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18 Apr 2006

quadruple bypass
Hi Doc,

My grandmother (72 years old) had a quadruple bypass last Friday (14/04/2006). She had 4 veins replaced and 2 leaking valves repaired. The operation took 6 hours and the doctor said that normally this would have been done over 2 separate operations.

The doctor has said that she is 100% “mechanically” due to the size of the op and also that she is a type 2 diabetic which is under control. She has already had the balloon pump removed etc… and they are pleased with the way her body is adapting to the change. However, on Sunday she started with a temperature and since then has been fluctuating between 38 – 39.3… She is on a broad spectrum antibiotic while the doctor farms mucus found in her nose to see what the exact cause of the temp is! However, the doctor who is being extremely vague has said that it if the temperature doesn’t drop (go away) etc… then she could develop septicaemia which could obviously be fatal.

The nurses seem to be more positive and have said that he does tend to be vague. My question to you is… Is it normal for patients to get a temperature after an op of this size and could a antibiotic normally solve the problem?

We just want to find out if a temperature is a really bad thing as the doc has just said that she is adapting well but due to the temp she is still critical.

Thanks for the help!

Many Thanks
Answer 378 views
Expert
HeartDoc

01 Jan 0001


Dear Nick,

Yes, your Gran has had really major surgery, and from a mechanical viewpoint, has withstood it well if she can now function minus the balloon pump. In our unit, we do these combined procedures (valve + bypass ) together routinely, and not as separate procedures.

After any surgery, it is normal for the body to respond with an inflammatory response, part of which is a temperature. This is all part of the healing response. However, in your Gran’s case, this temperature is very high. She is also a high risk patient for a number of reasons : age, diabetes, multiple procedure, long bypass time, valve replacement.

The valve problem is the most important here. I am presuming that she has had a valve replacement, or at least a valve repair involving the insertion of some sort of ring. Just a leaky valve by itself, is risky because it becomes the target of any bug in her body. The bugs “seed out” on the valve, giving rise to Infective Endocarditis (IE). If there is any foreign material present – like a valve ring, or a whole new replaced valve – then this becomes an even bigger target for the bugs, so her risk of developing IE becomes greater. In her (immunologically) weakened state postop, if she does develop IE and it is not immediately and effectively treated, is can become an overwhelming infection, - a septicaemia – which can be fatal.

That is by way of explaining what could be happening. To answer your questions directly: In a patient who has had valve surgery, a temperature of this size MUST be regarded as IE until disproved . Her doctor is following the correct protocol by putting her onto an antibiotic which he thinks is the right one, until the lab results of the culture and sensitivity tests he has ordered are back. I hope that he has also done serial blood cultures to detect and identify any bugs which may already have entered her bloodstream, as this may be the crucial investigation. The bugs in her nose may not necessarily be the bugs in her bloodstream. If the results he receive show that she needs a different antibiotic, then he will obviously change to the correct one. Unfortunately, her diabetes places her at extra risk when it comes to infections, but I’m sure her surgeon will have taken that into account.

I hope that answers your questions, and that your Gran will make an uneventful recovery.

Regards,

HeartDoc
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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