Aortic valve replacement: Hi, I'm new... - British Heart Fou...

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Aortic valve replacement

Hi, I'm new here. My husband is having to have an aortic valve replacement (pig tissue). I am really nervous as he does all the cooking and pre-assessment nurse didn't seem eager to answer specific questions! I know that he will have to have a long recovery period - 3 months. Can he fly (to Scotland from London area) before then?

Can he eat things like seafood - prawns, crab, scallops etc? Can he have smoked meats and fish like smoked trout? Avocados, pomegranates - and cheese? I am very confused. Once he has recovered can he go back to normal eating - in moderation of course? I haven't found a detailed list of things to avoid. I do know he needs to drastically reduce the amount of alcohol he currently consumes.

I am also very nervous as to whether I will be up to looking after him - he is younger than me and very precise. I just don't think I can cope. Luckily he is having the operation in London so I can stay with friends.

Another question - how does he get home? I don't think the hospital will sanction an ambulance outside of London.

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Can he fly?

Yes he can. Southampton Hospital also serves the Channel Islands. Patients fly home to Jersey and Guernsey immediately after being discharged. You have to be sensible, no lifting heavy luggage into overhead lockers, but flying in itself isn't a problem.

Regarding eating, it's a bit of a minefield and for some reason people get extremely passionate about what diet is best, even though there's not much in the way of conclusive research to support any particular position! Your husband should try to go on a cardio rehab course which will give him lots of useful diet advice. The recommendation of the British Heart Foundation is a Mediterranean diet, ie oily fish twice a week, lots of fruit and veg, moderate diary, some poultry, very minimal red meat, cook with olive/avocado oil rather than vegetable/seed oil, zero processed meats or highly refined foods.

Good luck to both you and your husband!

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Thanks Chappychap. The difficulty is that he LOVES curry and cheese! He also drinks to excess but is cutting down - I think. You have reassured me. Don't know how I am going to cope though, I am scared! That's why I joined the forum. I'm also a lousy cook, but getting recipes from food magazines. Hope I can ask more questions.

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Hi granniea, welcome to the forum and good luck to both you and your husband! I had, at age 50, an AVR in December, also a tissue valve (Edwards Inspiris). I can only answer from my own experience but here goes if it helps.

Diet and cooking. Whereas with a mechanical valve and Warfarin there are some restrictions on diet (especially foods containining vitamin K) this shouldn't be an issue for your husband. Obviously if he is put on any drugs that interact with certain foods, he should steer clear while on them, but you and he will be advised of that at the time. I am lucky in that my only medication is dissolvable aspirin and so there are no constraints on what I can eat at all (though a healthy diet is a good idea generally of course). I personally love all of the foods you've listed, apart from pomegranates, and will happily eat any of them!

Ditto, alcohol. Again, the main issue with alcohol as I understand is the interaction it has with Warfarin but, with a tissue valve (and assuming he isn't put on Warfarin for a different reason) that once more shouldn't be an issue. However, alcohol can of course have a negative effect in terms of raising blood pressure levels and so, yes, he may want to look at how much alcohol he is consuming to stay healthy in terms of general heart health. But, at least from my experience, there isn't a specific link between having a new tissue valve and drinking or not drinking alcohol. Personally (and bearing in mind I was discharged a week before Christmas!) I didn't drink at all for the first few weeks - really just didn't feel like it - apart from a glass on Christmas Day. My wife and I then went on the wagon during January and February, but that was more for general health/weight/diet reasons rather than heart specific. I do have a drink or two, normally at the weekends, but try to keep drink free during the week but, again, that is more for general health reasons (and because I am aware of my blood pressure, which is still slightly high) than anything to do with the valve specifically.

One thing I guess - if he is a keen cook - is that he'll need to be careful for the first 12 weeks with lifting pans and pots etc. Basically anything heavier than a half-filled kettle of water is the advice. But as the sternum heals he should gradually be able to do more and more.

Travel. Chappychap's lifting/luggage advice is spot on. But also the big thing I found for the first 4-6 weeks was fatigue. A fog of exhaustion! So it may be less about whether he can travel because of the valve - he can in principle - and more about whether after what his body has been through he'll feel up to it? I made a point for about the first month of going to bed for a couple of hours in the afternoon. This gradually progressed to shorter naps and then going to bed to have a read, to then taking time out to read stretched out on a sofa and so on. But it does all take time. I travelled for the first time post-discharge (train to London for work) at about seven weeks, but reluctantly, as I would have preferred to leave it a few weeks longer. As it was, physically it was absolutely fine, but I did feel a bit wobbly, both physically and emotionally. Second time was then totally fine.

