Heart Valve Replacement

What is a heart valve replacement?

A heart valve replacement is open-heart surgery done to replace a valve in your heart with an artificial valve.

Replacement valves may be mechanical or biological.

• Mechanical valves are made completely from man-made materials.
• Most biological valves are made from animal tissue: porcine valves are made from pigs, and bovine valves are made from cows. Some valves come from human donor hearts.

When is it used?

The operation may be done when a valve in your heart does not open or close all the way.

The heart valves work with each heartbeat to keep blood flowing to the body. A valve may leak or stop working because it is damaged by disease or because it was abnormal at birth. Valves that don't work right put extra strain on the heart. When damaged or abnormal valves cannot be fixed, artificial valves may be used to replace them.

This surgery is done only when:

• Medicines are not helping your heart valve problem.
• Opening up abnormal valves (balloon valvuloplasty) or repairing them (surgical valvuloplasty) will not work.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Allow for time to rest. Try to find other people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems after surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow all instructions provided by your healthcare provider. Shower and wash your hair with a special anti-infective soap the night before the procedure. You will not be allowed to eat or drink anything after midnight before the procedure.

What happens during the procedure?

You will be given a general anesthetic. The drug will relax your muscles, put you in a deep sleep, and keep you from feeling pain during the operation.

The surgeon will make a cut (incision) in your chest and divide the sternum (the flat bone in the center of the chest). You will be connected to a heart-lung machine, which will take over the work of your heart and lungs during the operation. The surgeon will then stop your heart and make a cut in your heart to reach the valve. He or she will usually remove the valve and replace it with an artificial one. In some cases the valve may be left in, with the artificial valve placed inside it.

Your surgeon will then close the cut in your heart and restart your heart. The surgeon will then close the cut in your chest by wiring together your sternum (breastbone) and then close the skin with stitches. Some tubes will be left in your chest to drain blood and fluid, which normally gather there or in the sac around the heart.

What happens after the procedure?

You will be in the intensive care unit (ICU) for a few days. You may then go to a regular hospital bed. Your entire stay in the hospital may last 2 to 8 days.

If you have a mechanical valve, you will need to take blood-thinning drugs (anticoagulants) for the rest of your life to prevent blood clots from forming on the artificial valve and causing a stroke or other problems. Biological valves do not need the long-term use of blood thinners.

Mechanical valves last a very long time—in most cases 20 years or more. Biological valves do not last as long as mechanical valves.

Ask your healthcare provider if you should take antibiotics before you have dental work or procedures that involve the rectum, bladder, or vagina. Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Your heart may be able to work well again, improving your quality of life. In many cases valve replacement will help you live longer.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• The new valve in your heart may not work quite right.
• Your kidneys and lungs may need temporary help after the operation. This means that for a time after the surgery you may need dialysis to help your kidneys. Or you may need to be on the ventilator longer to help you breathe.
• You may have mild problems with memory or thinking.
• You could have a stroke during or soon after the operation.
• The sac around your heart may become inflamed after the surgery and cause pain. You may need medicine to control pain. This may mean it takes you longer to heal and recover.
• You may have infection or bleeding.

There is risk with every treatment or procedure. Talk to your healthcare provider for complete information about how the risks apply to you.

When should I call my healthcare provider?

Call 911 right away if:

• You have a lot of chest pain.
• You have problems speaking or with your vision.
• Your arms or legs feel numb or you cannot move them.

Call your healthcare provider right away if:

• You have a fever over 101.5°F (38.6°C).
• You get short of breath.
• You have redness, swelling, pain, or drainage from your incision.
• You notice swelling in your legs or ankles.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.