postoperative management for valve surgery

8/2/2019 Postoperative Management for Valve Surgery

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the extremities, allowing adequate venous

return to the heart and decreasing the risk

of thrombophlebitis. Sequential compression to the lower extremities can be discontinued once the

patient begins ambulation.

A urinary Foley catheter is placed

and secured during surgery. Securement

of indwelling urinary catheters with a

strap to stabilize the catheter and prevent

tension on the distal urethra at the meatus is recommended. The catheter can be

removed as activity levels increase, after

which patients should be encouraged to

walk to the bathroom.

Peristalsis usually resumes within 48

to 72 hours postoperatively and is stimulated with increased patient mobility. It is

not unusual for the patients to experience

a postoperative delay in return to normal

bowel function secondary to anesthesia

and surgical intestinal manipulation. This

may cause a delay in initiating oral food

and fluid intake and may require temporary use of a nasogastric tube. Once bowel activity resumes, as

evidenced by bowel sounds with flatus and/or fecal passage

through the stoma, oral intake may be

gradually progressed from clear liquids to

a diet low in insoluble fiber.

Output must be carefully monitored,

as high volumes of electrolyte-rich effluent can be problematic. Ileostomy pouching systems can be

attached to bedside


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straight drainage to decrease the need for

constant pouch emptying and to promote

effective pouch adherence.

The colon absorbs up to 5 liters of

water per day along with 400 mEq of sodium. This absorptive function is reduced

with ileostomy, therefore, in preparation

for discharge, patients must be taught

to recognize the symptoms of dehydration, including fatigue, headache, nausea,

and increased ileostomy output. Dietary

modifications to thicken the stool and

decrease bowel motility should be considered. The use of bulking agents (e.g.,

Citrucel or Metamucil) and antidiarrheal

agents (e.g., Lomotil or Imodium) are frequently beneficial.

3

Nutrient absorption is often reduced

with extensive bowel resections. The patient who has had a significant portion of

the terminal ileum removed may experience altered absorption of Vitamin B12

.

Depletion of this vitamin results in pernicious anemia, which may manifest as peripheral neuropathy.

Because the liver

stores Vitamin B12

, the patient should be

monitored for declining serum B12

levels,

so that replacement can be initiated when

appropriate.


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Along with the standard assessment

variables for postoperative care, the nurse

must assess the color and hydration of the

stoma. The end ileostomy should appear

moist and pink. A pale pink stoma may

be indicative of anemia; a dusky (dark

red or purplish) stoma should be promptly reported to the surgeon for evaluation.

This alteration in stomal appearance most

commonly appears during the first 3 to 5

days postoperatively and may be due to

stretching and tension of the mesenteric

vessels, indicating inadequate perfusion.

This requires surgical revision.

With each pouch change, the integrity of the mucocutaneous junction should

be assessed. A patient at risk for compromised wound healing may also develop

mucocutaneous separation a breakdown

of the suture line securing the stoma to

the abdominal surface. This in turn may

cause stomal retraction resulting from

the loss of stomal support at the abdominal surface. Most often, this complication can be managed

conservatively, with

the assistance of the COCN and the use of

absorptive products to facilitate wound

healing and the integrity of the pouching

system.


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Special considerations for nursing care for valve repair

The principles of nursing care for this group of patients are similar to those undergoing

other forms of cardiac surgery, and Margereson and Riley (2003) provide a comprehensive

overview of pre- and postoperative care.

There are special considerations for patients who may already have chronic arrhythmias,

altered left ventricular function and pulmonary hypertension. Great care is required withfluid management and haemodynamic monitoring. Ricci et al (2000) and Donias and

Karamanoukian (2000) describe the main complications of aortic and mitral valve surgery,

which are summarised in Box 1.

Nurses can help patients understand the nature of their disease and the risks and benefits

of surgery. While medical treatment may provide symptomatic control and surgery can offer

improved long-term outcomes, there is an important role for secondary prevention for these

patients who may not be perceived as having the same risks as those with coronary artery

disease.

Nurses can provide support for patients as they adapt to living with a prosthetic valve.

