Introduction - Male, 67. AV repair, LAD CABG -I almost sound like I know what that is

[joel1947]

I am trying to read many of the posts here, and am glad that their are so many. Many years ago I knew I had a heart murmur, but did not know what it meant. I served in the NAVY and am/was pretty active so it never slowed me down. 5 years ago I had prostate cancer and during the pre-op the anesthesiologist was concerned about the murmur, which must be quite pronounced because I am often asked if I would mind if a few more people listened to it. Apparently there are certain characteristics that are hard to hear unless you are me, then it is easy. Anyway, at that point I began to see a cardiologist and have regular ECG. I was asymptomatic and continued to run and bike and have an exam every six months. My cardiologist said that it needed watching and that someday I may need an operation, but it is impossible to predict. There was a fair amount of regurgitation and some aortic dilation, but still within normal limits. I was also told it was caused by a BAV and I should tell my children to have it checked. Fortunately they are fine.

I switched cardiologists (the new one was also treating my wife and was closer) and he said pretty much the same thing. If/when my lifestyle was impacted I would know it and then it would be time to talk surgery. My performance started to drop off. I would run 5 miles and be fine, but now after 3 I start to get tired and cannot run for 5. Or I bike 25 miles and have to slow down the last 5 miles. No pain, no real symptoms other than performance. And heck, I am 67, so what do I expect. But I went to the cardiologist and the echo did show a worsening, and my numbers were climbing out of normal. So time for surgery. There are a number of good hospitals and surgeons in Boston so I asked around and my cardiologist had a recommendation and I have some physician friends who gave recommendations and I spoke with a few and chose one that I felt comfortable with, does a lot of surgeries, and has a great reputation. And he is affiliated with a good hospital. So I went in for a round of catheterization and lo and behold turns out I also had a blockage in one artery (90% in LAD). Had a discussion with my surgeon (while in the cath lab) and he was very patient and open. Could have a stent right then which would possibly allow a minimally invasive valve replacement or do a CABG which meant OHS. I was nervous about the minimally invasive and am not at all worried about OHS, I decided to go with the standard opening up the chest. I believe it is much easier on the surgeon and if you are able to tolerate it, that is the best way right now. If I was more frail I would have chosen differently. Anyway, all set and two Fridays ago went for my pre-op. They did an echo, chest X-ray, blood, and I spoke with anesthesia and surgeon people. Well, surprise. Turns out I do not have a BAV. I understand that echo through ribs and lungs can give a poor picture. And even though I had a number of ecgs over the years, people see what they want to see. And everyone wanted to see the football instead of the Mercedes logo. Actually one time in the past the sonographer did say that it did not look BAV to her and I did ask, but no change in the diagnosis. And the regurgitation and injection fraction and root size and all that stuff indicated the need for a valve replacement so it really was not that important. But anyway this ecg, perhaps a new machine, clearly showed all three leaflets operating.

SO my surgeon explained to me that there was a probability that he could repair may AV. From all that I have read that is a better solution, so off for more tests. A CAT and a TEE which I had last wednesday and now my surgeon believes with a high degree of probability that he can repair. I am still relatively without symptoms. The surgery is unfortunately not scheduled until August 19. He wants to do it on a Tuesday. Monday is always busy because of the weekend, and he wants me to have my first few post-op days during the week so everyone is available if need be. I hate the waiting and I think I am now thinking I have symptoms, but they are probably in my head, not in my chest.

Anyway I will be posting a few questions, but wanted to introduce myself first.

Thanks

 

[Duffey]

Hi, glad you joined the forum and look forward to hearing any questions or concerns you may have.:smile2:

 

[Paleowoman]

Hi Joel, welcome to the forum ! It's quite normal to think yu are having symptoms in the weeks before surgery, every little thing you think is your heart when it can be your nerves ! I was completely asymptomatic before surgery….but understandably anxious ! Not sure that minimally invasive can have been explained to you ? With mnimally invasive it's open heart surgery just the same, but the incision isn't the full length of the sternum. It's the way they normally do aortic valve replacement these days when they don't need to do anything else. I had the minimal one and, to be honest, it's practically the full length of my sternum ! Here's a link to the thread where I posted some pictures recently: http://www.valvereplacement.org/forums/showthread.php?42982-My-incision-scar I'm not sure of the advantage of this, but I suppose there may be slightly quicker healing of the sternum ?

