Heart Valve Surgery: What to Expect

Valve-replacement surgery is a traditional procedure that has been improved by recent advances in technology. If one of the heart’s four valves is damaged and can’t open and close properly, it must be repaired or replaced. Newer techniques allow more valves to be repaired today than in the past. However, when a valve does need to be replaced, the newer generations of valves are significantly improved. For example, the newest type of valve — the “stentless” valve — results in better blood flow through the valve and is proving to be longer-lasting.

What Are Heart Valves?

They are the four valves that open and close as blood flows through your heart. When blood moves forward, the valves open. When the valves close, they prevent blood from leaking backward.

Why Am I Having Heart-Valve Surgery?

You are having this surgery because one of your heart valves is damaged. It is either not opening fully and blocking blood flow (stenosis) or it is not shutting tightly and leaking blood (insufficiency or regurgitation). Heart-valve surgery involves replacing or repairing the damaged valve.

How Did My Heart Valve Become Damaged?

There are several things that could have damaged it. A birth defect, called congenital malformation, can weaken a valve over time. Illnesses like rheumatic or scarlet fever and some bacterial infections can cause damage as well. Valves can also be injured during a heart attack.

The most common valve problem is stenosis of the aortic valve, which directs blood out of the left side of the heart. Stenosis occurs when these valves become hard and cannot open fully. The most common mitral valve problem occurs when blood leaks backward toward the lungs.

Is There Anything Special I Need To Do Before the Procedure?

If you take aspirin or other blood-thinning medicine, contact your doctor for instructions a week before the procedure. You should also avoid eating or drinking anything after midnight on the night before the surgery. Please leave valuables, including large amounts of money, at home so they will not be lost when you are being moved to different rooms for treatment and recovery. Also, do not wear rings or other jewelry to the hospital because they will need to be removed before the surgery. Follow any other instructions you are given.

How Is the Procedure Performed?

First, you will receive anesthesia, a medicine to put you to sleep and prevent you from feeling pain during the surgery. Your doctor will make an incision (cut) down the middle of your chest and will divide your breastbone (sternum) to reach your heart. Next, as medicines are being used to stop and protect your heart, you will be connected to a heart-lung machine that will circulate your blood.

Your doctor will repair or replace the damaged valve. A repair may involve trimming extra tissue or sewing torn pieces. It may also involve implanting an artificial ring to strengthen the repair or fix the size and shape of the valve. A replacement involves removing the damaged valve and inserting an artificial valve (several types of mechanical and tissue valves are now available).

When the surgery is complete, your doctor will restart your heart, remove the heart-lung machine and carefully rejoin your breastbone using steel wires. The incision in your chest will then be sewn closed.

What Will I Feel During This Procedure?

Your anesthesiologist will regularly check the level of your anesthesia to make sure that you do not feel any pain and that you sleep through the entire procedure.

What Happens After the Procedure?

When you wake up, you may notice that you are connected to tubes, wires and medical devices. These may include: a tube in your mouth to help you breathe; a bladder catheter (tube) to drain urine; an arterial line to monitor blood pressure; a heart monitor for checking your pulse and heart rhythm; and an intravenous (IV) line for medicines, blood and other fluids. These tubes and wires will be removed as soon as they are no longer needed.

While you are recovering in the hospital, you will be taught breathing and coughing exercises that you need to do to prevent bodily fluids from collecting in your lungs. You will also begin a walking and light exercise program to regain your strength.

Is There Anything Special I Need To Do When I Go Home?

Yes. You should follow these and any other instructions given by your doctor:

• To help your breastbone heal properly, avoid heavy lifting and sudden tugging or pulling. It will take up to three months for your breastbone to heal. Ask your doctor for special instructions.
• Protect the incision in your chest by gently washing it and patting it dry daily and by watching for any signs of infection, such as redness, swelling, pus or high fevers.
• Walk short distances and perform light exercises, slightly increasing activity levels each day.
• Check your weight, temperature and pulse on a daily basis and tell your doctor if you notice any signs of heart problems, such as sudden weight gain of more than 3 pounds; shortness of breath; a slow, rapid or irregular heart beat; or chest pain that is not due to the incision.
• If your doctor prescribes a medicine called Coumadin, be sure to take it at the same time daily and have regular blood tests performed. Coumadin is a type of medicine known as an anticoagulant, which prevents blood clots (thick lumps of blood) that can block blood flow and cause a heart attack or stroke. You may have to take this medicine for a long time.
• If you plan to have any other medical or dental procedures, tell your doctor or dentist that you have had heart-valve surgery.