Heart Valve Surgery
Once a valve problem has been diagnosed and surgery scheduled, you’ll have some things to do. Some preparations will help make your surgery go smoothly. Some will help you get set up for your return home from the hospital. And others will help you feel more at ease. Your doctor will talk with you about the risks. Write down all your questions in advance so you don’t forget to ask them.
The week before surgery
Steps you take before your surgery can help make both the surgery and recovery go smoothly. Follow your doctor’s instructions.
Ask your doctor about scheduling any dental work you might need before your surgery. Ask your doctor if you need to take antibiotics when you have dental work. Dental work could let bacteria into your bloodstream. This can cause infection on a new valve.
Give your doctor a list of every medicine you take. This includes supplements and over-the-counter medicines. Your doctor may have you stop taking some of them or start taking others before surgery.
If you smoke, quit right away. You will do better during and after surgery.
Arrange for an adult family member or friend to drive you home from the hospital. Have a helper available for your first week or two at home.
Prepare and freeze food. Or arrange to have food brought in while you recover.
Make changes around your home to make it easier to get around. One example is to reduce the need to climb stairs.
The day before surgery
You may be asked to wash with special soap the night before surgery. The morning of surgery, don’t use deodorant, lotion, or perfume.
Follow any directions you are given for not eating or drinking before surgery.
During your surgery
Your surgeon will first gain access to your heart. To get to the heart, the surgeon usually makes a cut (incision) down the center of the chest. The breastbone (sternum) is then separated. If your surgeon plans to reach your heart by a different means, he or she will discuss it with you.
A heart-lung machine will put oxygen in your blood so your heart and lungs can be still during the surgery.
The surgeon will either fix or replace the problem valve. If you have another heart problem, the surgeon may do a second procedure at the same time to take care of it, too.
After surgery is done, the surgeon rejoins the breastbone with wires. The incision is then closed. In many cases, the breastbone heals in 6–8 weeks.
3 ways to treat problem valves
Different problems call for different treatments. Your doctor will talk with you in advance about the treatment that is best for you. In some cases, though, the plan may need to change once surgery has begun. The 3 basic ways to treat valve problems during surgery are:
Repair of the valve. Whenever they can, surgeons prefer to fix a valve rather than replace it. The most common kind of repair involves sewing a ring around the entrance to a valve to improve its size or shape. Another involves cutting tissue to let leaflets open or close better. When repair isn’t possible, the valve will be replaced.
Replacement with a mechanical valve. Mechanical valves are made of metal or hard carbon. There are many designs. Valves can last for decades. But blood tends to stick to them, forming clots. So if you get a mechanical valve, you have to take warfarin for life. This is an anticoagulant medicine that prevents blood clots.
Replacement with a tissue valve. A tissue valve usually comes from a pig or a cow. Blood does not clot as easily on tissue valves. So patients getting tissue valves may need warfarin for only a short time. Aspirin is sometimes used instead. Tissue valves may wear out faster than mechanical valves. So they may have to be replaced sooner.
Recovering after surgery: In the hospital
After surgery, you’ll spend at least a day in the intensive care unit (ICU). Highly trained nurses will monitor you closely. When you’re ready, you will be moved to a general care room. You’ll stay there for 5–6 days. While there, you’ll recover further and get ready to go home.
Recovering after surgery: At home
You’ve just come through one of the major events of your life. So give yourself time to get better little by little. Expect good days and bad days. At first you may tire easily. But being active will help you recover. Find the right balance between rest and activity. And follow all instructions you’re given.
Risks and complications of heart valve surgery
Most valve surgeries have an excellent outcome. But any major surgery carries risk. Valve surgery risks include:
Bleeding, or the need for a transfusion
Heart rhythm problems, stroke, heart attack, or death
Problems in the lungs or kidneys
Failure of the new or repaired valve
Damage to the heart
When to call your doctor
During your recovery, call your doctor if you:
Are short of breath while resting, or after only a little exertion
Notice your heart beating fast or slow or skipping beats (palpitations)
Gain more than 2 pounds in 1 day(s) or 5 pounds in 7 days, or your legs swell (retaining fluids)
Feel dizzy or lightheaded
Have nausea or vomiting that doesn't go away
Have a fever of 100°F (38°C) or higher, or as directed by your healthcare provider
Notice changes in your incision, such as swelling, oozing, or getting red or tender
Have pain in your chest or shoulder that gets worse instead of better
Have clicking or grinding in your breastbone
March 20, 2017
Antithrombotic therapy for prosthetic heart valves: Indications. UpToDate., Indications for valve replacement in aortic stenosis in adults. UpToDate.
Fetterman, Anne, RN, BSN,Mancini, Mary, MD