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.