Intense Pre-Op Testing Day

[skeptic49]

PHOTO: "Sternal Lok Blu" Rigid Sternal Fixation

Today was pretty intense. First I met with my surgeon's right hand man, a nurse-practitioner named Bill. Bill has been very helpful since I first met with him. Today he answered the follow-up questions that I had such as about the total number of incisions I would wake up with post surgery (7 or 8 including three or four drainage tubes, two regular IVs, an arterial IV, and a neck incision for a cardiac catheter!), what medications I would be on, probably at least six including a water pill, something for my bowels, a pain killer, a beta blocker for blood pressure medication, aspirin, and coumadin. I also asked Bill about the relative complexity of my procedure. On a scale of 1 to 10 with 10 being highly complex, my procedure a "Button Bentall" is an 8 or a 9. That's why you go to a major university center like Temple or Penn, a heart center of excellence, to get this type of surgery. Bill also explained the timings that my husband Dan can expect for my procedure. The operation will last between six and eight hours including prep time and post surgery housekeeping before I will be transferred to the ICU. If my procedure starts as scheduled early Monday, Dan can expect to get a report from my surgeon Dr. Wheatley sometime between about 1 PM and 3 PM. Bill also commented on the general anesthesia used. Two different agents are administered. One knocks you out and the other paralyzes you.

After meeting with Bill I met with my surgeon Dr. Wheatley. By this point in the process most of my questions had already been answered. I did disucss the possibility that I might require a permanent pacemaker post surgery. Dr. Wheatley told me that there is only about a 10 percent chance of that. Since I blog about BAV disease and aneurysms and my own situation, I might want to write further about it at some point. In this connection i asked Dr. Wheatly if he planned to take photos of my procedure. He indicated that he did not do this routinely but he would try to make some media available for me.
After meeting with Dr.l Wheatley it was time for pre-admission testing. This included an examination by a nurse-practitioner, blood work, and chest X-rays. I got anti-bacterial body wipes that I must use the night before my surgery and also on the morning of the surgery. I also asked if I could see the cardiac intensive care facility and the step down unit, but apparently Temple Hospital does not allow casual visitors to these facilities.
Finally, Dr. Wheatley asked me if I would be interested in participating in an evaluation of an alternative sternal closure device, "Sternal Lok Blu," which are metal plates screwed to the sternum instead of wires. Dr. Wheatley feels that this method is superior to the wires. I agreed but since it is a study only half of the participants will receive the rigid sternal fixation devices and the other half will get the usual closure with wires. I'm hoping to be one of the lucky recipients of the Sternal Lok Blu closures. I won't know until after the study ends, though, in about a year.
So now I have only four days before surgery happens. The train has left the station and I'm on board. There's no getting off now.

Jim

 

[pellicle]

fascinating image ... is it for sternal closure or something else?

 

[Paleowoman]

Good you had such a good pre-op test/assessment - really it's much better that you go into surgery knowing all this…, not that it will make any difference to you while you're under and still asleep after surgery. The surgeon told my husband that my surgery would last between three and four hours so hubby was very surprised to get a call from her just over two hours after the start of surgery ! They were really quick with mine. The night before surgery I also met with my aneasthetist - in the UK you are admitted the afternoon of the day before surgery. My anaesthetist was wonderful, he spent a lot of time with me explaining the anaesthesia and answering my questions about it - like I was worried about it not working and ICU psychosis, he was very reassuring. My anaesthetist is the Preseident of the Royal Sociaety of Anesthetists so I was really privileged to have him and that's why I list him first in my signature rather than my surgeon - it is the anesthetist that keeps you alive during surgery while the surgeon gets on with the cutting and sewing job ! I was also worried about the intubation - I never felt the tube after surgery when I woke, never felt that intense thirst some people complain about, and actually my best day post operatively was in ICU once I was fully awake ! I felt really well, very with it, no pain, good appetite, and no pain at all when they removed the drainage tubes either !

All the best for your surgery - that sternal closure thing looks good.

 

[skeptic49]

fascinating image ... is it for sternal closure or something else?

Yes, it is an FDA-approved system for rigid closure of the sternum. The advantage over wires is that the plates keep the two halves of the sternum in correct alignment. As a result, there is supposed to be quicker healing and less pain.

Jim

 

[epstns]

When I was doing my pre-op interviews, I asked my surgeon if they used any of the alternative closure devices then available (IIRC, the "Talon" was the newest and greatest product at the time) and he told me that they did not. He felt that if properly installed, the wire did a good job, with minimal metal left in the body. It looks like the Sternal Lok device goes in much quicker than wires, and possibly with less potential for other injury in the process. I would bet that 6 months or a year later, it makes little difference, but with a device that installs much more quickly, your total time on the table may be less, and there may be less possibility for the annoying bone movement felt by some patients as the sternum heals.

Either way, wishing all the best for you. Just stay on schedule and you'll get to your stop on time!

