What medical issues to get fixed before the surgery

[plsflgood]

As any major dental procedure becomes more risky after an AVR surgery (chance of the valve infection), obviously, all pending dental issues better be resolved before the surgery.

My question is: what other health conditions are better be taken care of before an AVR surgery, rather than after it ?

 

[selma]

Interesting...I just got back from the dentist who is committed to getting me back into good oral health before May 11. My guess would be that if you are due for a colonoscopy or endoscopy, for many reasons I'd get that done before the surgery. I'd be interested in hearing about this, too.

 

[Mentu]

For about six months after surgery, I found that other doctors were hesitant to perform any procedures, however, minor. My Ophthalmologist asked for a statement from my cardiologist before performing lens replacement. My Orthopedist required the same before injecting my knees to ease the degeneration of my joints. Also my 10 year colonoscopy was postponed until after six months. So, you are correct that there may be some hesitance after surgery but I didn't find any problems after six month of recovery. With respect to dental treaments, you should already be using profilactic anti-biotics; this will also be true for us all at every vist for the rest of our lives to reduce the chance of endocarditis.

Larry

 

[Jkm7]

Most surgeons require dental clearance before they perform valve surgery to assure you have no infection in your mouth. They also do not permit any dental visits for any reasons before six months post op. Most dentists wouldn't touch you without your surgeon's clearance for the most emergent reason.

If you will be on coumadin post op, have your colonoscopy before the surgery so you won't have to go off ACT as some doctors require. There is disagreement whether it is necessary but some doctors are firm they will not do colonoscopy if your are fully anti-coagulated.

If you have any small procedures you have been putting off that might involve bleeding, do them before your valve surgery particularly if you will be on coumadin after.

 

[dcc617]

I was all set up for surgery in mid-Jan. Then, I developed a GI bleed. The good news is my colon is in tip-top shape. The bad news was when they did the endoscope, they discovered a bleed. Apparently it caused quite a stir. There was quite a bit of blood that was removed & the ulcer cauterized. Promptly admitted to the hospital for observation and 2 units of blood. Two weeks later I had the all clear. If the heart surgery had gone ahead, there were have been serious results. My cardiologist told me that people with serious valve issues can get an AVM. So.....make sure your digestive tract is in good shape.

 

[tom in MO]

I agree with the advice about your digestive track. I have chronic hemorrhoids and my colo-rectal doctor recommended I have a colonoscopy (not due for a year). This was to make sure the blood was related to the rhoids, and not some new thing that developed, and that the current rhoids were minor (if not he'd band or burn them during the colonoscopy). My surgeon agreed. I was not required to get any dental checkup, but did anyway. The surgeon did examine my mouth as part of pre-op procedures.

 

[Ovie]

I had some concerns before surgery about minor issues. However my Doctor refused to acknowledge or even look into any of them, he said lets deal with my heart issue first. Since after surgery, he has said the same thing, except it's, let's wait to you're healed up. I don't think any of it's serious, but like Mentu said, some won't even do anything other than minor issues.

 

[ElectLive]

This is slightly off track, but I thought might be worth mentioning. I was diagnosed with moderate to severe sleep apnea several years prior to my surgery. I gave CPAP a try a few nights, then gave up, thinking I couldn't handle the daily hassle, and still not too convinced by the local sleep center how necessary it really was (I wasn't symptomatic). I also later saw a specialist who normally would have recommended corrective jaw surgery, but when he found out I had BAV, would not even think about it, due to endocarditis risk.

Anyway, I basically just ignored it from then on. But when I found out I needed heart surgery, in only a few weeks, a cardiologist and pulmonologist both were firm in the belief that I needed to control the sleep apnea condition prior to the surgery. Intermittent low oxygen levels and heightened stroke risk during sleep may not be that big a deal in the normal life of a young person, but they become a lot more important concerns when facing heart surgery, short term recovery, then life in general with a prosthetic valve. So, I started back on CPAP a week before my surgery, used it in the hospital, and every night since. Nothing like a little extra motivation to take care of things in a timely manner.

 

[Sean L]

Regarding dental issues BEFORE surgery...Apparently new guidelines say, for most, that antibiotics are NOT required for dental work. At least that's what two cardiologists have told me. From what I understand, this is a pretty recent change...

 

[ElectLive]

Regarding dental issues BEFORE surgery...Apparently new guidelines say, for most, that antibiotics are NOT required for dental work. At least that's what two cardiologists have told me. From what I understand, this is a pretty recent change...

Yes, that change was included in the 2008 update to the ACC/AHA Valve Disease Guidelines, basically recommending antibiotics only in the highest risk groups (which does include those with a prosthetic valve) based on a reexamination of the scientific evidence. Specifically excluded from that high risk group were many of the pre-surgery folks such as those with bicuspid aortic valve. It's interesting, though, the guidelines also indicated something to the effect of "some doctors may still feel more comfortable" continuing the previous recommendations unchanged. So, it is still somewhat controversial.

 

[Jkm7]

Regarding dental issues BEFORE surgery...Apparently new guidelines say, for most, that antibiotics are NOT required for dental work. At least that's what two cardiologists have told me. From what I understand, this is a pretty recent change...

The new recommendations are not that new..... about 3 or 4 years now.
Just about everyone here take antibiotics before dental work. I did prior to surgery and post surgery, my cardiologist, surgeon, dentist and Primary Care doc all said to never have any dental work whatsoever without being pre-medicated. Those of us with prosthetic valves fall into the exception to the most recent guidelines.

Sometimes references are made only to aortic valves but some of us have mitral valve issues and we are also advised to pre-medicate. I can't speak for valves in other positions but think it is the same.

 

[Ovie]

^^^^ glad you clarified that, I've been told to make sure to take antibiotics before dental cleaning.