Generally, if it helps, I was in and out in a week. I fully expected to come home something of an invalid - needing to be helped up and down stairs, confined to bed for most of the day, being brought my meals, being helped with dressing and washing etc. In reality, I experienced none of that. I was much more capable and "able" than I had ever expected I was going to be. In fact, we had bought various "patient" cushions and things like a bed tray for eating meals off, which we ended up never needing. I could dress myself, go up and down stairs, wash myself, make myself a plate of food, get up and down off the sofa etc. As I say the main thing was not overdoing things and taking it slow and steady. But physically - for me at least - I found it astonishing. Also, again at least for me, once the dressings came off the wound was left to heal in the open air, so there were no dressings to manage. Plus (to my very pleasant surprise) no support stockings. One tip - a good thing for him to practise pre-op is getting up from a chair or sofa without using his arms, as he won't be able or shouldn't push on them at the beginning. I also found I had a very stiff neck and shoulders for a few days/weeks (they get manipulated during the operation) but stretching exercises should help, and the hospital should be able to advise.

I started walking outside, initially just around the block and initally accompanied by my wife but then gradually building things up, after about a week. Within a month or so I was doing about a couple of miles a day, though everyone is going to be different. I also right from the off noticed an immediate improvement in heart function, sort of a revelatory "oh so this is what it's like for everyone else"! Hopefully your husband will feel the same. As Chappychap advises, if he can get on a cardiac rehab programme, that'd be a good idea too, as I've certainly found it helpful, both physically but also just in terms of feeling confident in your new valve/heart.

I had my op at St Thomas' in London and they give you a handy leaflet, here is a pdf link to it

guysandstthomas.nhs.uk/reso... plus also this one especially is good

guysandstthomas.nhs.uk/reso...

Finally, you asked about patient transport home. It's going to vary from hospital to hospital and it was something we discussed at length. I was, as I say, at St Thomas' in London, but live on the south coast, so a bit of a trek. St Thomas' did offer a patient transport service but it was made quite clear that a) it was for patients who had no other option, b) because it is essentially a bus of patients you might have to sit around waiting for it for a while, c) it goes around the houses dropping everyone off so can take a long time, and d) is only insured to take the patient so any partner/carer has to make their own way home anyway. So we looked into various alternative options. I didn't really fancy navigating Waterloo Station at (most likely) rush hour in the week before Christmas just days after major surgery. When we looked into it a taxi from our area to the hospital and back, while not cheap, was about the same cost anyway as anytime train tickets for the two of us plus what taxis were likely to cost getting us to and from each station. So we just bit the bullet did that, and I was very glad we did. I took about three/four hours as it was through rush-hour/Christmas traffic - lots of sparkly shop windows to look in the dusk - but it was door to door and not overly exhausting. But this may be something you want to talk to the hospital about. A lot of other patients had friends/relatives who acted as taxis for them, but that wasn't an option for us. I also by the way know a guy on here who had the op at St Thomas' in the autumn who did the patient transport option and found it fine.

A final note of hopefully reassurance, if I may. For me the whole mental and emotional build-up - the terror, fear etc - was almost worse than the operation itself, though the first few days after aren't fun. It is a very straightforward, standard operation these days and so I'm sure he'll be in good hands. Bear in mind you too may find it hard as the helpless, worried observer fending off/managing all the calls and updates from friends and family. So don't forget to look after yourself. It is a major operation, and it will take him time to recover - and I was very lucky in that I had and have had very few complications and side-effects - but fingers crossed and I'm sure it will go well for him and you. You'll all soon be out the other side and on to the next chapter of life! Good luck and do keep posting or asking for advice or reassurance as that is what all us "hearties" are here for! Nic x

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Nic

I have read your reply with tears in my eyes. Thank you!! We live in Berkshire and my husband is having his op in St Barts. He is 65 (will be 66 in August). He is NOT fit and isn't able to take instruction - he is extremely bright and does research. I am hoping he comes through everything with flying colours. Thanks for the info about the taxi - I am considering a private ambulance to give him a more comfortable ride. Thanks also for the link to St Thomas. We got something very similar from Barts. Luckily I am staying with friends in North London for the duration. My husband considers me dozy at times - I'm 7 years older, but think I can manage salads and simple meals. I really appreciate the time and effort you have given in your reply. I am now on Kalms to help me through - he has to have an angiogram on the 21 June. I hope you don't mind if I ask more questions to you and others.

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Hi Nic

I have MORE questions - sorry! How do you get in and out of a car after surgery? Could you eat a curry and when? Did you need button-down shirts that were a size larger? What foods did you have to avoid after a pig tissue replacement?

No doubt I will have more later! Thanks in advance. I bought a pedometer yesterday and have bought some frozen fish. A friend also suggested SIMPLY FRESH so will investigate that.

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No problem!

1) By bending down? I had no mobility issues to speak of getting in and out of cars at all. The main thing is I guess the chest wound will be sore/tender so some support between the chest and the seatbelt is a good idea. A wedge/maternity cushion or wrapped towel can do this. He may want a cushion under his bottom for comfort or if the journey is going to be bumpy. But it's only his heart that is being operated on, not his legs or arms!

2) Yes. I seem to recall I ate curry a number of times in the hospital (though none of the hospital food was great in my opinion to be honest). It's just how he's going to feel really. There's no restriction on when he should eat curry - if he's a real curry fan and it'll make him feel better go for it! If it's going to make his eyes water and cough and splutter and therefore hurt, perhaps hold off for a bit? It's just common-sense really.