Those with a mechanical prosthesis will start long-term anticoagulation therapy that willdemand changes in lifestyle and self-management. The risks of native and prosthetic valve

endocarditis should be raised with patients who are waiting for or who have had valve

surgery; education about prophylactic antibiotic therapy for dental and other invasive

procedures should be discussed.

Hospital-acquired infection plays a greater role in infective endocarditis than has previously

been emphasised. Good infection control practices in hospital can reinforce education

messages given to valve patients who are learning to reduce the risk of developing infective

endocarditis (Ekyn, 2001; Sparacino, 1999).

Those undergoing surgical intervention require specialist support throughout their diagnosis

and treatment. Surgery can affect the long-term outcomes for these patients, but quality oflife and benefit from surgery is likely to be enhanced by effective patient education and by

encouraging patients to be involved in decision-making.

Aortic valve surgery - open

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Aortic valve surgery is done to replace the aortic valve in your heart.

Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It

opens up so blood can flow out. It then closes, keeping blood from flowing backwards.

An aortic valve that does not close all the way allows blood to leak back into your heart. This is

called aortic regurgitation.

An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.

In open surgery, the surgeon makes a large cut in your breastbone to reach the heart and aorta.
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Before your surgery you will receivegeneral anesthesia. This will make you unconscious and unable to

feel pain.

Your surgeon will make a 10-inch-long cut in the middle of your chest.

Next, your surgeon will separate your breastbone to be able to see your heart and aorta (the main

blood vessel leading from your heart to the rest of your body). Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is

stopped while you are connected to this machine. This machine does the work of your heart while

your heart is stopped.

If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your

surgeon will remove your aortic valve and sew a new one into place. There are two main types of new

valves:

Mechanical -- made of man-made materials, such as titanium or ceramic. These valves last the

longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or

aspirin, for the rest of your life.

Biological -- made of human or animal tissue. These valves last 10 to 12 years, but you may not

need to take blood thinners for life.

Once the new valve is working, your surgeon will:

Close your heart and take you off the heart-lung machine.

Place catheters (tubes) around your heart to drain fluids that build up.

Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal.

The wires will stay inside your body.

This surgery may take 2 to 5 hours.

Sometimes other procedures are done during open aortic surgery. These include:

Coronary bypass surgery

David procedure

Graft of the first part of the aorta (large blood vessel leaving the heart)

Ross (or switch) procedure

Why the Procedure is Performed

You may need surgery if your aortic valve does not work properly. You may need open-heart valvesurgery for these reasons:

Changes in your aortic valve are causing major heart symptoms, such as chest pain (angina),

shortness of breath, fainting spells (syncope), or heart failure.

Tests show that changes in your aortic valve are beginning to seriously harm how well your heart

works.

Your heart valve has been damaged by infection of the heart valve ( endocarditis).
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You have received a new heart valve in the past and it is not working well, or you have other

problems such asblood clots, infection, orbleeding.

Risks

Risks for any anesthesia are:

Blood clots in the legs that may travel to the lungs

Blood loss

Breathing problems

Infection, including in the lungs, kidneys, bladder, chest, or heart valves

Reactions to medicines

Possible risks from having open heart surgery are:

Heart attack orstroke

Heart rhythm problems Incision infection, which is more likely to occur in people who are obese, have diabetes, or have

already had this surgery

Infection of the new valve

Kidney failure

Memory loss and loss of mental clarity, or "fuzzy thinking"

Poor healing of the incision

Post-pericardiotomy syndrome (low-grade fever and chest pain) that could last up to 6 months

Before the Procedure

Always tell your doctor or nurse:

If you are or could be pregnant

What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your

surgeon how you and your family members can donate blood.

For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your

blood to clot. These might cause increased bleeding during the surgery.

Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).

If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before

stopping or changing how you take these drugs.

During the days before your surgery:

Ask your doctor which drugs you should still take on the day of your surgery.

If you smoke, you must stop. Ask your doctor for help.
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Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in

the time leading up to your surgery.

Prepare your house for when you get home from the hospital.

The day before your surgery, shower and shampoo well. You may be asked to wash your whole bodybelow your neck with a special soap. Scrub your chest two or three times with this soap. You also may be

asked to take an antibiotic to prevent infection.

On the day of your surgery:

You will usually be asked not to drink or eat anything after midnight the night before your surgery.

