and Crabb expects to resume his normal lifestyle within a year. That is about the same timetable as Clinton’s.
His left leg also has a series of staples in three places where Krahnert harvested new tissue to create new arteries.
“I was looking for some relief from the angina pain,” Crabb said. “I was looking for a better life.”
Crabb had his first heart attack in 1992. His jaws ached, which he never associated with heart disease but is one of the symptoms along with the better-known chest pains. He was on a low-fat diet, which he admitted he did not follow 100 percent of the time.
Twelve years ago, Crabb said, balloons were inserted to open the clogged arteries in three places, but they missed the main heart artery, which was totally blocked this time around.
After he began having chest pain recently, a diagnostic catheterization revealed the serious blockage in the main artery of his heart and the three smaller arteries that had the previous “balloon” treatment, which were 85 to 95 percent blocked, he said.
He clutched a heart-shaped red pillow to his chest as he coughed. The pillow serves a medical purpose. Patients can find some relief from the discomfort caused by coughing. The pillow “stabilizes” the opened wound beneath to prevent tearing or damage from the muscle contractions. Hiccups are also a hazard that the pillow helps with, said Meg Talley, the charge nurse and head of Crabb’s step-down, post-operative cardiac unit.
Crabb was off the mechanical ventilator, but still wore a small oxygen tube on Friday. He’d been up and walking with assistance. Three large drainage tubes, which had caused him “escruciating pain” during the first day following surgery, had been removed from his chest and lung area.
His experience has been normal, Talley said. Crabb had gone from the operating room to a cardiac surgical intensive care unit, with one nurse to each patient, to a less intensive unit by Friday, with a patient-nurse ratio of three to one.
Crabb, who is in sales and does some farm-type work for a living, said one of his grandfathers had heart disease. But Crabb said he had no other health problems before the blockage was detected.
Laughing and joking with his surgeon and the nurses, Crabb was looking forward to going home.
“I’ll be able to sleep the night through without being waked up to check my vital signs,” he said.
Proven Track Record
Bypass surgery is a tried-and-true option with a 30-year history of success, Krahnert said last week.
Krahnert founded the 14-year-old cardicac/thoracic surgery program at FirstHealth Moore Regional Hospital in Pinehurst. He did the first coronary bypass surgery there in September of 1990.
The program has been ranked among the nation’s top 100.
“We do just over 400 heart cases a year,” Krahnert said in a Thursday telephone interview. “Seventy to 80 percent are coronary bypasses. The rest are valves and other treatments.”
The hospital does repairs and replacements of leaking valves along with the more dramatic treatments.
Krahnert considers the Clinton case a testimonial to First-Health’s traditional emphasis on the bypass operation. Krahnert and his fellow cardiac surgeon, Dr. Andy Kiser, concentrate on doing these procedures, in which history has given them the most confidence.
FirstHealth is not jumping on the experimental bandwagon of procedures that some larger hospitals like New York Presbyterian-Columbia have as options.
“We are operating on older, sicker patients than we were 14 years ago,” he said. “We are routinely operating on those we didn’t use to do because of their conditions.”
Newer surgical methods such as robotic or keyhole surgery that are less invasive were apparently not considered an option when it came to operating on the former president.
“When it came to crunch time, they went for the bypass,” he said.
Krahnert said the Pinehurst hospital has traditionally had a lower than 1 percent fatality rate for coronary bypasses, compared to the national fatality rate of 1 to 2 percent.
The youngest person he ever operated on was a 31-year-old woman. She was a diabetic and smoked. Both parents had suffered heart attacks. Because she drove trucks for a living, Krahnert suspects she also ate junk food — another culprit.
The oldest patient to undergo a bypass was 93, Krahnert recalled.
“The average age is 66-67 for coronary bypass surgery for us,” he said, adding that some people in their 80s have it as well.
In bypass surgery, a new artery is created to feed the heart with oxygen-rich blood that it needs to function. Heart attacks are caused when the heart’s blood supply is cut off or seriously reduced. Other treatments are also designed to relieve heart artery blockages.
Clinton and Crabb can both expect to live a normal life span and eventually go back to an active lifestyle, but only after at least a yearlong convalescence.
Less Invasive Procedures
More and more patients, frequently those in the earlier stages of coronary disease, choose a less invasive, newer “stent” treatment developed eight years ago.
Before any kind of treatment is done, a diagnosis of the problem is completed by a cardiologist and treatment options are considered, based on the individual patient’s condition and needs, said Dr. Patrick Simpson, a cardiologist and chief of cardiology with Pinehurst Medical Clinic. He is a staff cardiologist and director of the noninvasive catheterization lab at Moore Regional.
“It’s very individualized,” he said.
A catheterization procedure photographs the patient’s arteries to find out where blockages are and how extensive they are. Then, either an angioplasty approach using balloons or stents (small wire cages that are inserted in to the arteries to keep them open) can be carried out if blockages are in limited, fairly small areas, he said.
The other option is bypass surgery, which is usually performed if a patient is a diabetic and has multiple blockages, he said.
At FirstHealth, doctors perform 4,000 different heart surgical procedures yearly, including valve replacements and repairs. About 1,500 of them are angioplasty-stent procedures. Some require as little as an overnight hospital stay.
More and more stents are newer “drug eluting” stents. They are covered with medicine that prevents scarring and blocking the host artery.
“The stents usually go to the younger patients,” Simpson said.
This buys them more time for potentially having two bypass surgeries in future years, he said.
Stents, he said, successfully keep 96 percent of the patients who get them clear after one year. The average is 92 percent for diabetic patients.
Simpson said the coronary bypass is good for an average of 10-12 years.
Some patients have two bypasses during their lives, but few can have three and recover satisfactorily from the rigors of surgery.