3) Yes I did buy one size larger shirts though that was in anticipation of there being dressings under my clothing which in the event there weren't. But yes comfortable clothing that doesn't cling or restrict is a good call. The main thing is clothing that doesn't need to go over the head as he won't be able to lift his arms fully initially. So yes button-down shirts (and don't forget pyjama fronts - some people forgot and were struggling with their tops at times), zip tops etc. I also got some trackie bottoms for comfort and some thick socks (as it was winter). Basically comfortable and "easy" clothing.

4) None? There are as far as I'm aware no restrictions on what foods I can or can't eat. Just as per before I guess it's about trying to live/eat healthily? But that's about general heart/body health rather than the tissue valve as such? The only valve-specific medication I'm on is dissolvable aspirin, and so there are no food/drink limitations to that (apart from ideally taking it after food). Obviously if he is on drugs that do cause a reaction to various foods or drink he should avoid until the course has finished.

A pedometer is a good idea! Personally I love fish, frozen or fresh, so yes both sound delicious to me! I guess it's just what you will feel comfortable cooking and what he will feel comfortable and happy eating? But unlike with Warfarin there really aren't any food restrictions as far as I'm aware; at least I don't have any.

Hope that helps. Sounds like you're doing a great job on the planning/preparation!

Nic x

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Hi granniea

I had a valve repair on the 22 May 20014 at age 69 in the Royal Brompton. It was successful and I am pleased to say I am still here.

I would think he will be on anticoagulants for a fair while which will only affect his diet if he is on warfarin. He will be able to follow his normal diet but he will probably be in full recovery mode so his appetite may be much diminished at first.

If you haven't discovered the joys of cooking there are a lot of 'instant salads' in the shops these days, along with ready meals, shakes, smoothies and fruit. Anything easily digestible is good: - rice pudding, frozen mashed potato, etc.

It takes about 8 weeks for the breastbone to knit together and heal and its not a good idea to plan on lifting anything in that time. which means no driving as well for a while

Nic's advice is sound - one of the best posts I have seen on this post. Before they let you out of hospital the medics will have your man taking showers, dressing himself, walking around the wards and getting about generally. If you are concerned about his alcohol consumption try and get some alcohol free drinks in.

With regard to travelling back I got a taxi to Paddington, my wife bought tickets from a machine on the station. We were going to travel first class as a post operation treat, but the discharge process was sudden and quick so we just grabbed the next train to Cardiff and off we went, back to the land of mist and magic.

Get a V shaped pillow to help him sleep and make sure he has a comfortable dressing gown. Loose jogging trousers are easy to get on and off and make getting dressed a bit easier at first. Summer is coming, it's a great time for an operation.

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Thanks lanc2 - especially about the pillow which I've already bought from Stow. It is reassuring to hear how you were able to take public transport. I think we will take a taxi if necessary as I don't want to risk infection. He is awful about medication, so please keep your fingers crossed I don't have too many problems.

We have a sofa bed downstairs so he can sleep there for the first few days at least - and it has air con (we bought it earlier this year as neither of us can tolerate heat) so think that is where he will be.

You have reassured me - but now I'm on Kalms, I can cope a bit better.

Thank you.

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About food. My wife used to be a chef and I have spent 40 years being kicked out of the kitchen. Now that her mobility is severely restricted I now have to do all the housework and cooking. I am a dab hand at burning water.

To make life easier I now use M&S as they have a good range of ready meals and/or separate dishes to make up meals. Got another freezer so any excess or near use by date can be frozen. Well worth going to have a look.

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Thanks for this - I'm sure I can cook chicken, but our supermarket is sadly lacking in fish varieties and I think my husband will get fed up with salmon twice a week. Will check out M&S tomorrow when I go into town.

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You can anti bacterial gel from most chemists/tescos etc. quick wipe and off you go. Aldi's frozen lemon sole is good, lots of frozen veg in the freezer section, poached eggs are easy in a small frying pan. Bring water to the boil, slip in the eggs, do nowt for a couple of minutes, butter your toast and off you go. He probably won't be very hungry for the first fortnight anyway, but you might be able to tempt him with good quality Ice cream. Lots of calcium is the order of the day..

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Thanks for this - I've lots of antibacterial wipes and gel left from an accident I had a few months ago.

Great tip about Tesco's - Waitrose doesn't have a great selection of plain frozen fish. I'm reluctant to give him seafood - prawns, lobster, scallops, mussels etc - because of the iodine. I feel so much better after reading everyone's kind tips. I am just praying all will be OK and all my husband has to do is relax and recover - and do his exercises and walking!!!!

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Hello, my husband had an AVR 16 months ago. When it comes to food, the only thing he can’t have is cranberries as he had a mechanical valve and is on Warfarin. My husband loves curry and wanted one fairly soon after coming home. I use a jar of Pataks sauce, add a dollop of mango chutney and diced chicken, plus any leftover veg or chickpeas. It’s reasonably simple as you can buy diced chicken. He was happy and my brother-in-law who fancies himself something of a curry expert pronounced it delicious.

All the best for you both.

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