aortic valve replacement info

Advanced Practice Columnist / Guide · Oct 11, 2007

Can any of you tell me your experience with older adults undergoing aortic valve replacement ? What to expect post op, issues of concern, especially when they already have impaired kidney function - etc..
Looking for any info/advice on this as it is not my usual base of knowledge in the field.

Hi, I am an NP working in Cardio-thoracic Surgery. I have seen older adults undergo aortic valve replacement...even ones who are in their 80's. However, everyone is different and multiple factors affect outcomes of heart surgery. You did not specify details in your post aside from impaired kidney function but that's OK because I would like to direct you to the Society of Thoracic Surgeons website. There you will find a risk calculator based on patient data you input yourself and it will give you results of the likelihood of post-op morbidity and mortality based on the patient's data you entered.

Here's the link: http://66.89.112.110/STSWebRiskCalc/

RN1989 · Oct 11, 2007

Biggest things I have found is pain control and being unwilling to do what they should. I find my patients have run the gamut from refusing all pain meds to acting like they are dying when I've given them enough meds to kill a horse and have to practically shake them to death to get them to wake up. Then of course they frequently don't want to do IS, ambulate, oob with all meals, etc.

The first time I meet the pt, we go over the rules:

You ARE going to hurt somewhat. I cannot make you comatose so that you won't hurt. But I will give you medicine to control the pain. If you are comfortable just sitting or laying, and your pain only reaches a 3-4 when you do your IS or ambulate, then this is a good goal. If your meds are not adequate, I will work to find you a combo that is effective. You must be oob for all meals. You must ambulate. You must use IS minimum of 10 times during every hour with goal of reaching "x" level. If you cannot do the IS 10 times in a row effectively, then you can do it throughout the entire hour, but it is imperative it be done. You need to use the urinal or hat so that I can do I/O.

Once I go over things, giving all the rationale, I rarely have a problem and usually have the pt say - "Why didn't someone tell me all this before?". The worst thing is when you get elderly person who had no quality of life to begin with and was coerced into the procedure by either doc or their family. They are the most difficult to get through this and frequently have poor outcomes if they make it out of the hospital. One thing that you can use to motivate them is fear of the nursing home. There have been times I have had pts refuse to try to do anything for themselves until I ask what their plans for dc are. They they have no idea what they will do and when it becomes obvious that they would be sent to NH - they usually work extra hard.

Seattle74 · Oct 12, 2007

Hi, I am an NP working in Cardio-thoracic Surgery. I have seen older adults undergo aortic valve replacement...even ones who are in their 80's. However, everyone is different and multiple factors affect outcomes of heart surgery. You did not specify details in your post aside from impaired kidney function but that's OK because I would like to direct you to the Society of Thoracic Surgeons website. There you will find a risk calculator based on patient data you input yourself and it will give you results of the likelihood of post-op morbidity and mortality based on the patient's data you entered.
Here's the link: http://66.89.112.110/STSWebRiskCalc/

Thank you so much for the link. I will look at it tonight. Age is also a huge factor, plus the concerns I have regarding the cardiac rehab that is not an option post op. Along with GI problems and severe anemia,etc... There are so many factors involved for this gentleman being evaluated. I just want any info I can read and be more informed. Thank you again !

Seattle74 · Oct 12, 2007

Thank you so much for the info. The cardiac rehab and efforts to keep moving that is NOT optional is exactly what I am deeply concerned about. The cardiologist today recommmended more tests to make sure that also the mitral valve is not also a concern too. I am glad they are being cautious and not just wanting to go in there regardless of outcome. This is a family member that is being considered and there is so much to really consider to make sure that quality of life is improved and not lessened if surgery is done. It is always harder when it is 'your own' . I appreciate the info - thank you so much !