This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but

be careful not to swallow.

Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Expect to spend 5 to 7 days in the hospital after surgery. You will spend the first night in the ICU and may

stay there for 1 or 2 days. Two to three tubes will be in your chest to drain fluid from around your heart.

These are usually removed 1 to 3 days after surgery.

You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV,

in a vein) lines to deliver fluids. Nurses will closely watch monitors that show information about your vital

signs (your pulse, temperature, and breathing).

You will be moved to a regular hospital room from the ICU. Your nurses and doctors will continue to

monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine

to control pain around your surgical cut.

Your nurse will help you slowly resume some activity. You may begin a program to make your heart and

body stronger.

A temporarypacemakermay be placed in your heart if your heart rate becomes too slow after surgery.

Outlook (Prognosis)

Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms,

you may have a stroke. Bleeding can occur, but this is rare.

Biological valves tend to fail over time. But they have a lower risk of blood clots.

For best results, have aortic valve surgery at a center that does many of these procedures.

Before Surgery: Are You a Good Candidate for a Heart Transplant?
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Before you can have a heart transplant, a team of healthcare professionals will want you to think about what is likelyto happen if you do get a new heart. This depends on your physical health, your mental health, and your ability to getthe transplant medicines you will need.

Below are the processes that determine how long this evaluation and preparation phase can take.

Visiting a Transplant Center

This visit can be arranged by your doctor, a nurse, or a social worker. You can also make the appointment on yourown. Your doctor or his staff will be asked to send your medical records to the transplant center to make sure youcurrently do the following:

take your medicine properly

have no medical conditions that will prevent you from receiving a transplant

More information:Finding Out if You Are Sick Enough to Need a Heart Transplant

Having Your Physical and Mental Health Evaluated

Evaluating Your Physical Health

At the transplant visit, you will have a very thorough evaluation of your medical condition by transplant teammembers. The transplant team may require further testing to evaluate the following:

your heart

your kidneys and gallbladder

your stomach, esophagus, and intestines

your lungs

your bladder

your teeth and gums your prostate if you are a man

your breasts and cervix if you are a woman

There may be other tests and examinations that the transplant team may need to perform.

Evaluating Your Mental Health

You may need to see a social worker or psychologist to make sure that you do not have the following:
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alcohol or drug addiction

emotional problems that may interfere with your health

More information:Evaluation Period

You Will See an Insurance Specialist

You will see an insurance specialist to evaluate your insurance to make sure you have enough coverage formedication after transplant. Once it is determined that you are a good candidate for transplantation (healthy patient),the transplant team will work with you to find the best transplant for you.

During Surgery: Notification and Preparing for Surgery

Notification for Surgery

When we find a suitable donor for you, one of the members of the transplant team will notify you by telephone. It isimportant that you always leave a number where you can be reached if you are away from home. We would not liketo have missed getting in touch with you if you were out of touch.

As a rule of thumb, we will always call your home first. We recommend youpurchase a pager as a means of contacting you, otherwise, we will rely onyour home, work, relative, or cell phone number as a means of contactingyou when we get an offer for you.

Preparing for Surgery

Right before surgery, you will have blood drawn so that we have up-to-dateinformation about the key components of your blood. You will also be askedto give us a urine specimen. In order to cut down on the possibility ofinfection, you will have your chest thoroughly washed with a specialcleansing solution, and your chest may be shaved. Finally, you will receivemedications that will help to relax you and begin to make you feel sleepy.

After Surgery

The decision to receive a transplant is a major one and should not be made without a great deal of thought forseveral reasons:

First, transplantation is a major surgical procedure that involves some degree of risk. Specific information about

the risks and major complications associated with the surgery will be discussed with you during your evaluation

period.

Second, transplantation requires a serious and definite commitment by you and your family to the maintenance of

a strict posttransplant regimen. This regimen will need to be followed for the rest of your life. Many patients findthat following the strict diet, medication, exercise, and clinic regimen requires changes in their lifestyle. All of the

medications prescribed are necessary and must be taken at specific times. Your diet may restrict calories, fluids,

salt, fats, cholesterol, and carbohydrates. Also, you will not be able to drink alcohol, as it will affect your

immunosuppressant levels. You will need to exercise daily to keep your body strong. You will be expected to visit

the clinic as directed for follow-up examinations, medication adjustments and testing.

