After my cardiology review midweek I’m being booked in for an angiogram and it’s been suggested I will be considered for an aortic valve replacement in the next couple of months. It seems the fact I get breathless on exertion and my valve is only 25% of the diameter it should be puts me close to the severe stenosis stage .
I’m just thinking about how my AF will be affected during and after the operation. My last ablation 16 months ago was pretty successful with only a few short episodes of mild AF recently . Bearing in mind I’m on anticoagulants I assume I’ll be taken off them for a period of time and post op I will be given some form of pain relief .
Given that anything stronger than paracetamol is not advised for AF sufferers will I be at risk of triggering episodes during recovery . I’m generally fit and well so not too concerned about the operation other than the length of time to get back to normal but do wonder how my AF burden will be affected by it longer term .
Id love to hear from any members who have had the same experience.
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Hammerboy
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Obviously check with you doctor or pharmacist but what is commonly not understood regarding paracetamol, is that for it to be fully effective for constant pain, it’s best to regularly take two tablets at least three times a day rather than occasionally as or when needed. Hope all goes well….
If you’re going to Royal Papworth you need fear you’ll have any pain at all. Post my heart transplant at Pappers I was pain free until I decided I didn’t need to take them anymore, 4 hrs later I was begging for them. Take what’s offered & you’ll be fine!
You can rely on Papworth to be one step ahead of you regarding anticoagulants & AF, they won’t put you at any risk & will be upfront with you about everything.
Sorry to hear this. My husband was in this position about 5 years ago and in persistent AF. Angiogram was no problem - about 30 minutes. He was offered a TAVI (much less invasive procedure) rather than open heart surgery, just wondered if this was offered as an option?
In the end it was decided that if AF could be controlled the stenosis would not be ‘bad’ enough to warrant a replacement and that’s what happened.
I’m hoping it doesn’t affect my AF negatively as the last year since my ablation has been much better . It’s really how they handle pain relief as I’m told it’s given for the first few days and I don’t want it to kickstart regular AF
I understand that from the view of a patient who can't tolerate ohs but if it's minimally invasive, shorter recovery time (so less time occupying a itu or general bed) why not do it for everyone?........ unless, its not as effective as doing the full monty.
Hi, I looked in to minimally invasive, for my valve repairs, 2 yrs ago, but there are few hospitals who did it and fewer surgeons who had experience, having done 20 or more, as benchmark. Also if its complicated or any probs they have to open you up to sort them out, so for myself I went with tested experience and had the open heart. Mimimal much more common in Europe and USA. Only small scar but you need someone to look after you for next 2 mths as you are restricted by surgery in what you're allowed to do.
I was told I would need to go elsewhere for a minimally invasive but that was 2 years ago and I know they have done them this year. I've been told I can't go back to work for 3 months after ohs. As a self employed bod, I'm keen to have something that has a quicker recovery time.
I'd think it could depend on kind of work, if using PC at home probably manage that after 4-6 wks, driving or lifting probly 6-9wks. I was told no pulling, pushing or lifting for 6-8wks after mine, not even to use your arms to push up from a low chair/settee and someone else can't pull you up either. See my post to Hammerboy re after care.
The risk with any open heart procedure is that the heart tissues become inflamed and this can lead to "Post-Operative AF" (POAF). Incidence of POAF is around 30% after heart surgery. POAF can range from very short term and goes away by itself, or sometimes a short course of Amiodarone is given, possibly with a cardioversion, then you come off the Amiodarone once the heart is settled. With prior AF history, I don't believe there's specific data giving incidence of POAF, I've certainly never seen any.
I had a history of AF going back 20 years, successfully ablated in 2002, and like you only very brief episodes thereafter. In 2017 I then suffered an aortic dissection and had a 14 hour op to repair the aorta and put a new (mechanical) AV in. My AF returned, though strangely looking at some photos which showed my bedside monitor, I was in NSR about 5 days after the op, so I presume it came back a little after that (I was in an induced coma for about 4 weeks).
I was eventually put onto Amiodarone, which after a long time, many withdrawal attempts, and some serious revisions to get my potassium levels up, I am now thankfully off it. I'm now in NSR with ectopics, bigeminy, trigeminy etc.
What I had done is probably orders of magnitude more stressful on the heart than "just" the valve.
