Heart Valve ReplacementBy
Sarah Lewis, PharmD
What is a heart valve replacement?
A heart valve replacement removes a diseased or damaged heart valve and replaces it with a new heart valve. Heart valves keep blood flowing in one direction through the four chambers of your heart. They open to allow blood to flow forward to the body. They then close tightly so blood does not leak backwards into the heart. Diseased or damaged heart valves can cause a backflow of blood or not allow blood to flow forward normally.
Heart valve replacement is a major surgery with significant risks and potential complications. You may have less invasive treatment options, such as a heart valve repair procedure. Consider getting a second opinion about all your treatment options before having a heart valve replacement.
Types of replacement heart valves
The new valve used in a heart valve replacement is called a prosthesis. The types of heart valve prostheses include:
Animal valve prostheses, also called biological or tissue valves, come from either pigs (porcine) or cows (bovine). Tissue valves may also have some man-made parts attached to them. Tissue valves may last 10 to 15 years before they need replacement. These valves do not require taking blood thinners for the rest of your life.
Human valve prostheses come from human donor hearts. These valves are also called biological or tissue valves. They may also have some man-made parts attached to them and may last 10 to 15 years before they need replacement. These valves do not require taking blood thinners for the rest of your life.
Mechanical valve prostheses are man-made valves, created from a form of carbon. Mechanical valves are generally more durable than tissues valves. Mechanical valves generally last more than 15 years. However, you must take blood-thinning medication for the rest of your life if you have a mechanical valve.
Other surgical procedures that may be performed
Your doctor may also perform other procedures in addition to a heart valve replacement. These include:
Coronary artery bypass graft (CABG, heart bypass surgery) uses a graft to make a new route for blood to flow around blocked coronary arteries in the heart. Grafts are made with healthy vessels taken from other places in the body.
Percutaneous coronary intervention (angioplasty) involves widening or opening a blocked or narrowed coronary arteries in the heart. A stent is typically placed in the artery to keep it open longer.
Why is a heart valve replacement performed?
A heart valve replacement is a major surgery that your doctor may recommend when one or more of your heart valves does not open or close correctly. A heart valve that does not close all the way leads to regurgitation. Regurgitation lets blood flow backward instead of forward.
A heart valve that does not open all the way is called stenosis. Stenosis is a narrowing of the valve opening. It prevents blood from flowing forward effectively.
Your doctor may consider a heart valve replacement for you if your heart valve disease causes serious symptoms. These include fatigue, dizziness, passing out, shortness of breath, and swelling of the ankles. It is often preferable to repair instead of replace the valve if possible. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a heart valve replacement.
Your doctor may recommend a heart valve replacement to treat:
Aortic regurgitation or stenosis. The aortic valve opens to allow blood to leave the heart and closes to prevent blood from flowing back into the heart.
Congenital heart valve disease, a condition that is present at birth
Mitral valve regurgitation or stenosis. The mitral valve opens to allow blood to leave the left atrium and enter the left ventricle. It closes to prevent blood from flowing back into the left atrium.
Prosthesis replacement when a previous valve replacement is no longer working or is causing problems
Pulmonary valve regurgitation or stenosis. The pulmonary valve opens to allow blood to leave the heart and go to the lungs to pick up oxygen. It closes to prevent blood from flowing back into the heart.
Tricuspid valve regurgitation or stenosis. The tricuspid valve opens to allow blood to leave the right atrium and enter the right ventricle. It closes to prevent blood from flowing back into the right atrium.
Who performs a heart valve replacement?
A cardiac surgeon performs a heart valve replacement. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon.
A subspecialist called a congenital cardiac surgeon may perform the surgery on a heart valve with a congenital defect (a defect present at birth).
How is a heart valve replacement performed?
