Friday, January 29th Daddy had an EKG, blood work, Chest X-ray, Pulmonary function test-Spirometry, and Carotid Duplex Scan. It was certainly a busy day.
In between all of these things Mama, Daddy, and I met with Dr. Coselli’s Nurse Practioner, Kathy Loring, for quite some time – and then with Dr. Coselli for a brief visit between his surgeries.
We learned many things about hearts. One of Daddy’s problems is an aortic root problem. There are a few ways that they are going to address his aneurism and blocked valve. This is how I understood it:
They will go in through the front chest wall, where he had his previous surgery 17 years ago to have the mechanical aortic valve put in. When the surgery begins they will have reviewed all of the test results, x-rays, echocardiograms, and the PET/CT scan that Daddy had done on January 21st after the fluid was drained from his lungs. All of these things will help the doctor determine the best treatment and surgery once he opens daddy’s chest wall.
Depending on where the aneurism is on the artery will depend on whether they replace the St. Jude’s valve. If they do replace the valve then they will use a tissue valve (they are far more advanced than they were 17 years ago) and there is a chance that Daddy could stop taking the Coumadin! That would be great for sure.
They are going to replace the part of the aorta that is too large with a Dacron graft. As mentioned above the new valve will depend on where exactly the aneurism is located in reference to the valve. The doctor is also going to most likely take in internal mammary artery and attach it to the left side of Daddy’s heart where the blocked artery is and that will take care of the blockage. If there turns out to be a problem on the right side, there are a few things that they can do for that. The one most likely is that they would take a vein from one of Daddy’s legs and use that for a bypass to the right side of his heart.
The entire process of prepping for surgery, anesthesiology, surgery, and then closing up, etc. will probably take about 6-7 hours. They estimate that the actual time he will be have the surgery itself is about an hour or little longer. They will put him on a cardio pulmonary bypass machine through his right shoulder for the actual operation itself.
Daddy’s probably going to be in ICU for about three days and then will move to the 10th floor for up to about seven more days for his recovery.
As far as recovery, it will take about six months for the ablation to take effect and it must form scar tissue to get to a normal sinus rhythm. Because there is scar tissue from his previous surgery and from the Proton radiation he received in 2008, the recovery could be a little harder. Nurse Kathy talked about something called “Dressler Syndrome” – which is an inflammation of the sac around the heart – it not uncommon for patients to have this after heart surgery. She said it sounded like Daddy had this the last time he had heart surgery too.
Dr. Coselli said that Daddy is a good candidate for this surgery because of the lack of signs of cancer [we have not been specifically told it’s in remission – but they say that the scans look good and there is no evidence of cancer] and also three other things: Daddy’s left ventricle is in good condition, his lungs are up to handling the recovery, and his physical condition is good.
One of the really cool things for his recovery pain is a thing he is going to have implanted just under the surface of his skin where the incision is. It’s called an ‘ON-Q PainBuster Catheter Placement’ and it will work for four days on it’s own and then the nurses just pull it out like a suture. It automatically administers a continuous, regulated flow of local anesthetic through a specially designed catheter to the site.
So – the surgery is set for Monday and Mama and Daddy will be there before 6AM!!!
Stan, Carol, Laura, Stacie, Kathryn, and Kenneth
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