Pre-Operation Assessment

[Red]

Hi Everyone,

I'm a newbie to this so please bear with me.

I was born with a congenital heart defect; bicuspid aortic stenosis and regurgitation, so an operation was always on the cards for me. I always thought it would be in 20 years time, that is 20 years from whatever age I was/am at the time. Apparently, it's 20 years !

I was informed back in October, that the recommendation was surgery for AVR within 6 months, quite a shock for me as I am, or thought I was fit and well !

I am going for my pre-op assessment in a couple of days, any thoughts on questions I may not be aware I need to know ?

Thanks,

Red

 

[clay_from_nj]

Pre-op assessment - is that with the surgeon? It may be obvious, but ask a lot of questions, especially "Why?" and "How?"

 

[Mentu]

Hi, Red, if you are speaking of the Pre-Op appointment just before surgery, there are a few things they will ask that you might consider before hand. At my Pre-Op appointment, I was asked if I had a will and had I prepared a medical directive. Valve Replacement comes with very low risk but it is not without risk so it seemed to me that these two items were just a matter of being prudent. You could certainly do them ahead of time. It is a time you can ask a lot of questions relating to your hospital stay. I had a question about my best friend who I wanted to be able to visit the ICU; he was also my Medical Executor. After raising the issue, it was never a problem following surgery. Mostly it was dealing with bureaucracy relating to the hospital stay along with a final round of tests.

I hope this helps.

Larry

 

[BostonJohn]

Hi Red,

I am in a similar situation as you are- I have known about the valve problem for a while, but I was always told that I would be "much older if not a senior" by the time it came to be time for surgery. Things don't always go as planned, however, and I found out a little while ago that it was time to get it done. I will be have surgery next Tuesday (March 25th) at the ripe old age of 27. I was a little confused and angry over the course of the last year, but I have found this site to be enormously helpful, particularly in shedding light on how many people are in a very similar situation, and I discovered that not only is it not that rare to have this done at a young age, but I was also encouraged to see just how well it worked out for so many people who are now enjoying happy, healthy lives.

As for pre-op appointments, I had several meeting with the cardiac surgeon, my regular cardiologist, and a "second opinion" cardiologist that my surgeon recommended to nail down a specific timeframe, but I just had my actual "pre-op" exam yesterday (one week out from surgery). In previous meetings, we discussed valve options, the basics of the procedure, recovery timeline, etc. At my pre-op exam yesterday, they took blood and urine specimens, an EKG and a chest x-ray, and I met with a Nurse Practitioner to do a very thorough health assessment, as well as walk me through every step of the process from the minute I am admitted until I am at home with a home nurse. While it had the effect of making things suddenly very "real," it was a pretty simple process, and talking to the NP was very helpful and comforting.

I would encourage you to browse many conversations on here as more questions arise. You can probably find just about any answer or opinion that you are looking for without even posting all that much. I hope this helps.

Best,

-John

 

[Red]

Hi Guys,

Thank you so much for responding so quickly.

I have already met the surgeon, he seems like a really nice guy and having researched him, he's the man for me.

My pre-op assessment is to see if I am fit for surgery (!) I wonder what happens if I'm not ? So I guess they'll do some bloods, scans, x-rays etc...

I also have a 'Cardiac Surgery Seminar' the following week where I get to meet the various teams. I must admit I was more that a little scared when I saw that I get to meet the blood transfusion team, I hadn't given that a thought !

John, I hope you op goes well on the 25th, I'll be thinking of you and sending good vibes. I know what you mean when you say it seems more real. I had weeks of inactivity, no appointments or anything and just as I convinced myself it was all a big misunderstanding I had the letter asking me to come for the pre-op. Hey ho, must me me then.

I have been having a little look around the forum and everyone is so helpful and supportive and I thank you all for that, the world, my world and yours, is not quite so scary after all.

I particularly liked the 'what surprised you ...' thread it was very informative and made me laugh out loud, which in the beginning I wasn't sure I would do again.

So thank you all so much once again.

 

[maisiejane]

Hi Red, here in the UK, the pre op assessment consists of a chat with the cardiac nurse specialist, then she checks your weight, blood pressure, urine and takes groin and mouth swabs and generally assesses your current state of health, then you go off for an ECG to check your heart, then to xray to check your lungs and finally blood is taken.
It is a good time to ask questions or discuss any concerns you may have.
Good luck.
Deb xx

 

[Paleowoman]

At my pre-op assessement I had the same tests as Deb, that is the swabs to check for MRSA infection, urine test, chest x-ray and ECG. Then I had a long talk with the cardiac specilist nurse and went through all my other health conditions, what meds I was on and gave him (lots of cardiac nurses in the UK seem to be men) copies of reports from the other consultants I'm under. NOT that it made the kind of difference it should have ! After surgery they kept giving me my meds at the wrong times, preferring to give them to me at the standard medication round times rather than when I was actually supposed to have them ! They also gave me an incorrect inhaler and I had to keep ringing the bell to get my own one given to me. And this wasn't NHS, this was private ! Must have been bad luck because the cardiac nurses seemed very competant individually, and the hospital has a very good reputation….but anyway, at the pre-op assessment they are supposed to get things in order…. They also went through how things would be on discharge, ie was everything organised at home. And then they went through what surgery would be like, how it affects the person. And I could ask questions too - the cadiac specilaist nurse spent about two hours talking with me and hubby and I went away very confident !

