Heart Valve Replacement

Surgical procedure to replace a damaged heart valve with an artificial or transplanted valve. The heart's four valves, which open and tightly close, allow blood to flow from one chamber to another or to and from the heart. If needed, more than one valve may be replaced at the same time.

Parts of the Body Involved

Heart and chest

Reasons for Procedure

  • Congenital valvular defects
  • Narrowed, stiff valves that obstruct the free flow of blood through them
  • Loose, leaky valves that allow blood to flow the wrong way through the heart
  • Infected heart valves

Risk Factors for Complications during the Procedure

  • Pre-existing heart or lung condition
  • Advanced age
  • Recent or chronic illness

What to Expect

Prior to Procedure

Your doctor will likely do the following:
  • Physical exam
  • Echocardiogram
  • X-ray
  • Electrocardiogram (ECG, EKG) - a test that records the hearts activity by measuring electrical currents through the heart muscle
  • Cardiac catheterization (possibly) - the insertion of a tube-like instrument into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply
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
  • Arrange to 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

Anesthesia - General

Description of the Procedure - The surgeon cuts through the skin and breastbone, opens the chest, and connects 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. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.

After Procedure - Youll 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 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 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
  • Excessive bleeding
  • Pneumonia
  • Phlebitis (blood clots of a vein)
  • Anesthesia-related problems
Average Hospital Stay: 2-8 days; the first 1-3 days are usually spent in an intensive care unit

Postoperative Care:
  • Deep breathe and cough 10 to 20 times every hour
  • The day after surgery, expect to walk with help
  • You will be started on anti-coagulant medications (blood thinners) to prevent blood clots from forming around the valve
  • Only take medications approved by your doctor

Outcome

The surgical site in your breastbone heals in four to six 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 anti-coagulant 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