• Heart Valve Replacement

    Definition

    This is surgery 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. The valves also allow blood to leave the heart through the large blood vessels. The valves make it so that blood can only flow forward when the heart squeezes. Usually, only one valve is replaced at a time. But, at times, one or more valves may need to be replaced. The new heart valves can be:
    • Mechanical (metal and plastic), such as a St. Jude valve
    • Made of tissue—most commonly 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 tissue
    Aortic Valve Replacements: Mechanical vs. Tissue
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    Reasons for Procedure

    This procedure is done to repair a valve that is not functioning properly due to:
    • Congenital valvular defects
    • Narrowed, stiff valves that obstruct the free flow of blood
    • Loose, leaky valves that allow blood to flow the wrong way through the heart
    • Infected heart valves

    Possible Complications

    If you are planning to have heart valve replacement, your doctor will review a list of possible complications, which may include:
    • Infection
    • Blood clots formation around the valve, which can cause a stroke , kidney damage, or damage to the extremities
    • New valve does not work properly
    • Bleeding
    • Anesthesia-related problems
    • Death
    Some factors that may increase the risk of complications include:
    • Smoking
    • Pre-existing heart or lung condition
    • Advanced age
    • Recent or long-term illness
    • Stroke
    • Recent infection

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • 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 —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.
    Leading up to your procedure:
      If you had to stop medicines before the procedure, ask your doctor when you can start again. Medicines often stopped include:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • Make sure you are getting regular dental care.
    • Arrange for a ride to and from the hospital.
    • Arrange for help at home after the surgery.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    The doctor will cut through the skin and breastbone. The chest cavity will be opened. Next, your heart will be connected to the heart-lung machine. This machine will take over the functions of the heart and lungs during the surgery. Next, the doctor will stop the heart. He will then make an incision and remove the damaged valve. The new valve will be stitched into place. The doctor will check to make sure the valve opens and closes properly. The incision in the heart will be closed, and the heart will be restarted. Once the heart is working fine, the doctor will remove you from the heart-lung machine. The chest will be closed with wires. Lastly, the skin will be closed with sutures.

    Immediately After Procedure

    You will be closely monitored in the intensive care unit (ICU) with the help of the following devices:
    • Heart monitor
    • Breathing tube (until you can breathe on your own)
    • Chest tubes—to drain accumulated fluids from the chest
    • A line into an artery in your arm or leg—to measure pressure
    • A tube through your nose and into the stomach—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 need to be replaced)

    How Much Will It Hurt?

    You will have pain while recovering. Your doctor will give you pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 2-5 days. The first day is spent in ICU. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may be instructed to:
    • Breathe deeply and cough 10-20 times every hour to help keep your lungs working well.
    • Walk with assistance. You may be encouraged to walk 2-3 days after surgery.
    • Take blood thinners to prevent blood clots from forming around the valve. If you have a tissue valve, you will not need a blood thinner. If you have a mechanical valve, you will have to take the medicine for the rest of your life.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Gradually resume your regular diet.
    • Work with a physical therapist.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions .
    The surgical site in your breastbone heals in 4-6 weeks. After the recovery process, you should be able to return to normal activities.

    Call Your Doctor

    After you leave the hospital, contact 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
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    • Coughing up blood
    • Rapid heart rate
    • Sudden headache or feeling faint
    • Problems with vision or speaking
    • Numbness or weakness on one side of your body
    • 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
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Library of Medicine http://www.nlm.nih.gov/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/

    References

    Cardiac catheterization. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/heart/services/tests/invasive/ccath.aspx . Updated February 2011. Accessed December 28, 2011.

    Cecil RL, Goldman L, Bennett J. Cecil Textbook of Medicine . 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

    Society of Thoracic Surgeons website. Available at: http://www.sts.org/ . Accessed September 4, 2009.

    6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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