Redo Aortic Valve Replacement with Heart Failure

You attend the subacute Coronary Care Unit to review a 52-year-old man with a six week history of increasing dyspnoea who has been scheduled for revision aortic valve replacement +/- mitral annuloplasty tomorrow. His past history includes a bioprosthetic aortic valve replacement eight years ago. On admission his echocardiogram showed severe aortic regurgitation and moderate mitral regurgitation, with an estimated left ventricular ejection fraction of 35% and a moderately dilated left ventricle. His only regular medication prior to this admission was aspirin 100 mg daily, but during this admission he has been commenced on: - furosemide (frusemide) 80 mg bd orally - perindopril 6 mg mane orally - dobutamine infusion 2.5 mcg/kg/min intravenously When you attend the ward you find him walking around with his IV pole. He weighs 80 kg.