Heart Valve Surgery

There are 4 valves in the heart. They connect the 4 heart chambers. The valves help move the blood through the heart as it pumps. Valves that are not working properly can sometimes be repaired with surgery.

Who is a candidate for the procedure?
The following conditions may require heart valve surgery:

• heart valve defects that are present from birth, causing congenital heart disease
• heart valves that become narrow and stiff, blocking the flow of blood through the heart
• heart valves that leak, allowing blood to flow the wrong way through the heart
• heart valve infections

How is the procedure performed?
Some heart valve problems can be fixed with a a minimally invasive procedure. A narrow tube, called a catheter, is inserted into an artery in the groin. The catheter is threaded through the body into the heart. The surgeon repairs the heart valve using special tools inserted through the catheter. Most people, however, require open heart surgery for repair of heart valve defects. This is an extensive operation that is performed under general anesthesia. The surgical incision for this surgery is usually down the front of the chest the length of the sternum (breastbone). However, in some cases, the surgeon is able to use a smaller incision down the sternum is an upside-down “T” shape for aortic valve replacements or between the ribs for a mitral valve replacement. Ask your surgeon what type of surgical incision is best for you.

Before the procedure, the person is put to sleep with general anesthesia . The chest area is first cleaned with antibacterial chemicals. Next, an incision is made into the breastbone or sternum to expose the heart. The person is then put on a heart-lung bypass machine. This device keeps the blood full of oxygen and blood circulating around the heart.

A heart valve operation can involve repair of the valve or a complete replacement. When a valve is repaired, the surgeon is able to fix the natural structures, sometimes with the add of a support ring. When a valve is replaced, the patient’s own valve is completely removed and an artificial valve is used instead. There are two types of replacement valves: mechanical and bioprosthetic. Mechanicall valves are generally made of special metal or plastic. Bioprosthetic valves are made of tissue which may come from human organ donors or from animals such as pigs or cows In the past, mechanical valves lasted much longer than Bioprosthetic valves. However, with new technology, the tissue valves are lasting much longer than in the past. Because of the metal or plastic surfaces in a mechanical valve, patients with mechanical valves will need to take blood thinning medications for the remainder of their lives to prevent blood clots.

After the valve is repaired or replaced, the person is taken off the heart-lung machine. Once the person's heart is working again to pump the blood, the chest incision is closed. The person is taken off general anesthesia and sent to the surgery recovery room .

What happens right after the procedure?
After surgery, the person is taken right away to the intensive care unit, or ICU. He or she will be given medication for the first few hours to make him or her sleep. When the person awakens, he or she should not be alarmed to find:

• a breathing tube, called an endotracheal tube, down the windpipe. This tube is attached to a ventilator, or artificial breathing machine, to ensure deep breaths and to make it easier for the person to breath. This will usually be removed on the same day as surgery, when he or she is awake, and able to take deep breaths.
• a stomach tube, called a nasogastric tube, in the nose to drain the stomach and prevent nausea and stomach swelling
• a narrow tube, called a urinary catheter, in the bladder to measure the amount of the urine the body is making.
• one or two tubes in the chest to drain fluid from around the heart
• many intravenous, or IV, lines to give fluids, medications and blood as needed
• a small tube in the wrist to monitor blood pressure closely
• a tube in the neck to monitor how well the heart is pumping and to allow an easy, painless way to draw blood

The person will be given pain medication as needed.

On the first day after surgery, many of the tubes will be removed. The person may be transferred to the step down unit, or telemetry unit, if there have been no problems. In the telemetry unit the person will:

• be asked to breath deeply and cough often to prevent pneumonia
• be encouraged to sit at the edge of the bed and dangle his or her feet
• have the chest tube and urinary catheter removed
• eat, if possible, starting with clear liquids
• be given pain medication if it is needed
• begin walking the day after surgery. This will help to prevent blood clots from forming, and reduce ankle swelling.

It may take months for a person to fully recover from open heart valve surgery . During this time, the incision will heal slowly, with some redness, tenderness and swelling present for several months. The person will be advised to:

• have a check-up with the surgeon about 10 to 14 days after the surgery
• take showers instead of baths for 4 to 6 weeks until incision is completly healed.
• begin a walking program. Activity should be increased gradually as the person is able to tolerate it.
• avoid lifting and straining for 4 to 6 weeks
• not drive for 4 to 6 weeks
• resume sexual activity as desired after the first check-up with the surgeon
• rest twice a day for the first few weeks, and get 8 to 10 hours of sleep at night
• expect some constipation if pain medication has been used often, eating extra fruits and vegetables can be helpful to prevent constipation.

People with artificial or mechanical valves are usually put on blood thinning medications permanently to prevent blood clots. Individuals with tissue or bioprosthetic valves may need blood thinning medications for a short period of time, but will usually be able to stop taking them within a few months after surgery.

What are the potential complications after the procedure?
All major surgery carries the risks of bleeding, infection and death. After heart surgery, irregular heart rhythms, known as arrhythmias may also occur. Incision and chest muscle pain may last for months. Some numbness in the skin near the incision may also occur. However, this problem often gets better over time.

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