Postoperative course
Due to the risk of complete heart block after TVR, we routinely place
permanent epicardial pacing wires on the RV and sometimes on the RA. The
electrodes are placed in a subclavicular pocket on either side. In our
experience, the majority of patients will not need a permanent
pacemaker, but if so it may be connected in a separate procedure a few
days postoperatively. CaHD patients undergoing valve surgery have a
slower recovery and normally require prolonged intensive care to monitor
cardiac and renal function, control of infection and carcinoid activity.
Intravenous octreotide therapy is usually continued for 3 days
postoperatively in collaboration with endocrine oncologists. For
anticoagulation, we routinely use low-molecular weight Heparin for 3
months, and then switch to aspirin.