Your heart valve replacement will be performed in a hospital using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an endoscope through a three to four inch incision in the chest. The endoscope is a small, thin camera that sends pictures of the inside of your body to a video screen. Your surgeon views the surgical area on the video screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a large one used in open surgery. Surgical tools are threaded around structures, such as the breastbone and muscles, instead of cutting through or displacing them as in open heart surgery. Minimally invasive surgery may also include the use of a surgical robot or special imaging technologies (computer-assisted surgery) to help your surgeon view the area and perform the surgery.
Open heart surgery involves making a six to eight inch incision in chest through the breastbone (sternum). Open surgery allows your surgeon to view and access the heart directly. Open heart surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open heart surgery may be a safer or more effective method for certain patients.
Catheter surgery may be an option for patients who are not candidates for other types of valve replacement surgeries. Catheter surgery involves inserting a catheter (a long, thin tube) through a blood vessel in your groin. Your surgeon will thread the catheter up and into the heart until it reaches the diseased valve. The catheter tip contains a deflated replacement valve that expands once the catheter is in place. This type of heart valve replacement is an emerging technology that is only available at certain medical centers.
Surgeons sometimes combine minimally invasive techniques with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you require an open surgery to safely and effectively complete your surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different heart valve repair procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform your heart valve replacement using either general or regional anesthesia, depending on the specific procedure. General anesthesia is more common for these procedures.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your heart valve replacement
You will be admitted to the hospital the day before your heart valve replacement surgery. For minimally invasive procedures, you will probably report to the hospital the morning of your surgery. The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
Your surgery may involve a heart-lung machine (cardiopulmonary bypass). This machine temporarily takes over the heart’s job of pumping oxygen-rich blood to the organs and tissues. This is the traditional type of open heart surgery. It allows the surgeon to operate on a heart that is not beating and has no blood traveling through it.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout your surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a heart valve replacement?
As with all surgeries, a heart valve replacement involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a heart valve replacement
Complications of a heart valve replacement include:
Heart arrhythmias or problems with heart rhythm
Post-pericardiotomy syndrome, which is a low-grade fever and chest pain for up to six months following open heart surgery. A pericardiotomy is a surgical incision of the sac that surrounds the heart.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for heart valve replacement?
You are an important member of your own health care team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a heart valve replacement by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, electrocardiography (ECG), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing heart surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before heart valve repair and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a heart valve replacement? Are there any other options for treating my condition?
What type of heart valve replacement procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities? When can I resume sexual activity?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after heart valve replacement?
Knowing what to expect can help make your road to recovery after a heart valve replacement as smooth as possible.
How long will it take to recover?
You will go to an intensive care unit (ICU) after surgery and initial recovery. ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia have worn off and you are alert. You will have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain fluids from your chest and bladder, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. It is usually removed within 24 hours. . You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable.
You may move to a hospital room outside the ICU as you recover. This room will have equipment to monitor your heart rhythm and vital signs. Patients stay in the hospital after heart valve replacement for five to seven days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor will refer you to a cardiac rehabilitation program to help you recover. Full recovery takes a few weeks to a few months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your procedure. You surgeon and care team will treat your pain so you are comfortable and can get the rest you need.
Tell your care team in the hospital or call your surgeon after you go home if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a heart valve repair. Contact your surgeon for questions and concerns between appointments. You may hear the valve clicking open and closed if you have a mechanical heart valve. This is normal.
Call your surgeon right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, have a bowel movement, or pass gas
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
Weight gain of more than five pounds, which could indicate that you are retaining fluids, a potentially dangerous situation
How might a heart valve replacement affect my everyday life?
A heart valve replacement may cure your condition or reduce your symptoms so you can lead an active, normal life. However, replacing a valve that is damaged by heart disease or atherosclerosis (hardening of the arteries) will not prevent new valve damage.
You can make changes to your everyday life that to prevent or delay heart disease and more heart valve damage including:
Eating a heart-healthy diet
Getting regular exercise
Maintaining a healthy weight
Practicing stress management techniques
Treating other related conditions, including high blood pressure, high cholesterol, and diabetes
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