Post op care

[Bearface14]

My dad had open aortic valve replacement 2 weeks ago at St. George’s. He was discharged within 4 days of the operation with minimal medication and no plan for physio or rehab if any kind. His follow up with the surgeon is not until July and is only a phone appointment. Is that right? How can they tell the valve is working properly they haven’t done a follow up echo at all! How do they know his heart rate is stable and he is not back into AF again?! Can anyone give me an idea of what should happen - the hospital have been awful to say the least!

[Hidden]

Hello

I am not as knowledgeable as some on here but sometimes they start with a phone call and with the questions and answers you give they can tell if everything is sounding like it is ok

They could invite him for an echo later down the line

If he is in pain then I would contact his Doctor ask their advice and they may give a stronger painkiller

Maybe you could phone the ward and ask what your Dad should be doing at this stage and how he is feeling there should be some Rehab Nurses to talk to

You could always phone the BHF Nurses and talk to them to who give great advice

0300 330 3311 Mon-Fri 9-5pm

Others will come along that are more knowledgeable and have had this done and give you lots more feedback

Wishing your Dad all the best x

[Bearface14 in reply to Hidden]

Thank you 😊

[Chappychap]

Questions like this pop up all the time on this forum, there's clearly a huge disconnect between the after care that people would like, and the after care that the NHS consider necessary!

What's hard for us heart patients to accept is that the hospital has finished their job. We've been through this traumatic event and we're looking for masses of advice and reassurance, but all we get is the cardiologist and surgeon waving goodbye!

But when we put our car into the garage for a new clutch or alternator, we don't expect the mechanic to explain how the clutch works. Still less do we expect a cheery phone call from the mechanic at regular intervals asking how the new alternator is performing. It's the same for the surgeon and cardiologist, they fitted the replacement, it worked fine as the patient was being put back together, so as far as they're concerned it's job done and on to the next one!

There is some follow up, a kind of annual MOT for heart patients. Every 12 months open heart surgery patients are supposed to have a consultation with their GP or a specialist practise nurse. We get an ECG, blood tests, our blood pressure is measured, we get weighed and given a life style pep talk. Other tests are sometimes added depending on the needs of the specific patient. There's also a six session Cardio Rehab course after about eight weeks post op that the hospital arranges, but because of the pandemic that may or may not happen. If not the BHF (who sponsor this forum) run an excellent on-line version.

The key thing about cardio care is that for most of us, not all of us but most of us, the future is really in our own hands. We've got to be scrupulous about taking our medication, and we've got to get serious about changing our lifestyles. It's these two initiatives, much more than face time with a cardiologist, which will determine how many more years of good health we'll enjoy.

Good luck!

[Nettekin in reply to Chappychap]

I do like your comparison with a motor car having work done in a garage! In many ways it makes a lot of sense to me. On the other hand, the human touch is perhaps what we humans crave most. So while the surgeons and consultants may lose all interest once the mechanics are completed a better system of follow up (and even interest) would be lovely and may go a very long way to speeding up our recovery. X

[MountainGoat52 in reply to Chappychap]

I agree with everything that you've said, but follow up can be put in place. In my experience I wasn't just discharged and forgotten about by either hospital that I was in.

After my heart attack and stents in 2017, Kettering rehab was quickly in contact with a follow up face to face chat, assessment and programme. It was agreed that physical rehab would be delayed as I was doing fine and I had been referred to Papworth for a bypass. It took almost a year for that to happen, but again about 3 months after surgery I attended for tests, an X-ray and a face to face consultation with the surgeon before being discharged. By that stage I had already been passed on to Northampton hospital for follow up and had had a face to face meeting with someone in the Cardiology department there. An ECG was arranged and I was also referred to Pathology to try to determine the reason for my heart attack. Kettering then came back into play contacting me to set up rehab classes.

The way the 3 hospitals interfaced was amazing, but that was 4 - 5 years ago. The situation now appears to be that the backlog of patients awaiting surgery due to the pandemic has shifted the focus to getting patients through the system to reduce waiting times and as a result the level of aftercare offered by hospitals has suffered.

As for my personal on-going care, I've had to be proactive and even remind my GP practice that I should have an annual blood test. I've never had any further tests or ECGs. They aren't particularly interested when I send my blood pressure readings in and rarely put anything on my records.

[nilmonisikdar40]

I think it is utterly wrong to discharge after a major cardiac surgery and given a follow up appointment for a telephone consultation. I have heard from a surgical consultant that often he is pressurised by hospital managers to focus more and more on telephone consultation not based on clinical grounds but on administrative expediency. If something goes wrong soon after the telephone consultation, who is clinically responsible for it - certainly not the administrative manager but the clinician and in that case the cardiac consultant? Have anybody recently visited hospital out patient department and had the chance to survey what was going around. It is not that the place is full of patients waiting to be seen and not a sitting place is available. The pandemic and lock down has come and gone. If the managers feel that there is no sitting space for patients to sit and wait, at least the first consultation after surgery must be a proper consultation - which is face to face consultation. I hope that has been helpful.

[ChoochSiesta in reply to nilmonisikdar40]

I think we need to look at the bigger picture. We have waiting lists of 6 million+. The NHS have to prioritise.

[nilmonisikdar40 in reply to ChoochSiesta]

I am aware of the bigger picture which is the NHS is deteriorating in every aspects -whether General Practice or the Acute Sector. It is no longer the envy of the outside world. Prioritisation has to be made on the clinical needs of the patient not on grounds of age, gender or sexual orientation and certainly not on grounds of administrative or political expediency. NHS philosophy and constitution exactly states that.

