Big surgery coming up

[Jase_101]

I am scheduled for a rather large amount of procedures during my OHS in the beginning of March 2024 and my surgeon has said its better to try and get it all done in one op, I guess his thinking is "one and done"

I read a lot on the Forums about people who have had valves replaced and aortic aneurysms repaired at the same time but has anyone had a multi CABG done as well during the same surgery. I have been advised by my surgeon that the plan is to fix the following:

1. Aortic aneurysm as my ascending aorta now measures 5.1cm (Dacron Graft)
2. Aortic Valve Replacement - with a mechanical valve
3. Triple Bypass (CABG) to fix LAD, Diagonal artery and proximal PDA
4. Concomitant cardioablation
5. occlusion of left atrial appendage with an Atriclip

Its a surgical to do shopping list and I appreciate that any of the top 3 listed are complex enough on their own but all 3 in the "same sitting" is concerning as more complexity = more risk!

Has anyone had a lengthy and extensive surgery similar to what I am about to undertake as it would be good to hear how it was. I am 58 and I have been advised no exercise due to the AAA, but have been dieting hard and lost 3.5Kg already and aiming to lose another 8-10kg before the surgery date. Whilst like most people who face OHS, I hope for the best but still worry about the sheer scale of what lies ahead.

Thanks
Jase

 

[3mm]

Jase - I am not an expert; I only had mitral valve repair and aortic mechanical installation during my surgery. They confirmed ahead of time that i had nothing else that needed work.

Everything I read says it is best to do "one and done". In the long term, this minimizes the strain on your body. You can do this!

 

[pellicle]

Hi Jase, you do indeed have quite the smorgasbord of surgical issues happening there.

1. Aortic aneurysm as my ascending aorta now measures 5.1cm (Dacron Graft)
2. Aortic Valve Replacement - with a mechanical valve
3. Triple Bypass (CABG) to fix LAD, Diagonal artery and proximal PDA
4. Concomitant cardioablation
5. occlusion of left atrial appendage with an Atriclip

So let me say what I know while first saying "I can't really be sure of what will happen". I think you've priority ordered them well there. My two biggest issues in my last (which was my 3rd) OHS (in lets just call it 2012) was:

1. replacement of the aneurysm with a graft which also dealt with stuff further up the aortic arch and a complicated 'bovine' anatomy, see link below
2. valve replacement of the 20 year old and calcifying homograft (which was put in in 1992)

arch types​

both the complexity of reattachment of arteries to the arch and the location of the aneurysm and the complexity cause by this being redo#2 (surgery #3) led to increased time on cross clamp, which is the biggest predictor of problems in recovery.

Given that this is your first surgery, the CABG occurring should be simplified by the relative ease of access to the arteries (because of the lack of scar tissue, which causes adhesions). The other procedures have their own issues and complications and I'm not really schooled in ablaitonsor vascular surgery with clips, so I literally can't comment there.

All I can say is that the best you can do is be like the Stoic Archer metaphor; by
The Emperor Marcus Tullius Cicero. He wrote:

Take the case of one whose task it is to shoot a spear or arrow straight at some target. One’s ultimate aim is to do all in one’s power to shoot straight, and the same applies with our ultimate goal. In this kind of example, it is to shoot straight that one must do all one can; none the less, it is to do all one can to accomplish the task that is really the ultimate aim. It is just the same with what we call the supreme good in life. To actually hit the target is, as we say, to be selected but not sought. (On Ends, III, 22)​

This describes well the in combination with other stoic views that some things are out of our hands and others are within them. The surgery is out of your hands and all you can do is rely on the good planning and skills of the team that you will be in the care of when you lay on that bed.

From Marcus Aurelius

I've done it 3 times starting at 10, and here I am, nearly 60

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239556/
Best Wishes

 

[Jase_101]

Hi Jase, you do indeed have quite the smorgasbord of surgical issues happening there.


So let me say what I know while first saying "I can't really be sure of what will happen". I think you've priority ordered them well there. My two biggest issues in my last (which was my 3rd) OHS (in lets just call it 2012) was:

1. replacement of the aneurysm with a graft which also dealt with stuff further up the aortic arch and a complicated 'bovine' anatomy, see link below
2. valve replacement of the 20 year old and calcifying homograft (which was put in in 1992)

View attachment 889757arch types​

both the complexity of reattachment of arteries to the arch and the location of the aneurysm and the complexity cause by this being redo#2 (surgery #3) led to increased time on cross clamp, which is the biggest predictor of problems in recovery.

