Recovery after mitral valve replacement

RN12345656 · Nov 16, 2005

Obviously every pt is different, but you will do fine!! CT surgery will consult a Nephrologist on admission (depending where you have your surgery--it may be your own kidney doc).

My question to you is..do you have any other significant hx, ie. diabetes?

I am assuming you do HD vs. PD.

Most renal pts do great, you may require intraop dialysis. Sometimes you may require an extra day in the ICU--again everyone is different.

As far as the pain concerns..please remind the surgeon you have current pain control issues and may require more/additional pain meds. Timing will be the key--taking your pain med right before you're dialysed won't be a good idea (for obvious reasons)!!

Keep in mind too, you will be on coumadin long term if you have a mechanical valve. Best case scenerio...if you have a tissue valve you will only be on it short term.

Take care and good luck--you will do just fine!!

MedicalZebra · Nov 16, 2005

Thanks so much for your reply, heartnurseinva. :) Yes, I'm on hemo... I will be having my treatment directly before the TEE on December 8, which is when they will find out whether they need to replace the valve. Since I have a pork allergy, I'm hoping I can get a bovine valve... I am hoping to avoid having a mechanical valve so I don't have to mess with coumadin (I have seen many complications in other dialysis patients who are on it).

Thank God, I do not have diabetes... yes, there still things to be thankful for, even on dialysis!

And I will tell the surgeon about my low pain threshold-- I'm a redhead, and we are notorious for needing more anesthesia than the average bear.

RN12345656 · Nov 17, 2005

Glad I could help!! If you have any other questions..don't hesitate to ask-you can pm me.

Good luck on your TEE. A good friend of mine had her TEE while she was pregnant without sedation--horrible!! She's having open heart next month for her valve replacement.

Take care!

SEOBowhntr · Nov 24, 2005

Zebra,

You will likely be on continuous dialysis, otherwise known as CVVHD (Continuous Veno Veno Hemo dialysis) which is standard for most HD patients. You will probably also run increased risk for infection as you already know and another issue that could arise is difficulty controlling your BP, but that is usually pretty easily remedied. I think you also should be warned about the issues of poor appettite, which are common after surgery. And you will need to ensure that you consume enough protein to heal. I would also actually reccommend a mechanical valve over a bovine for the simple fact that you won't need to worry about replacement in 5-10yrs. You may also ask about valvuloplasty as an option as I've taken care of several patients over the last few years that had more simple valvuloplasty procedures instead of complete valve replacement.

Good Luck!!

RN12345656 · Nov 25, 2005

CVVHD is not the standard for every RF pt. It is a possibility depending on fluid volume/BP during the intra/post op periods. I am not sure how old Zebra is, but that is also a factor.

I don't think anyone should suggest or reccommend the type of valve you choose Zebra. I am sure the docs discussed the advantages and disadvantages to you.

SeoBowhntr--mechanical mitral valves require long-term coumadin therapy.

My best friend is on her 4th tissue valve and she is a 29yo cardiac nurse--she doesn't want a mechanical valve until she is old and gray. It is alot easier to suggest the mechanical valve to someone when you're not the one getting it:wink2: .

SEOBowhntr · Nov 25, 2005

CVVHD is not the standard for every RF pt. It is a possibility depending on fluid volume/BP during the intra/post op periods. I am not sure how old Zebra is, but that is also a factor.
I don't think anyone should suggest or reccommend the type of valve you choose Zebra. I am sure the docs discussed the advantages and disadvantages to you.
SeoBowhntr--mechanical mitral valves require long-term coumadin therapy.
My best friend is on her 4th tissue valve and she is a 29yo cardiac nurse--she doesn't want a mechanical valve until she is old and gray. It is alot easier to suggest the mechanical valve to someone when you're not the one getting it:wink2: .

And reasons like your friend being on her fourth tissue valve are precisely WHY I might reccommend a mechanical valve, or valvuloplasty. Is long-term Coumadin therapy worth having the chest "cracked" 3 more times and putting your life at risk, esp already having renal failure??? I'd think not in my opinion if it were me.

RN12345656 · Nov 25, 2005

Is long-term Coumadin therapy worth having the chest "cracked" 3 more times and putting your life at risk, esp already having renal failure??? I'd think not in my opinion if it were me.

But its not you making the decision...what are you?...a MechValve Rep? :rotfl:

I am not an advocate for either tissue or mechanical...I believe the right decision is the one the patient makes for him/herself..regardless.

I think if the surgeon was concerned about her RF with a tissue valve, he would have suggested the mech over the tissue.

As far as my friend..she is having mini-invasive surgery--thoracotomy approach. She's not having a redo sternotomy.