[Heyjude31 in reply to nilmonisikdar40]

I totally agree. I tried to follow due ‘process’ and go through my GP for answers when I had some real concerns following my bypass surgery. In my case the GP said they were either not qualified to answer my questions, or I was to speak with my cardio team. Fortunately for me my Cardio surgeon was very helpful, and I was able to see him. I think I wasted NHS time in trying to follow ‘process’ .

[MountainGoat52 in reply to Heyjude31]

I don't think that you wasted NHS time in following their process. They are the ones responsible for the systems that are in place that we as patients have to work to.

[Clairealou]

Hi there. I know how he/you feels after such major surgery that you’re suddenly thrown out on your own. It’s pretty scary! However, firstly, I’m guessing they’ve given him paracetamol as pain relief. This is what is usually prescribed and so long as it’s taken every 4 hours, is pretty effective. I’m guessing as he’s 2 weeks in now, he’s probably passed the worse. I have never bothered with rehab as the time you get an appointment through, you’re often back on your feet anyway. Get him to try some gentle walking. I do some walking videos on YouTube which have been really good called Leslie Sansome. She does some which are very gentle and you can do as much or little as you want. As for the appointment, yes, it’s a little surprising that the first one is only telephone but more and more common. I had my 5th valve replacement in September and haven’t had an echo yet to check on it. I think if your dad went back into AF, he’d feel it and could discuss with his GP who could probably fast track him back to hospital if it was too bad. Once you’ve had surgery, you definitely get taken more seriously.

I’m so sorry your dad has not had the care he wanted. Certainly sounds like he’s had the minimum they could offer which is no consolation when he’s been through what he has. However, stay on here, keep us posted on how he’s doing and message me privately if you want to. I’m a bit of an old hand at valve replacement now!

[Bearface14 in reply to Clairealou]

Wow 5 replacements! You must be well experienced by now, sorry you’ve been through it that many times. Thank you for your words, he is through the worse of it now but I feel it wasn’t even a lack of the care he wanted more the lack of care that should have been given. I’m still bitter if you can’t tell!!

I’m glad to hear you say he would feel if something wasn’t right, he has reassured us all that if anything doesn’t feel right he won’t keep it to himself!! Thank you 😊

[Adhtz21]

Glad to hear your Dad is ok. In terms of discharge, the time is about right. I had a 3 month review (phone due to Covid restrictions)) but did have an echocardiogram and a CT Scan with Contrast Dye at around 6 to 12 months. I had extra work done though including replacing part of my rising aorta. Not sure if this affects the follow up. Whilst I was offered Cardio Rehab, this did not take place due to Covid again but I did have exercises and phone contact with a Cardio Rehab Nurse. Personally, I get very frustrated with these telephone consultations as they are next to useless and a cop out. I insisted on a proper consultation at year 2. Now I am going for another echocardiogram when my turn is due. My surgical team at the Nottingham City Hospital were fantastic but on discharge to a local cardiologist the same cannot be said. Good luck to you and your Dad and put it in writing if you have any doubts.

[Berto47]

Hi, yes that was my experience too, I was very underwhelmed and disillusioned too with the aftercare

[reader1989]

Hey, Though am not an expert here still I would like to give you my suggestions. As far as your dad is health this is not a concern here. However, it is best to have regular follow-up to know more about recovery rate and other precautions to be taken.

[KTM1290SAS]

It looks like it's a postcode lottery on this. I had an aortic valve and rising aorta replaced in January in the Edinburgh Royal Infirmary and was drop kicked out of the hospital 5 days later without any advice on what I should do or not do, but they did supply me with a range of meds. I don't usually do "anxious", but this was the first time I did. I went to see my GP the next day and he was very re-assuring and the following day I received a call from the cardiac rehab nurse. If you don't get any contact from the NHS regarding rehab, I'd definitely get in touch with the hospital and your GP to get this started asap. Tracy, my Cardiac rehab nurse was a godsend and helped me through the next few months with advice and exercises to do. Now feel I'm pretty much fully recovered, but those first few weeks were hard. I hope your dad does get the same sort of support that I did and am sure he will be on the path to recovery very soon.

[Templar889]

Hi. Same situation as I was in after my op. They check the valve after fitting so that should be ok. As for rehab, I’ve had no contact from hospital regarding this. Did my own thing, slow walks at first gradually building up. I had hardly any meds also!!

[Wellington19]

I had aerotic valve surgery and partial myectomy in December, had echo while in hospital, operation at St. Barts, no care package or rehab, ,but outpatient appointment a7t JOHN RADCLIFFE about two months later

[Coper10]

I had AVR in March 21. I had a telephone consultation with my surgeon at 6 weeks to follow up and a CT scan 2 months after my op to check all was well. I was advised this scan would be an annual even5 along with a blood test. Cardiac rehab was offered at about 7 weeks post op, but due to covid consisted of some telephone calls. Subsequently, when I found face to face sessions had restarted, I got my GP to refer me back to rehab and had 8 sessions in the gym which were very helpful re my confidence and advice on heart rate levels during exercise. When I was first discharged, I was advised to walk 10 minutes daily the first week, then add 10 minutes each week to build my tolerance and stamina. When I got to an hour, I worked on increasing my pace or inclines. It did feel very scary at first being out of hospital. However, I had contact details for my cardiologist which was reassurance if I had a query.