Given that this is your first surgery, the CABG occurring should be simplified by the relative ease of access to the arteries (because of the lack of scar tissue, which causes adhesions). The other procedures have their own issues and complications and I'm not really schooled in ablaitonsor vascular surgery with clips, so I literally can't comment there.

All I can say is that the best you can do is be like the Stoic Archer metaphor; by
The Emperor Marcus Tullius Cicero. He wrote:

Take the case of one whose task it is to shoot a spear or arrow straight at some target. One’s ultimate aim is to do all in one’s power to shoot straight, and the same applies with our ultimate goal. In this kind of example, it is to shoot straight that one must do all one can; none the less, it is to do all one can to accomplish the task that is really the ultimate aim. It is just the same with what we call the supreme good in life. To actually hit the target is, as we say, to be selected but not sought. (On Ends, III, 22)​

This describes well the in combination with other stoic views that some things are out of our hands and others are within them. The surgery is out of your hands and all you can do is rely on the good planning and skills of the team that you will be in the care of when you lay on that bed.

From Marcus Aurelius

View attachment 889758
I've done it 3 times starting at 10, and here I am, nearly 60

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239556/
Best Wishes

Thanks Pellicle for taking the time to come back to me and I agree 100% that apart from getting physically and mentally ready if one can for the big day, its pretty much out of my control. With every surgery there is risk and I might feel a little easier if it was not so much that needed attending to, but such is life!

Thanks again.

Best wishes

Jase

 

[Jase_101]

Jase - I am not an expert; I only had mitral valve repair and aortic mechanical installation during my surgery. They confirmed ahead of time that i had nothing else that needed work.

Everything I read says it is best to do "one and done". In the long term, this minimizes the strain on your body. You can do this!

Thanks Mark

Your reply and advice is very much appreciated.

Best wishes
Jase

 

[Dano64]

Jase, I had the top two procedures done 2 years ago when I was 58. Those are the big ones as I understand it. My surgeon described the process as if he and I were going to take a leisurely walk in the park together. This was my second OHS. People told me that I looked better shortly after this surgery than I did after my first 21 years earlier. My best simplistic advice to you is to push yourself to walk, walk, walk in the hospital right after the surgery. I did that and my nurse commented on how too many patients fight this simple way to improve your recovery after this surgery. Best wishes to you for a quick and speedy recovery.

 

[Chuck C]

Best of luck with your upcoming procedure.

That sounds like a lot to get done at one time, but this is not that uncommon in the OHS world. Although I did not have CABG, I had two of the three big ones you mention, aortic valve surgery and dacron graft replacing my aortic root and ascending aorta. It sounds overwhelming to us, but to the surgical teams, these are all routine procedures, like any normal day at the office.

Also, it is much better to get this all handled at the same time, while they are "under the hood", so to speak. Credit to your team for making sure to take care of all of these procedures with one OHS. We often hear about members who get one of the above taken care of, only to learn a few years later that they need another OHS. So, despite it seeming like a long list, it is far better to get it all done in one go.

lost 3.5Kg already and aiming to lose another 8-10kg before the surgery date

I applaud you for your success in getting some weight off and your determination in losing more before surgery. Just make sure that your cardiologist is in the loop with your weight loss to insure that you are not losing too much too fast. I would also encourage you to continue with this goal after surgery. I know that when I was diagnosed with my aortic stenosis and a few other things in 2019, I made some lifestyle changes which I have continued to this day. Sometimes these things can be a wake up call and reminder that life is not a dress rehearsal and we have the opportunity and ability to make changes which will improve our quality of life and hopefully our quantity of life as well.

Wishing you all the best and keep us posted and give us a shout out from the other side, when you feel well enough.

 

[Chuck C]

My best simplistic advice to you is to push yourself to walk, walk, walk in the hospital right after the surgery.

I would agree with this completely. I was a walking fool after my procedure, even in the ICU. You want to get things moving soon and often. I made sure to ask them if it was ok for me to walk so much and they encouraged me that there was almost no upper limit and to keep moving if I felt the motivation to do so and that they would tell me if I am over doing it. If I was feeling uncomfortable or in some pain, I would do a few laps around the floor and it always made me feel better. Spending the entire day on our backs is not the ideal way to recover, so I would also encourage you to walk and move as much as they let you and as long as it is not causing discomfort.

