CHF person needing surgery

[bigheart2]

I have CHF.  Stable for at least a year.  Cardiomyopathy due to chemo.  EF% 25%.
Diagnosed in 2001 with DCM.  Damage mainly LV.  Bi-vent/pacer.  Have a nodule on middle lobe lung.  Unable to biopsy.  VATS need to obtain a wedge to identify if cancer or not. Concerned about my post op days and weeks because of my "crappy" heart.  No diabetes, some gastro problems.  Any advice appreciated.
Thanks.

[CCFHeartMD11]

Generally, when assessing a person's operative candidacy, there are several cardiac features that are important -- coronary artery disease, heart failure, arrhythmias, and valve disease. Usually, we are looking to see if any of them are unstable or not optimally managed. Recent heart attack or chest pain that hasn't been assessed/managed would be a reason to postpone surgery. Decompensated heart failure, meaning severe or worsening symptoms, volume overload, or even a new diagnosis would be a reason to postpone surgery. Uncontrolled arrhythmias including fast Afib, heart block, ventricular arrythmias, and symptomatic bradycardia would be a reason to postpone surgery. Severe aortic stenosis or symptomatic mitral stenosis should be addressed before undergoing an elective surgery. From your description, it doesn't sound like any of these issues pertain to you -- while you do have heart failure, you are treated medically, and if your symptoms and volume status are controlled, then you are probably safe to undergo surgery.

A lot depends on your fuctional capacity. Generally, we say that if you can complete 4 METS (metabolic equivalents), which is equal to walking up a flight of stairs, without significant limitation, then you are probably okay to undergo surgery.

Different surgeries carry different risks. Thoracic surgery is considered an intermediate risk surgery (meaning the risk of cardiac death or heart attack is 1-5%). A patient's comorbidities (or other medical conditions) plays into that risk, and having heart failure makes you higher risk than someone without heart failure, but the fact that it is compensated heart failure makes it more safe. And the absence of coronary artery disease, stroke, diabetes, renal failure make surgery that much safer.

You should definitely see your cardiologist to get his/her recommendations regarding the safety of surgery in your particular case.

[bigheart2]

Thank you for your comments.  I am able to walk up a flight of stairs despite my large old heart!!  I do not have any of the risk factors eg:diabetes,stroke, CAD.  My creatinine and BUN are always slightly elevated but no renal failure.  Have been on heart transplant list for 2 years however I have improved and been stable for over a year.  My nodule has been watched for almost 2 years.  9.6mm on last CT scan.  Transplant team wants to know what it is.  I understand their reasons.  Am aware of complications of immuno drugs post transplant especially on cancer cells.
Plan to have another CT tomorrow to see if nodule has grown/thickened etc.  Surgery is scheduled for next week.  Have seen both my own cardio man and transplant team but wanted other opinions/recommendations.  My "own" cardio man isn't as positive as my transplant team people seem to be.  I share his opinion and we both agree that the following weeks post surgery will be challenging to keep my CHF controlled.  I know no one can assure you 100% which I sometimes think we are all looking for!  Thank you so much for answering my post it was helpful.