Preventing POAF is a major target of much research. No particularly effective drug or supplement has been found, however, I have a very old paper saying that Ascorbic Acid reduced POAF, strange they couldn't bring themselves to call it vitamin C. I was taking 2000mg of C daily prior to my dissection, so this might have had something to do with my delayed transition to POAF. But vitamin C is definitely anti-inflammatory. I'm sure you'd need to take it for a longish time before the op to have any effect, and at a fair dose. Another that has seen some effect is NAC, or n-acetylcysteine, again due to its anti-inflam properties. The few trials that have been done on this for POAF were very short-term, i.e. a day or so before and after, so perhaps it's unsurprising the benefit was limited. I'm now on NAC to try and damp down my ectopics, and though it's early days (2 weeks) I do think it's helping, time will tell.
sorry to read this, especially after your successful ablation 🥲
I’m a little surprised that are doing this open heart as aortic valves can be replaced using a minimally invasive technique. Did they say why OH?
If it really must be open heart, you could ask them to do a maze at the same time. This would give you a stronger chance of keeping AF at bay.
I have never heard that re pain relief, I was on IV pain relief after my mini maze for the first day. I am also about to have hip replacement and plan to have pain relief. Your post has triggered my to go and check with my heart surgeon.
I was really intrigued by the pain relief point, I had pain relief and ibuprofen post mini maze, from reading up about this this morning it sounds like it’s not the pain relief triggers AF it’s that it interacts with blood thinners and other AF medication which in turn increase risk of AF. I am sure your team will be use to managing this and you’ll be fine, I expect they’ll take you off blood thinners before your surgery.
Thanks, apparently the TAVI option is only for patients who cannot tolerate surgery or are much older so I’m told . It’s also more complicated my cardio said but we’ll see when I talk to the Papworth team , interesting regarding the effects of drugs on AF and anticoagulants
How odd. Mt Birdi is a leading heart surgeon, no 1 in top doctors. He viewed my surgery, a lovely chap. I’m not trying to push him or private but just wanted to share his view. Putting you through open heart seems wrong just because you are young, there may be another reason of course. Good luck as you navigate this x
No, I didn’t have valve work only mini maze. Mr Birdi owns the private cardiac practice Nr Hunter works for. He does lots of valves that’s his specialism. He watched my procedure out of interest.
it’s quite common to suffer AF after aortic valve replacement. I had my valve replaced fourteen years ago and started going into AF post op which stayed with me on and off for years.
I would suggest you ask them about having the Cox IV Maze while they are in there and clamping the LAA which will be much better odds at no AF and would also mean no more anticoagulant for AF ever as well as reducing your stroke risk by 97%.
I had PAF and Atrial flutter prior to my OHS for tissue AVR. I also had a LAA clip and an ablation at the same time. I had tachycardia post op, plenty of pain relief and so far no reoccurrence of AF/AFl.
Had my aortic valve replaced a couple of years ago with a mechanical valve.Had af before the op and af after the op, its controlled by the drugs I am on.
The pain relief after the op was good in hospital and for the immediate time at home, I then used paracetamol 3x daily for some time until I felt I didn't need it anymore.
I think opiate painkillers are given, even though they bring their own problems "down below"! A relative and a close friend had the op and both recovered extremely well and surprisingly quickly (neither has AF).
I'm on the list for a mitral valve repair (caused by AF enlarging my left atrium) and the plan is for them to do a Cox IV Maze at the same time to combat the AF...... a BOGOF offer I suppose you could say 🤣.I did mention about pain relief and was told not to worry about that, they would dose me up to the eyeballs. As Mummyluv said, I believe that anti inflammatory meds react with anticoagulants.
I was also told that if they needed to replace the valve instead of repairing, they would with a mechanical one because of my age (pigs valves only last about 10 years so they dont want to keep repeating the op) , and then I would have to take Warfarin instead of Apixaban. I'm guessing that would be the same for you.
I write all my questions in a notebook and also make note of their answers.
Amazing how different things are said by different experts. I was told a pigs valve lasts between 15 to 20 years , also a mechanical valve is not appropriate for me. So confusing
Isn't it just. Don't know if it's due to the difference in the valves. Even at 15 to 20 years, I'd still need repeat ops (God willing 🤞😁) so I'm hoping it's just a repair. They have performed a minimally invasive op, keyhole type surgery, at my hospital this year so I'm going to ask about that.
