A New Beginning 2012-7 - UHSM

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What are the risks of valve surgery? Valve surgery, like any other surgery, carries a risk of complications. The risk of complications varies for each person and will depend on several factors including: • your age and sex • which valve is being operated on, and the extent of valve and heart muscle disease • whether you are having a coronary artery bypass graft at the same time as your valve surgery • whether you have diabetes, lung problems, kidney damage or any significant problems with the circulation to your brain or legs • the urgency of the operation. Your surgeon will take the above factors into account when assessing your individual risk. Possible complications are: • wound or chest infection • ongoing risk of infection (endocarditis). To reduce this risk all patients should have regular dental checks • irregular heart beat • blood clots can form, mostly on mechanical valves • wear or damage to valves - this is more common with tissue valves • stroke - there is always a very small risk of stroke with valve surgery. Consent for your operation A member of the surgical team will ask you to sign a written consent form for the operation to be carried out. Your surgeon will discuss the risks, benefits and alternatives for you as an individual. If you have any questions, please talk to the doctor before you sign the consent form. What will happen on the day of my operation? On the day of your operation the anaesthetist will have prescribed for you a ‘premedication’ to be given a few hours before your operation. This will involve you being given some tablets or an injection and possibly some of your normal medication. The premedication will help you relax and may make you drowsy. You will be taken to theatre on your bed. In the anaesthetic room the anaesthetist will put a drip into the back of your hand and give you the anaesthetic injection. Whilst you are asleep the anaesthetist will put a tube down your throat, into your windpipe and connect you to a ventilator (breathing machine). This tube stays in place throughout your operation. It is needed because during the operation it is necessary for your body temperature to be lowered to rest your heart and lungs and allow their function to be taken over by the “bypass and breathing machine”. Whilst the thought of having this tube in your windpipe is not pleasant, please remember that you will be asleep and therefore not aware of its presence. After your operation you will be transferred into the CTCCU whilst still under the anaesthetic. It is important for us to monitor your heart rate, breathing and blood pressure. Your sedation will be reduced once you are stable. The tube in your windpipe will be removed when your lungs are strong enough for you to breathe properly. 10 Healthy eating Research has shown that by making changes to your diet you can reduce your risk of recurrent heart problems. You should aim to achieve this by: Fats • reducing your saturated fat intake • including omega-3 fats weekly • having at least five portions of fruit and vegetables per day • reducing your salt intake • maintaining a healthy weight All fats and oils contain a mixture of saturated fats and unsaturated fats in different proportions. Unsaturated fats are either mono-unsaturated or poly-unsaturated. Saturated fats Too much saturated fat causes the level of cholesterol in your blood to increase. Therefore you should reduce your intake of saturated fat. Saturated fats are mainly found in: • butter, lard, suet, ghee, coconut oil, palm oil, and any products made using these, for example pastry, pies, cakes, biscuits • fat on meat, processed meats such as sausages, beef burgers, salami, corned beef • full-fat dairy products such as full-cream milk, cream, cheese, full-fat yogurt • manufactured foods such as chocolate, mayonnaise, cream substitutes. Unsaturated fats As part of a healthy diet you could replace foods that contain saturated fats with foods that contain unsaturated fats. Unsaturated fats can be good for our hearts. Some foods that could replace products high in saturated fats include: • oily fish • nuts and seeds • olives and olive oil • sunflower and rapeseed oil • avocado. Trans-fats and hydrogenated fats These fats are formed during food processing when they are subjected to high temperatures. They are mainly found in deep fried foods, shop bought cakes, biscuits, confectionery and crisps. It is important to eat as little trans-fats and hydrogenated fat as possible, because they cause your blood cholesterol to increase. 43
Non-modifiable risk factors Family history Coronary heart disease runs in families. Your own risk of developing coronary heart disease is increased if your father or brother was diagnosed with the disease under the age of 55, or your mother or sister was diagnosed under the age of 65. Other conditions which can run in families include high cholesterol levels, diabetes and hypertension. It is important that family members are aware of their own risk factors and take steps to prevent heart disease. Age The older you are the more likely you are to develop coronary heart disease. Gender Men are much more likely to develop coronary heart disease at a younger age than women. Women appear to be protected by their hormones until the menopause, after which their risk of heart disease increases. Ethnic background People from Afro-Caribbean backgrounds and South Asians are at a higher risk of developing coronary heart disease. Cardiothoracic Critical Care Unit (CTCCU) The amount of time spent recovering on CTCCU can vary from one individual to another. Patients will stay on CTCCU until they are fit to be cared for on the ward. The morning following your operation the consultant and anaesthetist will visit you. They will review your condition and decide whether you are to stay on CTCCU or be transferred to the ward. In general most patients are transferred between 12 to 36 hours after their operation. The nurse who is looking after you will keep you fully informed about your transfer. Your nurse will monitor your condition and assess when you are ready to begin breathing unassisted again. As you start to wake up your nurse will tell you that you are back on the CTCCU and that your operation is over. To check that you have woken up properly your nurse will ask you to move your toes and squeeze their hand. This helps them to assess how awake you are. You will still be very sleepy at this stage and you may become aware of the tube in your throat and windpipe. If, at this stage, your condition is considered stable the nurse will remove the tube in your throat. If not, the sedation will be topped up until you are ready for the tube to be removed. It is important to remember that whilst the tube remains in your throat you will be unable to talk. Do not be alarmed – your voice will return once the tube is removed. As your nurse will be monitoring your breathing very closely they will be with you all the time. They will ask you to communicate with them by nodding or shaking your head or by squeezing their hand. Some patients who have existing lung disease, for example asthma or chronic bronchitis, may need more assistance with their breathing. The consultant anaesthetist who speaks to you before the operation will tell you if they consider that this will be the case. Once you are off the ventilator and the tube is removed you will need extra oxygen via a facemask for approximately the next two days. The mask should remain in place for most of the time, but you can take it off in order to eat or drink. Pain Your comfort is very important to us. When you are pain-free it will improve your breathing and help your physiotherapy (see page 13). We will give you painkillers through one of your drips and gradually replace this with tablets as you recover sufficiently to be able to eat and drink again. It is important that you let us know if you are experiencing any discomfort so that we can adjust your painkillers to suit your need. Intravenous infusions (drips) Whilst you are sedated you will have several drips inserted. Some of these will be in your hand, others in your neck or shoulder. Most of these will be removed on the CTCCU before your transfer to the ward. You will be left with one drip in your hand and possibly one in a neck vein. Whilst you are under the anaesthetic, a tube (catheter) will have been put into your bladder. This will drain your urine whilst you are asleep and for a short time afterwards. The catheter may be removed during your stay on CTCCU or on the ward. 42 11
Page 1 and 2: Editorial board no. 1033/12 Copyrig
Page 3 and 4: Weeks 8 - 10 May be able to return
Page 5 and 6: Wythenshawe Hospital (UHSM) contact
Page 7 and 8: Support groups Ticker Club Tel: 016
Page 9 and 10: A guide to portion size: − pineap
Page 11: How to reduce saturated, hydrogenat
Page 15 and 16: High levels of fats in the blood (c
Page 17 and 18: Stress Research evidence has shown
Page 19 and 20: Studies show that benefits of using
Page 21 and 22: Generally you may return to: Light
Page 23 and 24: Active hobbies and sports In most c
Page 25 and 26: Home exercises The following exerci
Page 27 and 28: Perceived exertion scale When carry

A New Beginning 2012-7 - UHSM

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