If I were to limit myself to two bits of advice, it would be:

1) walk as much as you are allowed to in recovery, also after you get home from surgery and
2) Use the exercises with the breathing spirometer often. They'll likely have it right there in your room. For me, they came in once or twice a day to guide me in doing the exercises, but I was told that I should use it on my own about every hour, IIRC. They will collapse your lungs for the procedure, so it is vital to make an effort to get them to open back up and the spirometer is extremely important in this regard.

 

[Woodcutter]

Procedures 4 & 5 are common for a patient undergoing OHS who has any history of AFIB. They are (relatively) quick and simple procedures if the surgeon is already inside of the heart.

 

[Survived03]

Jase_101, good luck with your upcoming surgery. Let the surgeon and their team do the work, you focus on recovery. Six-nine months from surgery you will feel like a new person.

 

[Gail in Ca]

My 3rd surgery was a 2 surgeon job. I didn’t have everything you are going to have, but it took many hours. I was put under at 7am and didn’t awaken until around 9pm. I had my Dacron graft replaced from ‘89, my mechanical valve replaced from ‘00. The surgeon created a valve in hemashield graft for me while I was on the table. They also repaired my mitral valve with a anulplasty ring. And it took 3 hours to cut thru the scar tissue from previous surgeries just to start the surgery. I needed all this due to bacterial endocarditis. I awoke feeling good, like I could walk the halls! I was 54 yrs old.
I walked every day and night after being moved to the cardiac care unit from ICU.
I wish everyone had such an uneventful recovery!

 

[Jase_101]

Best of luck with your upcoming procedure.

That sounds like a lot to get done at one time, but this is not that uncommon in the OHS world. Although I did not have CABG, I had two of the three big ones you mention, aortic valve surgery and dacron graft replacing my aortic root and ascending aorta. It sounds overwhelming to us, but to the surgical teams, these are all routine procedures, like any normal day at the office.

Also, it is much better to get this all handled at the same time, while they are "under the hood", so to speak. Credit to your team for making sure to take care of all of these procedures with one OHS. We often hear about members who get one of the above taken care of, only to learn a few years later that they need another OHS. So, despite it seeming like a long list, it is far better to get it all done in one go.


I applaud you for your success in getting some weight off and your determination in losing more before surgery. Just make sure that your cardiologist is in the loop with your weight loss to insure that you are not losing too much too fast. I would also encourage you to continue with this goal after surgery. I know that when I was diagnosed with my aortic stenosis and a few other things in 2019, I made some lifestyle changes which I have continued to this day. Sometimes these things can be a wake up call and reminder that life is not a dress rehearsal and we have the opportunity and ability to make changes which will improve our quality of life and hopefully our quantity of life as well.

Wishing you all the best and keep us posted and give us a shout out from the other side, when you feel well enough.

Hi Chuck, thanks very much for the advice as its much appreciated and I will check with my cardiologist regarding my weight loss to ensure its not too much soon.

How did you feel after the surgery as you had some big procedures done.

I am just keeping focused at the moment to ensure I am as well as I can be before the surgery.

All best
Jase

 

[Jase_101]

My 3rd surgery was a 2 surgeon job. I didn’t have everything you are going to have, but it took many hours. I was put under at 7am and didn’t awaken until around 9pm. I had my Dacron graft replaced from ‘89, my mechanical valve replaced from ‘00. The surgeon created a valve in hemashield graft for me while I was on the table. They also repaired my mitral valve with a anulplasty ring. And it took 3 hours to cut thru the scar tissue from previous surgeries just to start the surgery. I needed all this due to bacterial endocarditis. I awoke feeling good, like I could walk the halls! I was 54 yrs old.
I walked every day and night after being moved to the cardiac care unit from ICU.
I wish everyone had such an uneventful recovery!

Hi Gail

Thanks for sharing your experience as its helpful to understand what other people have been through with their OHS and yours was a long one at 14hrs. I am not sure how long all the procedures will take that I am having done but I assume it wont be a quick one because 3 of the main procedures are fairly extensive in their own right.

Numerous members have advised me to walk and get mobile soon after surgery to help aid the recovery and as long as I pop out the other side I intend to be up and walking as soon as the nursing staff will allow me to.