Third, the medications you must take after the transplant have certain side effects that can be unpleasant and can

cause other medical problems. Some of the medications that prevent your body from rejecting the new organ can
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also decrease the ability of your body to fight off infection, can raise your blood pressure, or can cause your

bones to become weak due to loss of calcium (osteoporosis). During your evaluation, you will learn more about

other possible drug side effects. Please remember that not all patients will have the same side effects.

Because these medications are necessary in order for a transplant recipient to survive, some side effects areunavoidable. The risks associated with the use of these medications can be reduced only by learning about them,

taking them as ordered, and by careful monitoring during clinic visits. The transplant team will work closely with youand your family to teach you what you need to know to live successfully with a transplant. Your transplant team'shope is that you will be able to live an active and productive life after you receive a new organ.

What is transplantation?

Transplantation is the surgical placement of a human organ from a patient who has been declared clinically braindead (cadaveric donor). When an organ from a cadaveric donor is available, an organ procurement organization isnotified. After determining the suitability of the donor, the donor's family is approached regarding the option of organdonation. If the donor's family agrees to donate, blood work is obtained to rule out any possible infections.

The United Network for Organ Sharing (UNOS) is contacted and a list of potential recipients is generated. This list isdetermined by various factors, such as blood type, size, time waiting, and in some c ircumstances, severity of disease.The recipient transplant programs are contacted to offer the organ for the first recipient on the UNOS waiting list.Many times organs that are offered are not suitable and will be denied. The goal of transplantation is to provide youwith an organ that will allow you the best opportunity for a better quality of life.

What is cardiac transplantation?

Cardiac transplantation is a procedure of last resort. This means that there are no other medical or surgical optionsthat will improve your current heart condition. Heart transplantation involves the placement of a healthy heart from acadaveric donor into the recipient with end-stage heart disease.

What is heart-lung transplantation?


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Heart-lung transplantation is the surgical placement of a set of heart & lungs from a cadaveric donor into the recipientwhose own heart and lungs are badly damaged from a disease process. Like heart transplantation, heart-lungtransplantation is a procedure for patients for whom there are no other medical or surgical options.

Medications

Shortly after your transplant, you will be taking care of yourself and living a nearly normal life. In order to prepare youto care for yourself, it is important for you to know about all aspects of your medications. The nursing staff will giveyou your medications for the first few days after surgery. During this time, however, the nurses will teach you thenames, dosages, schedules, side effects, and reasons for taking each drug. Please be sure to ask them anyquestions that come to mind about each drug.

Note: This web site provides selected information available about cardiothoracic surgery which may become out ofdate over time. It is important that consumers see a healthcare professional for detailed information about medicalconditions and treatment. This information is not intended to be a substitute for the advice of a healthcareprofessional, or a recommendation for any particular treatment plan. The USC Department of Cardiothoracic Surgeryhas made and will continue to make efforts to include accurate and up-to-date information on this web site.

Rules for Medications

Types of Medications

Avapro

Baby Aspirin or Ecotrin

Cellcept

Clonidine Hydrochloride (Catapres TTS1-TTS-3)

Cyclosporine A (Sandimmune) (Neoral)

Diuretics

Dynacirc (Isradipine)

FK 506 (Prograf) (Tacrolimus)

Furosemide (Lasix)

Imuran (Azathioprine)

Metolazone (Zaroxylin)

Norvasc (Amlodipine besylate)

OKT3

Prednisone (Deltasone)

Procardia (Nifedipine)

Vasotec (Enalapril Maleate)

Medication Side Effects

CVS Pro-Care Lifetime Program

If You Have Problems Paying for Your Medicine

As you become familiar with your drugs, we will begin to increase your independence by letting you take them onyour own. We have medication sheets with dates, times, and dosages to help you adjust to your new routine. Themembers of the transplant team will be happy to help you and to answer your questions whenever you wish. Pleaseremember the following points:

You will not be taking every single medication described in this section. You will only take those medications that

are appropriate to your condition.
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A general range is listed for the dosage of each drug. Your doctor will determine the exact dose of each drug that

is right for you.

