What is heart valve repair or replacement surgery?
The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. To keep the blood flowing forward during its journey through the heart, there are valves between each of the heart's pumping chambers:
- Tricuspid valve. Located between the right atrium and the right ventricle
- Pulmonary valve. Located between the right ventricle and the pulmonary artery
- Mitral valve. Located between the left atrium and the left ventricle
- Aortic valve. Located between the left ventricle and the aorta
Heart valve repair or replacement surgery be done when valves are damaged or diseased and do not work the way they should. Conditions that may cause heart valve dysfunction are valve stenosis (stiffness) and valve regurgitation (leaky valve).
When one (or more) valve(s) becomes stenotic (stiff), the heart must work harder to pump the blood through the valve. Some reasons why heart valves become narrow and stiff include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your health care provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.
Traditionally, open heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve(s). Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays.
The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be made of plastic or tissue (made from animal valves or human valves taken from donors). There are pros and cons of each type, and you and your health care provider will talk about which is best for you.
Why might I need heart valve repair or replacement surgery?
Valve repair or replacement surgery is done to correct the problems caused by one or more diseased heart valves.
If your heart valve(s) becomes damaged or diseased, you may have the following symptoms:
- Chest pain
- Breathing difficulties
- Edema (swelling) of the feet, ankles, or abdomen (belly)
- Rapid weight gain due to fluid retention
There may be other reasons for your healthcare provider to recommend heart valve repair or replacement surgery.
What happens after heart valve repair or replacement surgery?
In the hospital
After the surgery, you may be taken to a recovery room before being taken to the intensive care unit (ICU) to be closely monitored for several days. Or, you may be taken directly to the ICU from the operating room. You will be connected to machines that will constantly display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Open heart valve repair or replacement surgery generally requires an in-hospital stay of several days or longer.
You will most likely have a tube in your throat so that your breathing can be assisted with a ventilator (breathing machine) until you are stable enough to breathe on your own. As you wake up from the anesthesia more and start to breathe by yourself, the breathing machine will be adjusted to allow you to take over more of the breathing. When you are awake enough to breathe completely by yourself and are able to cough, the breathing tube will be removed. The stomach tube will also likely be removed at this time.
After the breathing tube is out, a nurse will help you cough and take deep breaths every two hours. This will be uncomfortable due to soreness, but it is extremely important that you do this in order to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
You will get pain medication if you are hurting, and you should ask for the medication before you become extremely uncomfortable.
You may be on special IV (intravenous) medicines to help your blood pressure and your heart and to control any problems with bleeding. As your condition stabilizes, these medicines will be gradually decreased and turned off. If you have pacing wires in your heart, they will be removed, too.
Once the breathing and stomach tubes have been removed and you are stable, you may start to drink liquids. Your diet may be gradually advanced to more solid foods as you tolerate them.
When your healthcare provider decides that you are ready, you will be moved from the ICU to a surgical unit or acute care unit. Your recovery will continue there. Your activity will be gradually increased as you get out of bed and walk around for longer periods. You can begin to eat solid foods as you tolerate them.
Arrangements will be made for you to go home and a follow-up visit with your healthcare provider will be scheduled.
Once you are home, it will be important to keep the surgical area clean and dry. You will be given specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they were not removed before leaving the hospital.
You should not drive until your healthcare provider tells you to. Other activity restrictions may apply.
Tell your healthcare provider right away if you have any of the following:
- Fever and/or chills (these may be a sign of infection)
- Redness, swelling, bleeding, or drainage from the incision site or any of the catheter sites
- Increase in pain around the incision site
- Difficulty breathing
Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.