All the best
Jase

 

[Jase_101]

Jase_101, good luck with your upcoming surgery. Let the surgeon and their team do the work, you focus on recovery. Six-nine months from surgery you will feel like a new person.

Hi Survived03

Thank you so much for your kind wishes and helpful advice, much appreciated.

Best wishes
Jase

 

[Jase_101]

Procedures 4 & 5 are common for a patient undergoing OHS who has any history of AFIB. They are (relatively) quick and simple procedures if the surgeon is already inside of the heart.

Yes my surgeon said the same and it was "matter of fact" as he said while I am sorting the other main issues we might as well try and sort the AFIB so it made sense.

Thanks
Jase

 

[Jase_101]

Jase, I had the top two procedures done 2 years ago when I was 58. Those are the big ones as I understand it. My surgeon described the process as if he and I were going to take a leisurely walk in the park together. This was my second OHS. People told me that I looked better shortly after this surgery than I did after my first 21 years earlier. My best simplistic advice to you is to push yourself to walk, walk, walk in the hospital right after the surgery. I did that and my nurse commented on how too many patients fight this simple way to improve your recovery after this surgery. Best wishes to you for a quick and speedy recovery.

Hi Dano64

Whilst nothing in life is risk free I have the view that these guys are experts and I trust they are going to sort the issues and get me through it. I think like most people all I want to do is hear the monitors and beeping of machines in the ICU once the surgery is over to know "hey I am still here" the rest I can figure out.

I fully intend to get out of bed and walking as soon as practical after the surgery, even though I know it will most likely be painful.

All the best
Jase

 

[Chuck C]

How did you feel after the surgery as you had some big procedures done.

I felt good after my surgery. I had a couple of bouts of afib, which were not so fun and which are also very common after valve surgery, but other than those blips I felt good and better each day.

I would encourage you to be as positive as possible and look at each minor improvement as a victory. When you wake up in ICU, you will have many tubes and IVs connected to you. Each day of recovery, they will remove some of the IVs and tubes. Look at these as little victories on your journey to full recovery.

Use the breath incentive spirometer often and with each increase in volume that you achieve, take it as a small victory and pat yourself on the back.

And walk, walk walk.

In my first day of recovery, when I did my walks around the ICU floor, the nurse had to accompany me to push the two IV trees I was connected to, and I also had two big drainage tube pumps hanging off of my walker. But, I was determined to keep moving. I'll never forget my second day in ICU, my nurse started steering back towards my room after one lap around the ICU floor, but I told him I would like to keep walking. On the third lap, he told me that he was getting tired and asked if this cold be our last lap
I'm not saying you need to walk that much, but if you are comfortable doing so, and they give you the green light, I'm a believer in getting things moving as soon as possible and as often as they will let you. Look at each lap around the floor as a victory lap. You don't want to push your heart rate much, just keep moving to help the healing process.

As odd as it sounds, recovery can be fun. You have hundreds of little victories ahead of you as you recover. Enjoy and celebrate each and every one of them. Before you know it, you will be feeling 100% again and possibly much better than you felt prior to surgery. If you keep up the good habits, which you have adopted to achieve your recent weight loss, this could be the start of decades of feeling better.

Wishing you all of the best of luck!

 

[Gail in Ca]

Hi Jase,
Just another thought about longish surgeries. My then husband was the only one of my family there for the whole time. His cousin came to sit with him.
My family (parents, sisters),said later that they were getting worried when so many hours went by with no word about what was happening with me. I guess it’s good to let family members know it could be a long wait for news when it’s over.

 

[3mm]

Jase - I don't know about your hospital. When I had my surgery at Mayo Clinic in Minnesota, USA, they sent some text msgs to my brother's cell phone during the surgery.

 

[Jase_101]

Hi All,

Just an update on my surgery, which was postoned as it was due on April 4th 2024 however due to a bad lung infection I was suffering from at the time my Surgeon decided to called if off ujntil I was better.

Its now scheduled for May 16th, 11 days and counting and like most people on the forums I am apprehensive as I am yet to meet someone on this site, who has undergone a triple bypass, with a AVR and aortic aneurysm repair all in one surgery!

My surgeon has listed my case as complex and has requested that a Consultant in Surgical Echocardiography be present during the whole operation to perform a TEE. It seems a lot of procedures to be done in one surgery and I wonder how much it increases the risk of something going wrong.

I see many people posting that they have valves changed, aaa repair with a valve change, but none with a bypass added.

Thanks
Jase