Once you have a date the waiting can be a pain - I made sure I kept as fit as possible during the wait !

 

[joanpieroni]

Small Scars

Small Scars

Hi Joel, welcome to the forum ! It's quite normal to think yu are having symptoms in the weeks before surgery, every little thing you think is your heart when it can be your nerves ! I was completely asymptomatic before surgery….but understandably anxious ! Not sure that minimally invasive can have been explained to you ? With mnimally invasive it's open heart surgery just the same, but the incision isn't the full length of the sternum. It's the way they normally do aortic valve replacement these days when they don't need to do anything else. I had the minimal one and, to be honest, it's practically the full length of my sternum ! Here's a link to the thread where I posted some pictures recently: http://www.valvereplacement.org/forums/showthread.php?42982-My-incision-scar I'm not sure of the advantage of this, but I suppose there may be slightly quicker healing of the sternum ?

Once you have a date the waiting can be a pain - I made sure I kept as fit as possible during the wait !

I had AVR March 27th and the surgeon only made a 3" horizontal incision above my right breast so it is possible to have Aortic Valve replaced and not a full incision. The surgeon re connected my rib back to my chest wall with a titanium plate and 5 screws.

 

[joel1947]

Thanks,
I am certainly not an expert but he did explain all the options. Mini thoracotomy, TAVI, TAVR, and the minimal access median sternotomy as well as the classic median sternotomy. ANd I did speak with another surgeon as well. My surgeon actually specializes in non invasive / minimally invasive. I will ask him again though.

/joel

I stopped running, but am swimming and walking a lot.

 

[Paleowoman]

Thanks, I am certainly not an expert but he did explain all the options. Mini thoracotomy, TAVI, TAVR, and the minimal access median sternotomy as well as the classic median sternotomy. ANd I did speak with another surgeon as well. My surgeon actually specializes in non invasive / minimally invasive. I will ask him again though.

Hi Joel,

If it were me I would ask the surgeon which he feels most comfortable doing because you want the surgeon to feel comfortable and confident in what he thinks is best for you.

 

[epstns]

Hi, Joel,

Well, you have about the same set of circumstances I did a few years ago, at age 63. I, too, had known about my murmur for years and finally it was time for surgery. I had the pre-admission cath, and it was noted that my LAD was 50% blocked. We had the same discussion, and my surgeon said that he would rather "just take care of it while he is in there." So, I had CABG (LIMA - LAD, where they used my left interior mammary artery as a source - no leg incisions, so I could get back to my workouts sooner, we thought.)

I am now 3+ years down the road. I don't run any more (knees decided that for me), but I am quite active in spite of my pacemaker and all the complications I had post-op. Don't fool yourself - this is major surgery. But by the same token, don't sell yourself short. I can tell you that as long as we come out the other side upright and taking sustenance, life is good. You'll be fine. The better your conditioning before, the better you can come through it all.

Feel free to ask questions on-line, or if you want, use the PM features to contact individuals.

 

[joel1947]

Thanks Steve,
I called my surgeon and he will do the LIMA CABG. He wants to have the largest, clearest surgical field so he can do the repairs properly and apparently that is more involved than a valve replacement. But the advantages are many and I feel fortunate to have a repairable valve.

My question is what activity can I do pre-op. When I noticed my performance dropping off quickly I went to my cardiologist and I also cut out everything except some easy swimming and some hour-long walks. Now I am trying to figure out how much activity is safe until the operation. Obviously if I felt any pains or tightening I would stop and call my Dr., but I want do do some cardio. My life is not the same if I cannot work out. I gave up weights and stopped yoga (I do a fairly strenuous vinyassa flow that is tightly connected to breathing) but still want to bike and run or elliptical. (My knees are not great, but I an run at least twice a week without running out of ice )

So I called the surgeon but they say since I am pre-op it is up to my cardiologist. He will say to let any symptoms guide me. (If you are at all active, you really need to go to a cardiologist who is active. I am not a super athlete, but exercise is an important part of my lifestyle). SO while I wait for my cardiologist to call I ask if any of you stayed active after you were diagnosed or did you just wait til after the surgery? Personally I am very hopeful that I will be pretty good after surgery. I was not terrible with a major regurgitation and a blocked LAD, so am hoping to have more endurance after. The only warning I ever had was to not lift weights over my head and be careful with weights at all. Believe me, I understand that you are not doctors and that even if you were you could not advise me without even examining me, so am only looking for your experience.