When I first went on the the list nearly 2 years ago, they weren't doing any keyhole at all, just TAVI so things have obviously progressed.
A friend had a pig's valve. She was told that it would last 10 years. It was 12 years. They couldn't remove the infected valve so is on antibiotics for life. Auckland Hospital made her a special valve that's all she knows.
Hi the problem with warfarin is that it reacts with all types of NSAIDs and using other anticoagulants with Mechanical Valve Replacements is not licensed as I was told when I had valve replacement 6 years ago at the age of 48 for a Aortic Stenosis cased by congenital Bivalve Disease. This is a problem for me in that I also suffer with rheumatoid arthritis and after having pretty good pain control prior to the op I've had to manage with opiate type analgesia plus paracetamol since which is not really optimal regime and has left me with persistent joint pain. My understanding of the TAVI procedure is it’s not recommended for younger/fitter patients because it has a shorter lifespan than even a natural valve replacement which why my Cardiac surgeon recommended a mechanical valve over a natural valve as given my age I will probably need at least 1 redo of the valve. Though I don’t have issues with AF luckily I was left with issues of a persistent mild SR tachycardia but not AF which has been managed with medication and 1 ablation as it was thought it was possibly being caused by post operative scaring. The tachycardia now well controlled and only seems to reoccur if I’m late in taking my medication or have a chest infection.
Sounds like things worked out for you that’s great . I have osteo arthritis which is starting to affect some joints but so far not needing pain relief. I’m due an op on my big toe which will require fusing but I’m going to put it off as long as I can. Getting older sucks Elsie ally when you been fit for the majority of your life and all the aches , pains and issues all come at once 😩
Hi, I had open heart surgery to repair 2 valves in 12/21 at Brompton, aged 72. I was in AF at time so they sorted out medication etc. I also asked if they'd do an ablation when they were in there which they did. In for a week and was given paracetamol 1000gms, 3 x a day, worked pretty well, had little or no pain from surgery but chronic back pain maybe from way I was lying etc in surgery. Immediately after op they gave me doses of morphine which I asked them to stop because although effective it gave me hallucinations.
2 mths before op I had angiogram, clear, and TOE which revealed my Ejection fraction rate (EFR) was low, which caused concern. You need to ask your surgeon about yours if breathless. I had to have various resistant tests with scans to see if my heart would recover during and after op otherwise they said I might be put in an induced coma. Tests showed my heart would be fine. However, after op my HR was low 40 + so for various reasons a week later they put in a pacemaker to stop my HR going below 60.
Now 2yrs on a heart scan this year shows everything fine, My EFR is back to what it should be 60%+ and no stenosis etc. Pacemaker seems to do its job.
After open heart you haven't to lift, pull or push anything heavier than a cup of tea for about 2 mths to let the chest knit back together, which means you need someone to look after you, you can't even lift kettle to make your own tea. Things we did was we got a recliner chair so it could lift me out, and raised toilet seats so easier to get on and off.
Hope this helps if there's any other questions fire them off and I'l try to answer. Sorry for long response.
Lots of good info thanks very much . My EFR was over 60% on the latest scan which is good but my valve diameter is 1.1 and I’m breathless on exertion which has triggered the concern from my cardiologist . He’s booked an urgent angiogram and blood tests then he’s meeting g with the team to discuss going forward. I’m on statins and my cholesterol is 3.7 now with BP averaging 128 over 72 and oxygen at 95 ish . I think that’s why I was surprised he’s moving so quickly . I get tired a lot and have had the odd dizzy spell but my AF is pretty well controlled with only the odd random episode
It used to be Mid 50’s daytime and low 50’s at night although after a monitor was fitted it recorded some short runs of bradycardia during sleep . Since my last ablation my HR is high 60’s normally.
I’ve never heard that about painkillers and my cardiologist didn’t mention it. I fractured my neck of femur, was given IV morphine by the paramedics with the ambulance and endone (opiate) for post op pain for some time. No mention of AF concerns and I had no problems. I’m on Apixaban. Occasionally have to take Paramax (codeine and Panadol ) as prescribed by GP.
My GP and cardiologist both warned me to stay away from Ibuprofen and anti inflammatory drugs as it could trigger AF . Also they said being on anticoagulants
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