Man sitting in a wheelchair next to a doctor

Seven stents and a new aortic heart valve—that's what physicians found Carroll Stratmeyer, 78, needed when he arrived by ambulance at University of Maryland St. Joseph Medical Center's Emergency Department. All three of his major heart arteries were blocked, both carotid arteries in his neck were severely blocked and the aortic valve in his heart was barely working.

The challenge facing the team of emergency physicians, cardiologists and cardiac surgeons was how to save his life.

A Beautiful Fall Day Turns Critical

Carroll's lifesaving journey to UM St. Joseph's Heart Institute began one day last October after the retired Bethlehem Steel pipefitter spent four hours digging a hole to plant one of two new sugar maple trees in his front yard in Joppa. His hobby is gardening. Every year he plants a large organic vegetable garden from which he shares the fruits of his labors with friends, neighbors and family. He takes great pride in his landscaping work.

"That evening, I couldn't breathe or move, and I couldn't stop belching. By the next day, my chest pain was much worse," said Carroll, whose wife, Jackie, called an ambulance which took him to nearby University of Maryland Upper Chesapeake Medical Center. Following testing there, an expert team of physicians determined that Carroll needed a three-way heart bypass operation, so they arranged for his transfer by ambulance to the closest hospital in the University of Maryland system that performs open-heart surgery: UM St. Joseph Medical Center.

Not a Candidate for Open-Heart Surgery

At UM St. Joseph Medical Center, board-certified cardiologist Ronald Schechter, MD, who was on call that Sunday, led the team managing Carroll's care. Following testing, they determined that he was suffering from three major problems.

"Mr. Stratmeyer had suffered a heart attack, he had a bad heart valve and his heart muscle was weak," said Shumile Zaidi, MD, a board-certified cardiologist specializing in interventional cardiology and director of the Cardiac Catheterization Lab and Structural Heart Disease Program at UM St. Joseph, who was brought in on the case. "Because of the blockages in the carotid arteries of his neck, he was at risk of suffering a stroke during open heart surgery."

Due to this unique combination of cardiovascular issues, it was determined that Carroll might not be able to survive open-heart surgery. However, said Dr. Schechter, "I told Mr. Stratmeyer and his wife that although he had a very challenging set of problems, I thought we had a pathway to successfully stabilize the situation and a potential solution. I told them I believed that Dr. Zaidi, our cardiac catheterization team and our critical care team were up to the task and could get him a great outcome."

Dr. Zaidi added, "Dr. Schechter called me and was the one who drove Cardiologist Ronald the solution to the problem. The next Schechter, MD best option was to determine if we could perform cardiac catheterization with stents and fix his other problems."

Life-threatening Blockages

"His left main artery was 90% blocked; his anterior descending artery was 95% blocked and his circumflex artery was 95% blocked. Additionally, the arteries were blocked in multiple places. A heart ultrasound revealed that he had aortic stenosis, meaning that his aortic valve was not opening and closing properly. His heart muscle was weak and pumping at 25%. Normal is 50% to 60%. Both neck arteries had extreme blockages," described Dr. Zaidi.

"I was totally shocked to have all that blockage," said Carroll, who had no known history of heart disease and recently had his cholesterol checked with good results. He said that he used to jog and quit smoking a long time ago.

A Reassuring Plan Takes Shape

"The doctors came to the conclusion that Carroll could not have open-heart surgery.

It was heartbreaking," said Jackie. "Then they brought in Dr. Zaidi, and that man was a miracle worker. He said he would clean out my husband's heart arteries, place stents in them and fix his aortic valve. Dr. Zaidi came to my husband's hospital room at 11 pm that night to reassure him that everything would be OK and that he would be operating

the next morning. Dr. Zaidi had so much confidence that he gave us confidence."

To open Carroll's blocked arteries and implant stents, said Dr. Zaidi, "a major concern was could we perform heart surgery so that Mr. Stratmeyer would survive despite his weak heart muscles. The answer was that we implanted an Impella® pump into his heart to take over pumping his blood. The pump temporarily becomes your heart until the stent procedure is complete so that blood continues traveling to your brain and organs." The Impella is inserted through a sheath through a small incision in the femoral artery of the leg and guided over a wire into the left ventricle of the heart.

Seven Stents and a New Heart Valve

All this took place in UM St. Joseph Medical Center's cardiac catheterization laboratory. To open the heart's arteries, Dr. Zaidi and the cardiac catheterization team performed a rotational atherectomy, which, he explained, "is almost like using a drill to shave the plaque out of the arteries. Then, we placed seven stents into his arteries, they were so diseased."

Two stents went into the left main artery, three stents went into the anterior descending artery and two more stents went into the circumflex artery.

Carroll was weaned off the heart pump and remained in the hospital. Several days later, Dr. Zaidi gave him a new aortic valve without having to open his chest. The valve replacement was performed in the hybrid operating room (OR) adjacent to UM St. Joseph's cardiac catheterization lab. A hybrid OR is an advanced procedural space that combines a traditional operating room with an image-guided interventional suite. This combination allows for highly complex, advanced surgical procedures. Again, Dr. Zaidi performed the procedure by going through Carroll's leg artery, using guided imagery to replace his diseased valve with an artificial valve. Carroll only required light sedation for the procedure.

"Within 48 hours, Mr. Stratmeyer looked like a different person," said Dr. Zaidi. "He was less short of breath and more functional. This is probably one of the hardest cases I've done because of its complexity. It was challenging from all aspects, but planning was the key."

"It's very important that Mr. Stratmeyer is both a physically and mentally strong man with a great will to survive," added Dr. Schechter. "He never gave up and this allowed us to get him through this."

Springing Back to the Garden

Carroll said of his experience, "I've never heard of anybody getting seven stents. I'm doing much better now."

"The care at University of Maryland St. Joseph couldn't have been any better," said Jackie. "Despite everything, it was a wonderful experience. I could go on and on."

Carroll received physical and occupational therapy at home. He is regaining his strength and looking forward to spring when he can plant a new vegetable garden. His wife added, "Our grandson came over to finish planting the other sugar maple tree. I'll always look at these trees, watch them grow and remember what happened."