Unquestionably, the most striking thing about Esther Barbieri is how young she looks. A youthful, radiant glow sweeps across her elegant face and belies her age.
She is the matriarch of a huge, close-knit family – nine children, 30 grandchildren, 46 great-grandchildren, five great-great-grandchildren – scattered across three different continents.
A native of Peru, Esther has been a picture of health for almost all of her 95 years. Active, independent, a lover of dance and travel, Esther is also an avid walker – known to outrun just about anyone to catch the bus.
She was a seamstress in her homeland, raising her children on her own after becoming a widow in 1969. She immigrated to Canada at the age of 66 and, outside of regular visits to her home country, lives in the Greater Toronto Area with her youngest daughter.
Her journey to the Peter Munk Cardiac Centre (PMCC) came almost by accident.
In July 2014, she had a heart attack – the first health scare of her life. Visits to two other hospitals eventually led to her being fitted with a stent. Things improved, but only for a short time. She had several worrisome episodes in the months to follow, including fainting spells and shortness of breath.
"The cardiologist at the other hospital told us she couldn't be operated on, that her heart had been damaged," says Maria Barbieri, the eighth of Esther's nine children.
"He was going to prepare a report to let doctors here [at PMCC] know that there was not much to do. He wouldn't touch her because of her age. It was devastating. It was like all the doors were closed," recalls Maria.
Esther's valve was in urgent need of replacement. She went into cardiac arrest during one hospital visit, but she came back.
She was referred to the PMCC in November 2014, where doctors determined she wouldn't be a candidate for a Transcatheter Aortic Valve Implantation (TAVI) procedure. The race to find another option ensued.
Enter, Dr. R.J. Cusimano, a cardiac surgeon at the PMCC. In tandem with a medical team, he decided surgery was the only option.
"We were expecting doctors here to agree with the cardiologist at the other hospital," Maria recounts. Instead, "he told us that if he were going to operate on a 94-year-old lady, it was going to be my mom."
"The main risk was that I would have been wrong about her outcome," says Dr. Cusimano. "Most patients and families can accept death, especially in high-risk situations. The more difficult outcome is prolonged or permanent disability," he says.
"In her case, any neurological impact such as stroke or memory loss would have been the absolute worst case. That is why we surgeons are so happy when our patients wake up normally after an operation, whether we show it or not."
Esther became the oldest patient Dr. Cusimano has ever operated on. Her overall good health, physical strength and heart health history – all positives – were key to Dr. Cusimano's decision.
The Barbieri family waited, wondered, wished and paced during the 3.5-hour procedure, which happened on November 26, 2014. "We were drinking coffee like crazy," remembers Maria, tears welling.
"When Dr. Cusimano came out, he came out with both his thumbs in the air, smiling. We knew right away everything was okay," says Maria.
"He told us, 'Your mom is 94, but inside she is much younger.'"
"Now that her heart is fixed, she faces a prolonged survival with a good quality of life. At that age, quality of life is our primary goal. She will likely not die from heart disease, so she may live for many years," says Dr. Cusimano.
"There is no word to describe how grateful we are," says Maria. "Total elation," adds Maria's husband, John Simpson.
In January 2015, Dr. Cusimano gave Esther the green light to go dancing – one of her passions. And just three months after surgery she was in Lima, Peru, where she stayed until Mother's Day to celebrate with family there. Her next big adventure? Esther has been planning to travel to Italy to visit Maria's three brothers.
Adds Dr. Cusimano: "She is supposed to send me a postcard on her 100th birthday. That may very well happen."
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