 

[river-wear]

That sternal lock looks pretty cool. Sounds like they really wanted to get you into a trial of some sort ;-) I hope it makes your recovery more comfortable. I'm guessing that you'll figure out if you got this new thing or wires before the year is up. At least in my case I can feel where the end of the wires were twisted together at the top - it looks like with this device any "lump" will be lower down.

You're all ready to go - now try to relax and just follow the process until you're on the other side. Good luck!

 

[Paleowoman]

I'm guessing that you'll figure out if you got this new thing or wires before the year is up.

They normally do an x-ray at some point before discharge so get a copy of it and you'll be able to see whether it's wires - they show clealy on x-ray - or the new device. I think the new device looks great, and like Steve says, you would get less bone movement…maybe none by the looks of it !

 

[skeptic49]

They normally do an x-ray at some point before discharge so get a copy of it and you'll be able to see whether it's wires - they show clealy on x-ray - or the new device. I think the new device looks great, and like Steve says, you would get less bone movement…maybe none by the looks of it !

Thanks, Ann...yea I can get a copy of any post op X-ray. My surgeon told me that the idea for this came from orthopedics where they routinely use this kind of plates and screws arrangement when fixing bones. What took them so long to figure out that they could also use in on the sternum?

 

[pellicle]

Yes, it is an FDA-approved system for rigid closure of the sternum. The advantage over wires is that the plates keep the two halves of the sternum in correct alignment. As a result, there is supposed to be quicker healing and less pain.

fantastic!!

ahh ... I just re-read your post and found this dug into the post (I didn't read it all and expected the text would be close to the image).

Dr. Wheatley asked me if I would be interested in participating in an evaluation of an alternative sternal closure device, "Sternal Lok Blu," which are metal plates screwed to the sternum instead of wires. Dr. Wheatley feels that this method is superior to the wires

pardon me missing that ...

are they removed at some time?

it would appear that the screws do not penetrate (to the other side of) the bone. That could be very handy as in my case its a working theory that my bacteria got to my pericardium by travelling along the sternal wires.

then there is the litter of all the previous wires compounding infections for those of us who have redo operations

 

[ottagal]

Skeptic49,

Sounds like you had a very thorough pre-op and all your questions were answered which is always reassuring.
The Sternal Lok Blu looks pretty cool and based on what the experts say, it sounds promising!

Just thinking out loud and asking myself the question: "is the Sternal Lok Blu MRI compatible"? The reason I ask this, is I have had 2 MRI's the past year (one cardiac related and the other not). The sternal wires were not an issue, but they wanted to know about "all metal" in me. I wonder if this new device is MRI compatible? I also have a bovine valve, but wondering if one can get an MRI with a mechanical valve? I never asked that question. If I am correct, pacemakers aren't compatible with MRIs. Does anyone know?

Thinking of you and wishing you all the very best with your upcoming surgery. You are in excellent hands with a very competent team.

Will look forward to the 'update' in the post-op section. Will Dan be able to keep us apprised?

 

[skeptic49]

Pellicle: I was told that there is way to assess the depth or thickness of the sternum so that the Sternal Lok Blu screws do not exit the underside of the sternum. Dunno for sure, but I think the plates are meant to be permanent...not removed later.

Ottagal: Dan is not hard wired to the computer like I am but I have asked him to post updates here...I'll just leave my machine on with the sites up and he can just post messages. Thanks Ottagal! I didn;t think to ask about the MRI compatability of the Sternal Lok Blu plates. Good question!

Jim

 

[Zoltania]

Looks like the rigid sternal fixation study that Jim was a part of has published its results:

http://www.annalscts.com/article/view/16499 (abstract)
http://www.annalscts.com/article/view/16499/pdf (full document)

The full document shows that part of the study was done at Temple, where Jim had his surgery.

 

[pellicle]

Looks like the rigid sternal fixation study that Jim was a part of has published its results:

http://www.annalscts.com/article/view/16499 (abstract)
http://www.annalscts.com/article/view/16499/pdf (full document)

The full document shows that part of the study was done at Temple, where Jim had his surgery.

Thanks heaps for due diligence and bring this up. It's a subject I was actually quite interested in and it's good to get closure.
(Sorry, couldn't help myself there

 

[Zoltania]

pellicle - Grooooan!

skeptic49 - I hope your sternal closure worked out well for you. I saw in the archives that you needed to have your sternum reopened during your hospital stay. How are you doing now?

 

[DDT77]

Looks like the rigid sternal fixation study that Jim was a part of has published its results:

http://www.annalscts.com/article/view/16499 (abstract)
http://www.annalscts.com/article/view/16499/pdf (full document)

The full document shows that part of the study was done at Temple, where Jim had his surgery.

Figure 3 alone gives motivation to keep at reasonable weights...

6 months out from OHS with sternal closure: distinct bumps where the plates / screws are. generally, sternum / chest feels tight compared to wires used previously... negligible pain throughout for the sternal closure approach . I think I saw list price of ~ 25 kUSD on it though - as much as the valve...