 

[Red]

Hi everyone,

Well I have been to my pre op assessment and also a pre operative information day run by Harefield Hospital, which is where my surgery will be taking place.

It was as it said in the title very informative and we had the opportunity to ask questions etc. and there was a very lot of information given in a short space of time.

I thought I had quite a good grip on what was going on and my situation but hey, every day is a school day

I wondered what your experiences were; I have decided to go with a tissue (bovine) valve as I didn't really want to be on Warfarin and it was mentioned yesterday that it is entirely possible that I will have to take it for several months. Could someone please explain how that works and how I will be taken off it ?

Thank you so very much to everyone who contributes to this forum. It's good to know I'm not alone and fabtastic to follow those of you who have already boldly gone before.

Red.

 

[Paleowoman]

Hi Red - I was on warfarin, or at least a blood thinner of some type so I suppose warfarin, for a few days post operatively (I had a bovine valve) but no longer than that. I think the length of time may depend on if there are any particular problems or not. It's the beta blocker they keep you on for a while for sure to stop atrial fibrillation - I'm hoping to come off mine when I see my cardiologist in a couple of weeks. You would also be on a diuretic for a week or two, again that depends, my GP took me off the one I was on three days after discharge. I was also given omeprazole, a PPI for the stomach, and I came off that after a few days too and went onto Gaviscon Advance for a few weeks. Every hospital seems to give a different cocktail of medications post operatively.

When are you having surgery ? Must be soon if you had your pre-op !

 

[Red]

Hi Anne,

Thank you for your response, I think I'm 'handling it' then trip up again but hey the only way is up from here

I don't have a date yet, but I can call next Wednesday to ask. I was initially told that the doctors wanted it done within 6 months - which scared me quite a bit, but at my pre assessment the nurse said that my surgeon (Mr. Amrini) has a very long waiting list and it should be done sometime this year ! Please believe me when I say I would really rather not have this done, but I'm not sure how long my positive attitude will last with all the worrying and wobbles I'm having will last.

Feels a little strange, wishing for it to happen, hoping that they've made a mistake and waiting for the call to say they meant someone else.

Gerri x

 

[Paleowoman]

Your surgeon sounds really good Red, I just looked him up on Bupa as that gives extra info about these guys: http://finder.bupa.co.uk/Consultant/view/30436/mr_mohamed_amrani?ql=&fhospitalNetworkId= Click the About me tab. Definitely worth waiting for him to do the surgery on you !

None of this would like to have, or have had, this done. I'm sure none of us like it that we were born with bicuspid aortic valve....but there it is.......just feel confident that you will be in very good hands

 

[maisiejane]

Hi Gerri,
I to have had a bovine valve, I received a heparin injection the night before my surgery but no warfarin or other blood thinners following but I do take 75mg of Aspirin daily, like others I have been put on a daily beta blocker and it appears to be up to the individual cardiologist how long you remain on it. I was told pre surgery that the waiting list for my surgeon was 6 months so I asked to go on the cancellation list, that was in August 2013, they phoned me to go in for my operation in October (they gave me 2 days notice) but I was going away so refused, following that I went in 3 times but was cancelled due to emergencies, I finally got it done in February this year,
Good luck.
Deb x

 

[epstns]

Hi, Gerri,
After I had my bovine valve implanted, I was told that at my hospital the standard protocol for aortic tissue valve recipients was to take warfarin for 3 months post-op. This was to not only ensure that no clots formed around the valve as it healed, but as a "just-in-case" stroke preventative in case afib was to occur. I did have some afib during the first month after surgery, but none after.

When you take warfarin for a short time (like my 3 months), there was no "weaning" process. They just told me to stop taking it and my INR would gradually, over a few days, return to normal as the drug was metabolized out of my system. The only frustrating thing for me was that with all of my other complications, it just about the whole 3 months to stabilize my INR in target range, then I stopped the warfarin.

 

[rider76]

I'm currently going through "pre-op assessment" and have found it is more than just one appointment. I finally got an appointment with the cardiac surgeon and, like most surgeons, he wasn't very informative other than to tell me he'd schedule me for aortic valve replacement "in two or three weeks." I'll meet with his PA for more specific information before that. Meanwhile, since I am having severe breathing problems, I've also seen a respiratory therapist and a pulmonologist. My lung function is about 84% but the inhaler prescribed by the pulmonologist brought me up to 95%. The chest x-ray showed some tissue congestion in the lungs, so the cardiologist prescribed lasix. I'm having some problems with that, so have another appointment with the cardiologist this coming week. I guess I could call all of this pre-pre-op assessment. The more information the surgery team has about me, the more likely a successful outcome.