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:

• Dizziness

• Chest pain

• Breathing difficulties

• Palpitations

• 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 are the risks of heart valve repair or replacement surgery?

Possible risks associated with heart valve repair or replacement surgery include:

• Bleeding during or after the surgery

• Blood clots that can cause heart attack, stroke, or lung problems

• Infection

• Pneumonia

• Breathing problems

• Arrhythmias (abnormal heart rhythms)

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider prior to the procedure.

How do I get ready for heart valve repair or replacement surgery?

• Your healthcare provider will explain the procedure to you and give you a chance to ask any questions about the procedure.

• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is not clear.

• Along with a complete medical history, your healthcare provider may perform a complete physical exam to make sure that you are in good health before surgery. You may need blood tests or other diagnostic tests.

• You will be asked to fast (not eat or drink) for 8 hours before the procedure, generally after midnight.

• If you are pregnant or think you might be pregnant, you should tell your healthcare provider.

• Tell your healthcare provider if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).

• Be sure your healthcare provider knows about all medications (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. You may need to stop some of these medications before surgery.

• Your healthcare provider may do a blood test prior to surgery to see how long it takes your blood to clot.

• Tell your healthcare provider if you have a pacemaker.

• If you smoke, you should stop smoking as soon as possible. This improves your chances for a successful recovery from surgery and benefits your overall health status.

• Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during heart valve repair or replacement surgery?

Heart valve repair or replacement surgery requires a stay in a hospital. Procedures may vary depending on your condition and your healthcare providers practice.

Generally, open heart valve repair or replacement follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You will be asked to remove your clothing and will be given a gown to wear.

3. You will be asked to empty your bladder prior to the procedure.

4. You will be positioned on the operating table, lying on your back.

5. An intravenous (IV) line will be started in your arm or hand for injection of medication and to administer IV fluids. Additional catheters will be put in blood vessels your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for the additional catheters include under the collarbone and the groin.

6. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

7. A breathing tube will be put through your mouth into your lungs and you will be connected to a ventilator, a machine that will breathe for you during the surgery.

8. A soft, flexible tube (called a Foley catheter) will be put into your bladder to drain urine.

9. A tube will be put through your mouth or nose into your stomach to drain stomach fluids.

10. The skin over your chest will be cleaned with an antiseptic solution. If there is a lot of hair at the surgical site, it may be clipped off.

11. If you are having an open-heart surgery, your healthcare provider will make an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel. If you are having a less invasive procedure it may require smaller incisions.

12. The sternum (breastbone) will be cut in half. The healthcare provider will separates the two halves of the breastbone and spread them apart to expose your heart.

13. To do the valve repair or replacement, the heart must be stopped. Tubes will be put into the heart so that the blood can be pumped through your body by a bypass machine while your heart is stopped.

14. Once the blood has been completely diverted into the bypass machine for pumping, your heart will be stopped by injecting it with a cold solution.

15. When the heart has stopped, the health care provider will remove the diseased valve and put in the artificial valve, in the case of a valve replacement. For a valve repair, the procedure performed will depend on the type of valve problem that exists, for example, separation of fused valve leaflets, repair of torn leaflets, and/or the reshaping of valve parts to ensure better function.

16. Once the surgery has been completed, the blood circulating through the bypass machine will be allowed to reenter your heart and the tubes to the machine will be removed. Your heart will be shocked with small paddles to restart your heartbeat.

17. Once your heart is beating again, the healthcare provider will watch it to see how well the heart and valves are working and be sure that there are no leaks from the surgery.

18. Wires for pacing may be put into the heart. These wires can be attached to a pacemaker outside your body for a short time and your heart can be paced, if needed, during the initial recovery period.

19. The sternum will be rejoined and sewn together with small wires (like those sometimes used to repair a broken bone).

20. The skin over the sternum will be sewn back together. The incision will be closed with sutures or surgical staples.

21. Tubes will be put into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to drain fluids away from the heart as it heals.

22. A sterile bandage or dressing will be applied.

 

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.

At home

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.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• The risks and benefits of the test or procedure

• When and where you are to have the test or procedure and who will do it

• When and how will you get the results

• How much will you have to pay for the test or procedure

For more information go to www.riversidehealthcare.org/robotic-heart-surgery.html