Tuesday, March 5, 2013

Fontan Tomorrow

Fontan Tomorrow

We had Luke’s pre-op appointment and met with his surgeon, Dr. Mendeloff today.  Everything went very smoothly, except Luke really didn’t think much of getting his blood drawn or his x-ray taken (as expected).  Really, from the Mamma’s perspective, it was awful having to stand by and let them stick my three year old who I know was terrified and in pain.  I’m extremely glad that all his sticks tomorrow will take place while he’s under anesthesia.   
Luke already received his Beads of Courage for today and for surgery tomorrow.  Each bead represents some type of procedure that he will undergo:  x-ray, needle stick, insertions of breathing tubes, drainage tubes, foley catheter, central lines, the chest closure, and of course the surgery itself.  When the pre-op nurse handed the strand to me, I was completely overwhelmed at the visual representation of what Luke is going to go through tomorrow.  He is such a hero!
When we met with Dr. Mendeloff, Luke was very comfortable around him, and asked him to pick him up.  David and I were both glad that Dr. M got to see Luke awake and happy, since in the future he will likely only see him asleep or pretty mad.  
Dr. Mendeloff explained the details of the surgery for us tomorrow and answered some questions we had.  I basically had the gist of the surgery right, except for a few details.  
Many of you might be interested in some general things:  First, Luke is first case, so we will arrive at the hospital at 6:00 in the morning.  Since all of the pre-op chores were done today, they expect to have him in the OR by 7:00-7:15.  It should take about an hour for the anesthesiologist to get him to sleep, intubated, and his IV lines in.  Then Dr. Mendeloff will come in.  It should take another hour to get Luke’s chest open and cut through scar tissue (from both previous heart surgeries) to get to his heart.  They will then put Luke on the heart/lung machine to oxygenate his blood during the surgery, but we are relieved to know they will not have to stop his heart (better to avoid the complications he’s had in the past that came with starting his heart again).  The whole surgery should take about four hours start to finish, but it depends a lot on how long it takes to get lines (Luke is still a very hard stick) and cut through the scar tissue.  
Second, Dr. M told us that kids typically stay in the hospital for recovery between 5 days and a few weeks.  The length of time in the hospital primarily depends on how long fluid drains out of his chest after the surgery.  Because of Luke’s anatomy (specifically the small size of his pulmonary arteries), we might anticipate a hospital stay on the longer end of the spectrum.  Dr. M assured us that he is very aware of the trouble Luke had taking out the breathing tube after his heart cath, but he hopes to be able to extubate him by Thursday morning.  As always though, we’ll take our cue from Luke.  
Third, the mortality rate for this surgery is 2-3%.  Something we’d rather not even think about, but those are pretty great odds.  
Fourth, Luke will go home with o2 sats between 85% and 92%.  The further we get from surgery, his sats should increase slightly, up to 95% and stay there.  
Fifth, in 6-12 months Luke will go back for another heart cath.  They will check the status of the graft and the fenestration (basically a pressure release valve) that Dr. Mendeloff will put in the graft.  If pressures look good, they may be able to close the fenestration, but if they can’t, it can stay open indefinitely with no ill effects.  
Finally, we are so pleased with the team that will be taking care of our little heart hero tomorrow.  The surgeon, anesthesiologist, cardiac intensivist (doctor in the heart unit), and ICU nurse are all very familiar to us.  We are blessed to have so many wonderful people working on Luke tomorrow.  
We thank you for the prayers we know you will be sending up on our behalf tomorrow.  We need them desperately.  We will post updates on facebook and text message as much as possible.  


Rachael, David, and Luke

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