Your doctor will also tell you how often you should take each drug.

You will not experience every side effect listed for each drug. It is important, however, that you are aware of the

possible side effects for each drug so that you can seek medical attention if side effects do occur and so that you

understand any changes that occur in your body from taking the drugs. If the side effects of a medication prescribed for you cause you concern, do not decide against using it without

first checking with your doctor.

Diet and Nutrition

Introduction

Depending on the time factor when you are admitted for your transplant,your nutritional status will be evaluated by a dietician. All efforts will be

made to help you maintain good nutrition prior to surgery by makingspecific diet changes to meet your individual needs. Your dietician willanswer any of your questions, and make suggestions to you about the diet.

Once the tube in your mouth and throat is removed after transplant, yourdoctor will order a diet for you. Most likely, your first few meals will be clearliquids.

Clear liquids include:

Apple, cranberry, and grape juices

Jello

Ices

Ginger ale

When you can tolerate more, your diet will be advanced to a full liquid diet.

Full liquids include:

A large variety of juices

Hot cereal

Strained soup

Egg

Yogurt

Milk

Milk products like pudding and milkshakes

When you can eat these foods without difficulty, your diet will be advanced to solid foods. The exact diet chosen willdepend on your specific needs and will include recommendations by your dietician.

Diet and Immunosuppressive Medications

Caloric restrictions
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Cholesterol and saturated fat restriction

Concentrated carbohydrate restrictions

Dietary changes

Fluid and sodium restriction

Foods high in sodium (Na+) content

Other Dietary Restrictions

Protein Intake

After surgery, your appetite may be slow in returning. It should improve with time. Remember, however, that duringyour recovery, your body needs enough calories and protein to heal. Thus, eating is important. Some helpful tips toremember as you begin eating again:

If you feel nauseated or have other side effects from your medications, try to relieve your symptoms with clear or colditems like ginger ale and fruit ices and/or dry foods like plain bread or crackers.

You may feel more comfortable eating smaller frequent meals.

You may wish to circle extra foods on your menu to save for between snacks such as milkshakes and juices.

If you feel you just cannot eat enough, discuss this with the dietician. She may recommend a nutritionalsupplement, but try "real" food first.

NOTE: if you are placed on any diet restrictions, the dietician must authorize the use of any outside foods broughtinto the hospital by visitors.

Exercise

General Information

Almost immediately after your surgery, the physical therapist will begin to work with you. Even in the earliest daysafter surgery, exercise is important to cut down on your chances of getting lung infections, blood clots, and bedsores.Exercise in this early period will also begin to build up your strength for getting out of bed and walking. As timepasses, exercise will be important to regain the strength you lost while you were sick. Once you are at home andliving your new life, exercise is important to keep you strong.
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With a few exceptions (discussed below) you can return to your normal activities and exercises. We encourage you towalk as much as possible both during your recovery and when you are completely well. Be sure to rest duringexercise as indicated. Always remember, moderation is the key when getting back into shape.

Your physical therapist will work with you daily while you are in the hospital. Your exercise program will be designedin a progression that will improve your strength, endurance, and coordination. The physical therapist will review yourexercise program with you before you go home. He/she will also setup appointments to see you on your clinic days in

order to follow your progress and to advance your program as your strength improves.

Breathing Exercises

First, you will be asked to do breathing exercises by both your nurse and physical therapist. These exercises are veryimportant for getting your lungs back in shape after surgery and for preventing lung infections. The lung exercises willinclude taking deep breaths in and pushing the air out. You will be given a small breathing device, called an incentivespirometer, to practice your breathing. We will also use this to monitor your progress.

You will be asked to cough. Both coughing and deep breathing will cause pain over the chest incision at first. Yournurse and therapist will teach you how to splint the incision by holding a pillow and your arms over the incision toreduce the pain as you exercise. But you will find the more you do the breathing exercises, the easier it gets and theless it hurts.

Leg and Foot Exercises

You will be asked to do leg and foot exercises in bed. You do these to keep blood from pooling in your legs andforming clots. These exercises also work your muscles and keep pressure sores from forming on your heels. Theexercise include wiggling your toes, pointing your foot toward your face, bending your knees upward, rotating yourlegs at your hips, and tightening the muscles of your legs and bottom.

