“I had an echocardiogram done in early July and was scheduled for a follow-up appointment July 6. I never made it that far.”
Nathan Baker’s life revolved around bicycles. When not in his bike shop, the 40-year-old co-owner of Hush Money Bikes in Lancaster City raced competitively or enjoyed long rides alone or with his friend and training partner. The last thing the athlete ever expected was to be told he had a life-threatening heart condition.
In late June 2022, Nate hugged his training partner, who also happens to be a nurse practitioner. “She pulled away and said, ‘how long have you had that heart murmur?’ and I said I didn’t even know I had one,” he recalled.
Nate had been experiencing symptoms for a while, including extreme fatigue simply climbing stairs, but brushed them off until his friend urged him to get checked. His primary care provider referred him to The Heart Group of Lancaster General Health for a cardiac workup. There, Nate was diagnosed with a severely leaking aortic valve, a condition known as aortic valve regurgitation.
“I had an echocardiogram done in early July and was scheduled for a follow-up appointment July 6. I never made it that far,” he said.
On July 4, Nate was rushed to the emergency department at Lancaster General Hospital with dangerously high blood pressure and tingling in his fingers and toes. He was admitted for observation and, once stabilized, scheduled for surgery.
Aortic Valve Regurgitation
The aortic valve has flaps that control blood flow to the heart. If those flaps fail to close tightly, some of the blood pumped from the left ventricle can leak back in. This can result in an overworked and enlarged left ventricle, which may weaken and lead to heart failure.
Typically, the treatment for aortic valve regurgitation is replacement of the faulty valve. Fortunately for Nathan, his was not a typical surgeon.
Advanced Surgical Options
Not many heart surgeons do valve repair. Roughly 5–10% offer it nationwide, and of those, a fraction perform it regularly or offer minimally invasive options. Nathan’s surgeon, Jeremy McGarvey, MD, is among the region’s most experienced surgeons at aortic valve repairs and one of the few who performs it using a minimally invasive approach. Dr. McGarvey trained at Penn Medicine in Philadelphia, a leader in aortic valve surgery.
“The easiest approach is simply to replace the valve, and most surgeons would tell the patient they needed a valve replacement. But that’s not really our mentality. If the valve appears repairable, certainly for a young individual like this, we try to make any attempt we can to save it,” Dr. McGarvey said.
A Treatment That Supports the Patient’s Lifestyle
Given Nate’s age and active lifestyle, valve replacement was not the ideal solution. A prosthetic valve from an animal might last 10 years before it needed replacing, and while a mechanical valve might last a lifetime, it would require Nate to be placed on blood thinners for the rest of his life. For an active cyclist, that’s risky—one fall from his bike could potentially lead to a brain hemorrhage.
“For someone like him, repairing the valve is a perfect scenario because he keeps his own tissue, there’s theoretically a long-term durability that may spare him another heart surgery down the road, and he gets to stay off blood thinners. And by doing it minimally invasively, he can get back to his very active lifestyle very fast,” Dr. McGarvey said.
Nate underwent valve repair surgery at Lancaster General Hospital on July 18, and three days later, was strong enough to return home to begin his recovery.
As somebody who, in a typical week, rode a minimum of 200 miles on his bike, slowing down was an adjustment. He gradually began to resume his active training schedule, and added cardiac rehab with The Heart Group.
Nate is grateful he was a candidate for valve repair. “It was a pretty serious checklist. If I weighed an additional 30 pounds … if I were 20 years older … if the hole on the aorta had been a few millimeters lower on the valve, they couldn’t have done it. And just the fact that there is a surgeon here in Lancaster that can do it is another improbable factor. I just feel extremely fortunate,” he said.