A March 20 article incorrectly reported that Sen. Bob Graham (D-Fla.) had received a valve from a pig during a recent heart operation. The valve was from a cow. (Published 3/21/03)
During the 2000 presidential campaign, Richard B. Cheney's heart problems led some people to question whether he was healthy enough to serve as vice president. But when a candidate with a history of cardiac problems is at the top of the ticket, such questions are sure to be more pointed.
In the case of Sen. Bob Graham (D-Fla.), who hopes to be the Democratic nominee in 2004, heart problems should not prevent him from resuming normal activity or limit his ability to campaign for president or serve if elected, according to his doctor and other experts.
Surgeons replaced a valve in Graham's heart, bypassed two clogged arteries and repaired a small hole between two upper chambers during a Jan. 31 procedure at the National Naval Medical Center in Bethesda. The operation went smoothly, and Graham has been recovering without incident.
"He's looking much better," said Richard Elias, a professor of medicine at the University of Miami who has been overseeing Graham's care. "I think it's just a matter of time, probably a few weeks, and he'll be like his old self -- like nothing ever happened."
Graham has been instructed to exercise regularly after his recovery, building up to walking about 2 miles a day, Elias said. But aside from that, he will require no other treatment or special care, Elias said.
Other experts could not comment specifically on Graham's case, but said that patients like him typically recover fully and require no other treatment. Graham, 66, entered the race for the Democratic presidential nomination on Feb. 27.
"This is the kind of thing that, as a cardiologist, I'm very happy to find in a person this age because we can prevent progression of the disease and give them a normal life expectancy," said Thomas Ryan, a professor of medicine at Boston University.
"The surgery is very low-risk, and following surgery there are very few later complications," said George Beller, chief of the cardiovascular division at the University of Virginia Health System in Charlottesville.
Graham received a new heart valve from a pig, which is standard. Pig valves typically last about 15 years, at which time they often need to be replaced. But because the valve came from a pig, patients do not need to take blood thinners, which can cause complications.
Since they were already operating to replace the valve, surgeons bypassed two arteries and repaired what was described as a "pinpoint" hole in his heart. Otherwise, doctors would not have recommended surgery for those problems alone, Elias said.
Tests after the operation showed that Graham's heart function had improved considerably and that his cholesterol level and blood pressure were normal. Graham had begun taking a cholesterol-lowering drug before the surgery and will continue.
The only concern most patients like Graham face is the risk that the new valve will become infected, Beller said. As a result, patients typically take an antibiotic whenever they undergo a dental procedure to protect against bacteria or some other microbe entering their bloodstream, Beller said.
"Otherwise, patients can live a very normal life. They can lead a vigorous schedule and exercise without significant limitations," Beller said.
Doctors had been monitoring Graham's heart for several years after detecting an abnormality in his aortic valve, which opens to allow blood to leave the main pumping chamber of the heart and closes to prevent blood from leaking back in. The abnormality caused conditions called aortic stenosis and aortic regurgitation, in which blood flow is obstructed and leaks.
Tests this summer indicated that the valve's dysfunction was worsening more quickly than it had been, so Graham underwent a procedure known as cardiac catherization to inspect the valve more closely. The Jan. 21 procedure indicated that the valve had deteriorated to the point where it needed to be replaced.
Sidney Smith, a professor of medicine at the University of North Carolina at Chapel Hill, said the high success rate of such operations is an example of the progress in treating heart disease.
"We still have a way to go, but there are situations where we can definitely help return people to normal life," Smith said.