 

[joel1947]

Does anyone have any advice for diet? I am mostly vegetarian, but will have poultry or fish occasionally. It is not for religious, ethical, or health reasons, just seems to be a good diet for me. But the prospect of being in bed a lot, or at least very inactive makes me ask what is a good diet pre (and post). SHould I avoid spicy Mexian, Indian and Thai? Should I have a lot of leafy greens? Does it not matter at all? Or should I just pig out on ice cream and cheese cake and worry about it later?

Thanks

 

[Paleowoman]

Immediately after cardiac surgery and for a while you retain a lot of fluid as a result of how they pump you full of fluids during surgery (you'll be given diurectic meds for that). Once you've lost that water you'll find you've also lost weight ! Most everyone here has commented on the weight lost as a result of cardiac surgery, doesn't matter you're inactive. Mind you, you'll be made to get up and walk as soon as you're out of high dependency - on day two if all goes according to plan. But still weight loss occurs. Appetitie changes after surgery too. The one thing I learned was to have enough "reserves" - I didn't and lost too much weight which had a negative impact. After surgery eat what you can without worrying about it. Before eat well

 

[sunshine2cats]

how the heck do u have enough reserves ? i am so small about 130 and can lose 10 pounds from the flu in a day. i read barbara walters operation and she said she got very think and had milk shakes...would they approve fat drinks , surely. i am so anxious , going in for the test tomorrow at 6 ...i hope if they find clogged arteries , they put me out if they have to do anything? my doctor told me before that i had no heart disease that this valve was genetic. anxious! u bet!

 

[Rebecca]

Always have plan A, B, C and talk to your surgeon about this. I went in for a repair too because I was told that my valve was repairable but my valve was falling apart during surgery and I ended up with plan B a tissue valve. I was glad that I had full chest opening because it gave my surgeon a good view of my valve.

 

[joanpieroni]

Don't worry about what you are eating but you need to eat to gain strength, maybe someone can bring you some quiona and ask for eggs for protein. I lost some weight at first but after I started feeling better I was cooking at home a lot because I was bored and of course gained it back. So now it's time for me to go back to work hopefully I can loose some now. Just eat a balanced diet.

AVR- Edwards bovine valve- 3/27/14- Gates Vascular Institute Buffalo NY

 

[sunshine2cats]

thank you , how long Joan were you off work then ? i guess a lot of mashed potatoes would do the trick..i am just on the beginning that is why i am so nervous and trying to learn from all of you...any secrets to a better recuperation and getting through this. i still cannot believe it. i wake up and it is the first thing i think about. anyhow...have to get tomorrow over with first...thanks again.

 

[joel1947]

Rebecca,
That is exactly what my surgeon told me. He plans to repair the valve, but cannot guarantee it. He wants to have everything planned as well as possible. Opening someone up, then seeing something completely unexpected and saying, "Gee, what should I do?" would waste a lot of time. Obviously one chooses a surgeon who has done the procedure many times, but he will have a plan A, B and C, and also call audibles if necessary. It is up to me to make sure I have gotten him to explain it all to me.

 

[joel1947]

how the heck do u have enough reserves ? i am so small about 130 and can lose 10 pounds from the flu in a day. i read barbara walters operation and she said she got very think and had milk shakes...would they approve fat drinks , surely. i am so anxious , going in for the test tomorrow at 6 ...i hope if they find clogged arteries , they put me out if they have to do anything? my doctor told me before that i had no heart disease that this valve was genetic. anxious! u bet!

