Heart Valve Replacement - Genesys Health System | Grand Blanc, MI

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Heart Valve Replacement

Definition
Surgical procedure to replace a damaged heart valve with either a porcine or a mechanical valve. The heart's four valves, which open and tightly close, allow blood to flow from one chamber to another and also allow blood to leave the heart or enter the heart from the large blood vessels. Usually only one valve is replaced at a time, but at times one or more valves have to be replaced. Heart valves are either porcine (pig tissue) or mechanical and your surgeon will determine which valve is best for you.

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
Replace infected or diseased porcine or mechanical valves

Risk Factors for Complications during the Procedure

Pre-existing heart or lung condition
Advanced age
Recent or chronic illness
Stroke
Kidney or liver failure
Recent infection
Poor dental care

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 heart's activity by measuring electrical currents through the heart muscle
Cardiac catheterization (possibly) - the insertion of a tube-like instrument into the heart through an artery (usually in the arm or leg) to detect problems with the heart and its blood supply. It can also accurately define the valve problem
Have blood ready for surgery

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
Stop all blood thinners a week before surgery
See a dentist and get your teeth checked out
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 you to 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. Once the heart is working fine, you will be removed from the heart and lung machine and your chest will be closed with wires. The skin will be closed with absorbable sutures.

After Procedure - You'll 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 some 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
Infection of breast bone

Average Hospital Stay: 2-5 days; the first day is usually spent in an intensive care unit. Over the next few days, all the lines and tubes are removed. As you start to walk and eat a regular diet, you may be sent for rehabilitation therapy.

Postoperative Care:

Deep breathe and cough 10 to 20 times every hour
The day after surgery, expect to walk with help
You may be started on anti-coagulant medications (blood thinners) to prevent blood clots from forming around the valve. If you have a porcine (pig) tissue valve, you will not require a blood thinner after surgery, but if you have a mechanical valve, you will be placed on a blood thinner for the rest of your life.
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