SEOBowhntr · Nov 25, 2005

But its not you making the decision...what are you?...a MechValve Rep? :rotfl:
I am not an advocate for either tissue or mechanical...I believe the right decision is the one the patient makes for him/herself..regardless.
I think if the surgeon was concerned about her RF with a tissue valve, he would have suggested the mech over the tissue.
As far as my friend..she is having mini-invasive surgery--thoracotomy approach. She's not having a redo sternotomy.

HeartNurse,

I would advocate the mech. valve over the a porcine or bovine, but the best option would be a valvuloplasty if possible. I've seen several patients who were only able to get 2-3yrs out of their porcine or bovine valves and opted for the mechanical valve to prevent repeat procedures. I guess I was unaware that you could do simple valve surgery. Whether through a thoracotomy incision or having the sternum split, Cardio-pulmonary by-pass is required and each time you do this you put a patient under major risks of stroke, MI, aneurysm, etc. No, I am not a "rep," but looking at what may ultimately be longest lasting and safest. Zebra will make a decision based on a multitude of issues. One other thing to consider it the high incidence of Atrial Fibrillation in valve replacement patients, even with the use of "Maze" procedure and Radiofrequency ablation, which may ultimately require Coumadin therapy also. Though I understand the complications of Coumadin therapy with any patient, renal patients included, it still may be a better option than the risk Zebra may undergo with a repeat valve replacement 2 or 3 years from now. Is that a little more clear??

MedicalZebra · Dec 13, 2005

Hello again, everyone!

Well, I had the TEE... what a NIGHTMARE! Even though I told them that I needed extra anesthesia, apparently they didn't believe me. Result: I woke up MULTIPLE times during the procedure and tried to pull the probe out of my throat. When I finally got back to my room, my throat hurt like hell, and swallowing was difficult for the next three days.

The cardiologist called me the next day and said they were 'surprised' that I fought the probe even though I was pretty heavily sedated. When he told me that the next test on the list is a cardiac catheterization, I said, "Well, I hope you know by now that I need a LOT of anesthesia!" Honestly, why do they bother asking me about my problems with sedation if they are just going to do what they want, anyway? Like I need the added worry of being in pain during invasive procedures!

Anyway, what it boils down to is that the cardiologist thinks I need a mechanical valve. I have too much calcification to be able to use a bio valve, and he's of the opinion that dialysis patients calcify their bio valves too quickly for it to be an option.

I've already been started on coumadin, because I have stagnant blood swirling around behind the mitral valve. Tomorrow I will have my first blood-level test and will find out if my dose (5 mg.) needs to be increased.

Thank you, everyone, for your thoughts on my situation.

SEOBowhntr · Dec 13, 2005

MZ,

Sorry to hear that the TEE went so rough, we usually use Versed, and don't often have too many issues with patients waking up, nor remembering much if they do. Because you are a Dialysis RF patient, they may have gone light on anesthesia as most of the sedatives are renally excreted. The Heart Catheterization is usually pretty easy, they should numb up the chosen access site, usually the Rt. Femoral Artery, and then proceed to introduce a 6 French, most common catheter and perform the procedure through that. The worst part often times is being on bedrest after the procedure. I would agree with your Cardiologist, though I didn't know that calcification was more common with renal patients. I've just seen less complications with mechanical vs. tissue (bovine or porcine) valves, and would personally take a mechanical for myself if needed. I too am scared to death of surgery after damned near dying from a Tonsillectomy and Pharyngealpalatoplasty. (Had a little bleeding into the lungs problem) Good Luck, and keep us updated as you are able!!

Doug

MedicalZebra · Jan 9, 2006

Well, I had the cardiac cath on Friday-- and needed SIX doses of Versed plus a Valium-- and I still was screaming! I thoroughly scared the hell out of everyone in the cath room! I don't think there's any doubt that I need more anesthesia than what they are currently giving!

I got the collagen plug on the femoral artery, which is really sore now, but at least it's not infected. (It feels really gross, especially when I stand up.)

I am going for a consult with the cardiac surgeon on Wednesday the 18th, with a tentative surgery date of Jan. 25. The cardiac cath also showed a foramen ovale, which the surgeon didn't know whether it had been there since birth, or was caused by one of the tips of the IJ catheters I had for hemodialysis. So that will be repaired when they do the mitral valve replacement.

The surgeon said because of the extensive calcification, the surgery is going to be a lot tougher than they originally thought-- he mentioned the possibility that the heart could split during surgery. I am getting my Healthcare Proxy filled out tomorrow at dialysis-- just want to be ready in case the unthinkable happens.