Good luck with your test. I had one last week and it was much much easier and less painful that I thought it would be. I had one 90% blocked artery. The funny thing is that they gave me versed which makes you forget. When I got home in the afternoon I felt great and made some work phone calls. The next morning I could not remember much about the calls or the day. Apparently the calls went fine, I just could not remember them well. Here is a picture of me having my catheterization. Cannot wait to get some pictures of my heart! I could not embed the picture, but if you go to this link it may work. https://app.box.com/s/fpu144l6trmyhwk7x51h

 

[Paleowoman]

how the heck do u have enough reserves ? i am so small about 130 and can lose 10 pounds from the flu in a day. i read barbara walters operation and she said she got very think and had milk shakes...would they approve fat drinks , surely. i am so anxious , going in for the test tomorrow at 6 ...i hope if they find clogged arteries , they put me out if they have to do anything? my doctor told me before that i had no heart disease that this valve was genetic. anxious! u bet!

When I was in hospital they tried to encourage me to eat but all I could manage was a glass of milk and a few berries for meals. Because of the effects of the anaethesia and the analgesics I just didn't have any desire to eat, it was most peculiar, it wasn't that I felt nauseous, it was like I felt zero need to eat. Upon discharge my GP prescribed me high calorie nutritional drinks which helped a bit but I got underweight which didn't help recovery (went downhill week 3). When things improved I found chocolate helped me regain weight and strength (also frequent small meals), but when I one day have a re-do I will make sure the hospital gives me nuritional supplements for meals if I'm unable to eat much so I don't lose too much weight to begin with ! I didn't have any heart disease, no blocked arteries, CT angiogram 100% clear. Just bicuspid aortic valve which I was born with.

 

[epstns]

Joel - We're all different, but here's a bit more of my story. I was diagnosed when I was 51 or 52 years old. I had a bicuspid valve with aortic stenosis. I did not have any significant regurgitation - only the stenotic restriction of my valve opening. I continued my regular exercise schedule, which at the time included running 3 miles daily at a 7:30/mile pace, as well as medium-level weights (probably in the 40-60 lb range for me). I did not alter my workouts at all, at the start. Over time, I saw my performance decline, so I adjusted my expectations accordingly, but did not stop exercising. Eventually, I was down to jogging at about a 10:00 pace, with weights reduced to about 30 lbs.

Then came surgery at age 63. I worked out until about 1 week before. During surgery and recovery I had many complications. I won't hijack your thread to spell them all out here, but suffice it to say that I not only had the valve replacement and bypass, but also a pacemaker implant, and some other "interesting" stuff as well. I was not cleared to go to cardio rehab until about 12 weeks post-op. Once I got into rehab, though, no looking back. By the end of rehab, most people would never realize that I had heart surgery. Now, just over 3 years out, they can't believe it. I am now 66, and although I don't run, I do "power-walk" and ride a bike (stationary and on the streets) at a pretty good clip "for an older guy." I have changed my weight routine to low-weight with high reps.

So, for now, I would tell you to keep doing as much as you can, but if it doesn't feel good, don't do it. Use common sense and listen to your body. It will be worthwhile to stay in good condition, but it is not necessary to be an elite-class athlete to do well after heart surgery.

As for diet, enjoy yourself. After surgery, nothing tasted good for me. I didn't lose any weight, and once I got rid of the fluid build-up, I was just about where I started before surgery. I would recommend that you discuss with your docs the impact all the pain meds will likely have on your digestive system. The meds "blocked" me up so badly that I had to be readmitted to the hospital a month after valve surgery to get things back under control. There are numerous threads here about digestive issues, but Mira-Lax will be your friend.

It is all very manageable, even with some complications. Just try to keep it all in perspective. While the surgery may be a crummy experience, it is well worth it for the improvements we get after.

 

[joanpieroni]

thank you , how long Joan were you off work then ? i guess a lot of mashed potatoes would do the trick..i am just on the beginning that is why i am so nervous and trying to learn from all of you...any secrets to a better recuperation and getting through this. i still cannot believe it. i wake up and it is the first thing i think about. anyhow...have to get tomorrow over with first...thanks again.

I was off for 12 weeks, I have not lifted anything more than 5lbs. now it will be 15lbs when I return to work. Looking back, resting, getting outside for short walks and eating that protein will help, best wishes!!!!!!

 

[joanpieroni]

Joel, that's right the meds help you relax, kinda weird having the camera right above you it blocks a lot of stuff. I'm sure you feel better just knowing what's going on and finding out if there was any blockage. Are you having valve replacement too? My dr. couldn't get the catheter thru my bicuspid valve because it was so calcified. Having it replaced, I feel so good now. The hardest thing is waiting for surgery day.