Heart valve surgery and management of sleep apnea, continued

Since I posted in December I have selected a surgeon and met with him, had cardiac cath, and gotten through all the preop testing. I learned that my stenotic aortic valve is only open to one-quarter capacity. When I was shown the two possible replacement valves (animal tissue vs. mechanical) I was surprised that they are so large (the size of a quarter). Now it's easier to understand why I have trouble breathing when I do anything that involves walking up stairs or an incline or raising my arms.

My surgery is in a week and a half and I am now seeking advice on whether to take my CPAP (REMstar Pro2 CPAP with C-Flex set to a fixed pressure of 12) to the hospital or rent an APAP set to a pressure range that would give me more pressure if I need it. I was on a loaner APAP last summer to determine if I needed a pressure higher than 9 and I found it much more comfortable than my CPAP. Although I was able to adjust to the new pressure, I find it stressful at times and when my Medicare eligibility comes up next summer I will have another sleep study to determine if an APAP or Bilevel will be better for my therapy.

I will discuss the possible APAP rental with my sleep doctor this week. My surgeon is fine with it. The hospital does have machines but it is preferred that the patients use their own.

I am very fortunate that cardiac cath showed no blockages so I will have only valve surgery.

An issue concerning the phenomenon of "pumphead" (cognitive impairment that may be temporary or permanent following open-heart surgery) was addressed by an anesthesiologist and I was told that my brain would be monitored closely during surgery. Research into this issue has investigated various schools of thought: 1) Pumphead is caused by microemboli formed when you are on the heart-lung machine (the "pump"). 2) It is caused by the anesthesia and doctors will practice "neuroprotective interventions" to reduce the likelihood of cerebral injury. I have read about the "Goldilocks principle"--administration of just the right dose (not too little, not too much). 3) The underlying cause of your heart disease comes into play and the risk status of postsurgical patients is no worse than controls who have not had surgery.

If anyone has advice on whether I should use an APAP during my hospital stay, I would be grateful for the help in making my decision. If I rent one I'll get it a few days early and become accustomed to it at home. Thanks, Pat

Some hospitals only want to use their own machines (postsurg., in the Recovery room, not during surg. when you'll be monitored anyhow and on mech. assists), so you need to ask about that, but be prepared to bring your own and make sure the head OR nurse takes care of it and knows how to put it on you and at what pressure.

Pat, anything you can do to lower your stress will be very helpful. I think you should go for the APAP machine.