My uncle is clinging to life on a respirator in critical care at Mt. Sinai hospital 5 and ½ weeks after surgery some of us are not convinced he should have had. Any and all comments welcome and appreciated.
Aortic insufficency was found first apparently he's had it for years, but looked short of breath to his long-time doctor who said maybe its time to do something about it, though never mentioed it before. A stress test found he had a ejection fraction around 40, which went lower with exercise. They recommended a valve replacement with a porcine valve.
They then found the aortic root was expanded (I think), and said while they were doing the valve replacement they would put a band around the aorta to keep it from expanding more. At some point they decided the aorta was too wide for a band (was now at 4 cm, I think), and that they would replace 10 cm of the aorta with dacron. They would be using a Bentall Proceedure. They did an angiogram, and decided that they better do a bypass of one of the arteries as long as they were in there. And finally& since he had a history of supraventriciular tachycardia for which he was taking Tambacor, they wanted to zap that too so he wouldn't need the medication anymore.
The surgery took 8 hours. It took him 3 or so days to become conscious took him longer than expected to come out of the anesthetic. At that point, he was in atrial fibrillation, which the docs says happens 50% of the time, they shocked his heart with cardioversion. It seemed to worked, they shipped him to the rehab unit, and 24 hours later he was back in atrial fibrillation. He was transferred back, and after another day or 2 it was clear he was in heart failure. I believe one of the docs called it low output syndrome.
The usual meds for it didn't do much, though eventually he got back to sinus rhythm but the heart failure was still there. During the whole thing he was continually very short of breath. Docs said they didn't know what to do; had no long term game plan. He also developed an inflamed lining of the heart, which was an apparent an immune reaction to the surgery. They gave him prednisone which he had very bad reactions to, and eventually weaned him off that after about a week. He seemed to do better for 2 days, and they tried to do rehab again, but he could barely move and his blood pressure went too low when he stood up. They took him off lopressor, and more trouble breathing had them try an IV drip of dopamine and dobutamine. He then couldn't breath and they had to intubate him. Now all his systems are failing one after the other.
Was he a poor candidate for all of this surgery? He is 73 years old. Symptomatically, he was quite healthy, though he had gotten more tired lately (especially after the aniogram). Drug management was never tried or suggested either for the aortic insufficiency or the aneurism. In addition, he had not greatly functioning kidneys and had a number of arteries blocked off. He had radiation as a kid for Hodgkins disease and had a lot of compensations in his body because of it. The docs told him there was a good time and a bad time for surgery and this was a good time.
Sorry for the long description, comments most appreciated.
(p.s. his surgeon was top of the line apparently, and his long-time main cardiologist and his electrophysiologist were supposed to be excellent as well).
Update 7 Jul 2001
To say that this has been harrowing would be an understatement of rather major size. My uncle was taken off one of his life supports (dopamine and doubetol), but did not pass away quickly as expected. His blood pressure stabalized to 60 over 40 which cannot support brain function and they now recommend taking him off the respirator which they will do tomorrow. Up to now his brain would have been fine, but they had to keep him under heavy sedation because of the respirator. They will apparently keep the sedation when the respirator comes off so he won't wake up and suffer - which means also no miracle chance to breath on his own since the sedation prevents that. Too late now anyway. One memorable gruesome thing (from many) is that in his room there was a video of a giant clock on the TV screen - we realized when we got home that that was so that they can easily record time of death!
Since he felt healthy and led an active lifestyle before the surgery, it has been very difficult to come to terms with it all, besides the last 6.5 weeks of agony for him and us. Info that I have found out since is that the (aortic root?) aneurism was 5.0 cm; they would not have operated for "just that" but he also had aortic insufficiency (leaky aortic valve) with an ejection fraction that went down with excercise. He was under the impression that he only had 6 to 12 months to live without the surgery - but so far we cannot find any medical evidence in support of that.
Thanks much to those who contacted me to try to help in one way or the other.
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