This is a surgical procedure to replace a damaged heart valve. The heart's four valves, which open and tightly close, allow blood to flow from one chamber to another and also allow blood to leave the heart through the large blood vessels. Usually only one valve is replaced at a time, but at times one or more valves have to be replaced. Heart valves are either mechanical (metal and plastic), such as a St. Jude valve, or made of tissue. Tissue valves most commonly come from a pig (porcine valve) or a cow (bovine valve), but they may also be supplied by a human donor or even manufactured from your own tissues.
Echocardiogram
—a test that uses sound waves to visualize functioning of the heart, including the valves
X-ray
—a test that uses radiation to take a picture of structures inside the body
Electrocardiogram
(ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
Cardiac catheterization
(possibly)—the insertion of a tube-like instrument into the heart through an artery (usually in the leg) to detect problems with the heart and its blood supply. It can also accurately define the valve problem.
Have blood ready for surgery
In the days leading up to your procedure:
Do not take aspirin or other anti-inflammatory drugs for two weeks before surgery, unless told otherwise by your doctor.
Stop all blood thinners a week before surgery.
See a dentist and get your teeth checked out.
Arrange for a ride to and from the hospital.
Arrange for help at home after returning from the hospital.
The night before, eat a light meal and do not eat or drink anything after midnight, unless told otherwise by your doctor.
During Procedure
IV fluids, oxygen, anesthesia, and diversion of blood circulation through a heart-lung machine
The surgeon cuts through the skin and breastbone, opens the chest, and connects your heart to a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation.
The surgeon stops the heart, makes an incision, and removes the damaged valve. The new valve is stitched into place and checked to make sure it opens and closes properly. The incision in the heart is closed and the heart restarted. Once the heart is working fine, you will be removed from the heart-lung machine and your chest will be closed with wires. The skin will be closed with absorbable sutures.
After Procedure
You'll be closely monitored in the intensive care unit with the help of the following devices:
Heart monitor
Breathing tube until you can breathe independently, then an oxygen mask
Chest tubes to drain accumulated fluids from the chest
A line into an artery in your arm to measure pressure
A tube through your nose and into the stomach (a nasogastric tube) to keep the stomach drained of accumulated fluids and gas
Bladder catheter
How Long Will It Take?
3-5 hours, depending on how many valves are being replaced
Will It Hurt?
Anesthesia prevents pain during surgery. You may experience some pain during recovery, but will be given pain medication to relieve the discomfort.
Possible Complications
Infection
Blood clots around the valve, which can cause a
stroke
, kidney damage, or damage to the extremities
New valve does not work properly
Sac around the heart may become inflamed and painful
2-5 days—The first day is usually spent in an intensive care unit. Over the next few days, all the lines and tubes are removed. As you start to walk and eat a regular diet, you may be sent for rehabilitation therapy
Postoperative Care
Breathe deeply and cough 10-20 times every hour.
Two to three days after surgery, you may be able to walk with help.
You may be started on anticoagulant medications (blood thinners) to prevent blood clots from forming around the valve. If you have a tissue valve, you will not require a blood thinner after surgery. But, if you have a mechanical valve, you will be placed on a blood thinner for the rest of your life.
Only take medications approved by your doctor.
Outcome
The surgical site in your breastbone heals in 4-6 weeks. Once recovery from the surgery is complete, you should be able to return to your normal activities.
Depending on the type of valve you receive, you may need to take anticoagulant medication for the rest of your life. You will need to take antibiotics before some dental and surgical procedures to decrease the risk of infection.
Call Your Doctor If Any of the Following Occurs
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Cough, shortness of breath, chest pain, or severe nausea or vomiting
Coughing up blood
Rapid heart rate
Sudden headache or feeling faint
Problems with vision or speaking
Numbness or weakness on one side
Inability to urinate
Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
RESOURCES
American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000
National Library of Medicine http://www.nlm.nih.gov/
CANADIAN RESOURCES
Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/Page.asp?PageID=24
University of Ottawa Heart Institute http://www.ottawaheart.ca/UOHI/Welcome.do
References:
Cecil Textbook of Medicine
. 21st ed. WB Saunders Co, 2000.
Society of Thoracic Surgeons website. Available at:
http://www.sts.org/
.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