Changing Positions in Bed

You will be asked to change positions in bed with the help of your nurse. This is important in order to avoid pressuresores from lying on one part of your body for too long. Changing positions will also exercise your lungs. Like thebreathing exercises, changing positions will give you some pain over your incision. You can splint the incision in thesame way as described above.

Sitting, Standing and Walking

Before you know it, you will be sitting up with your legs over the side of the bed and getting ready for your first walk.Exercise at this point will begin with some sitting exercises for your legs. Walking will begin soon after your surgeryand will progress slowly as you are able. You will also begin a bicycle exercise program as soon as your therapistand doctor feel you are strong enough.

You will be taught gentle arm exercises, which are very important in preventing loss of movement or tightness in yourshoulder joints, and neck. You will also be shown stretching exercises to do before walking. Remember that theexercise program begins early. It is tailored to your needs, and will be essential to putting you back on the road torecovery.

Exercise Musts

When you exercise each day, there are certain things you should remember to do:

Warm up by doing stretching activities.

Push yourself to a peak level of activity and try to maintain it for several minutes to ensure a good workout for

your heart and other muscles. Any exercises like cycling, rapid walking and swimming are great.

Cool down by repeating the slow stretching exercises or walking.


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Exercise Don'ts

For the first eight weeks after surgery, avoid the following activities to allow your chest bone and incisions to fullyheal:

Do not lift heavier than ten pounds.

Do not push or pull objects heavier than ten pounds unless instructed to do so by your therapist or nurse.

Do not do sit-ups, push-ups, or pull-ups.

Stop any activity that causes pain or pulling across your chest.

Sexual Activity

You may resume sexual activity after your transplant. In the first few weeks after surgery, however, you may find thatpain along your incision may limit your activity to a certain extent. Just remember that during the first eight weeksafter surgery, any activity or position that causes pain or pulling across your chest, such as bearing weight on yourarms, must be avoided.

Vitamins and Minerals

Bactrim

Acts to prevent pneumocystis carinii pneumonia is one of the opportunistic infections frequently seen in patients

taking immunosuppressive drugs.More information...

Ferrous Gluconate

An iron compound which works with folic acid. Your red blood cell is usually low after transplant surgery due to

blood loss during the surgery.More information...

Folic Acid

Works with iron to increase your red blood cell count. Also prevents folic acid deficiency for those on

Imuran.More information... Nystatin (Mycostatin)

Works to decrease the growth of opportunistic fungus infections in the mouth and digestive tract while you are on

high doses of immunosuppressive drugs.More information...

Prenatal vitamin

General replacement of essential vitamins.More information...

Cost of TransplantationTransplantation is a covered expense for most insurance companies. The costs of transplantation vary on a case-to-case basis and negotiated with the individual insurance carriers by the transplant financial counselor. One of thebiggest costs is the length of time you spend in the Intensive Care Unit (ICU). The ICU is a hospital unit that hasspecially trained nurses and special equipment to monitor and maintain you immediately after your transplant. Thelength of time you spend in the ICU will depend on how sick you were before surgery and how quickly you recoverafter surgery.

Expenses covered by insurance carriers include, but are not limited to:

Fees for your evaluation
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Surgeon and operating room fees

Anesthesia costs

Length of stay in the hospital

Blood and other diagnostic testing

Organ recover costs

Rehabilitation costs such as physical or occupation therapy

Cost of the medications

Possible expenses to the recipient and family include, but are not limited to:

Patient and family transportation costs to and from USC University Hospital for evaluation, surgery, and clinic

visits after transplant

Housing, food, and living expenses if you and your family will need to relocate to the Los Angeles area for

transplant

The transplant team realizes that these costs will seem overwhelming to you. Do not lose hope. We discourageskipping clinic visits, blood tests, or biopsies in order to save money since these are all vital to your recovery and longterm survival. There are many funding alternatives that can be explored including private funds, insurance,government funding, fund raising campaigns, and charitable organizations. The financial counselor will work with youto sort out any financial concerns you or your family may have.

postoperative management for valve surgery

Documents