Surgical Heart Valve Replacement Procedure
In most cases, heart valve replacement is an open-heart operation. This means the surgeon opens your chest and heart to remove the damaged valve. In some cases, the valve can be replaced through a small incision near the breastbone or under your right chest muscle. This is called minimally invasive surgery.
To help you prepare for the procedure, your doctor may suggest:
- Talking with different members of the surgical team, such as the anesthesiologist, surgeon, cardiologist, respiratory therapist, and nurses
- Discussing the details of the operation with family members
- Visiting the intensive care unit where you may be sent for postoperative recovery
What Are The Types Of Open
There are two ways to perform open-heart surgery:
- On-pump: A heart-lung bypass machine connects to the heart and temporarily takes over for the heart and lungs. It circulates blood through the body while moving blood away from the heart. The surgeon then operates on a heart that isnt beating and doesnt have blood flow. After surgery, the surgeon disconnects the device and the heart starts to work again.
- Off-pump:Off-pump bypass surgery takes place on a heart that continues to beat on its own. This approach only works for coronary artery bypass grafting surgery . Your surgeon may call this beating-heart surgery.
How Long Does It Take My Heart To Heal Asks Carolyn
By Adam Pick on May 31, 2012
I just received a great question from Carolyn about heart healing after valve repair or valve replacement surgery. In her email, Carolyn writes, Adam Ive read a lot on your website about the time needed for the sternum to heal. But, what about the heart? After its stopped, opened, fixed and restarted, how long does it take for the cardiac muscle to heal? Thanks! Carolyn
I wanted to provide Carolyn an expert opinion, so I contacted Dr. Luis Castro, the Medical Director of Sequoia Hospital Heart & Vascular Institute, in Redwood City, California.
During his 28-year career, Doctor Luis Castro has performed over 5,000 cardiac procedures of which 60% included valvular treatment.
During our exchange, Dr. Castro offered several insights about how our bodies heal after heart valve surgery. First, Dr. Castro compared the healing rate of the sternum to the healing rate of our cardiac muscle.
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When You Can Expect To Wait
There are a few stops on the journey to getting surgery. We track wait times at two key points.
Your family doctor refers you to a specialist.
The number of days between your specialist getting the referral from your family doctor and your first appointment with the specialist.
You meet with the specialist.
The time it takes for you to get any tests , if necessary, or have further consultation with the specialist before they decide if you need surgery.
Because everyones situation is so unique, we can’t track this wait period.
You and your specialist decide to go ahead with surgery.
The number of days from when you and your specialist you will have surgery to actually having the surgery.
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Why Is Open Heart Surgery Performed
Your doctor may recommend open heart surgery to treat a variety of diseases and conditions of the heart. Your doctor may only consider open heart surgery for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on open heart surgery.
Your doctor may recommend open heart surgery for:
Breathing And Coughing Exercises
You will have some fluid in your lungs after the breathing tube is removed. If this fluid collects in your lungs, you could develop pneumonia. To prevent pneumonia, a respiratory therapist or nurse will help you learn deep breathing and coughing exercises. Do these exercises as you are told to. Holding a pillow tightly to your chest when you do your coughing exercises also helps. For breathing exercises, you may use a device called an incentive spirometer. Using this device helps your lungs recover. There might be phlegm or secretions in your throat, especially if you smoke. It can sometimes be difficult to get the phlegm or secretions out of your throat, but it is very important to do so. Your healthcare team may give you breathing treatments containing special medicine to help you get rid of the phlegm.
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Care Of Your Incisions
As you heal, your incision will look better and the soreness will go away. Changes in the weather, too much or too little activity and sleeping in one position too long may cause increased soreness. You may also feel numbness or itching or see redness or swelling, which will also stop with time. To care for your incisions, we suggest:
- Wash gently with mild soap during your daily shower. Dry carefully with a towel. Pat it dry Do not rub the incision.
- If you have small pieces of white tape over your incision, you must remove them after you have been home for seven days. If the strips come off on their own, you may leave them off.
- If your incisions are puffy, have areas of redness, are oozing, or begin to open slightly, call your surgeon.
- Women should wear a bra. A good support bra will reduce the tension placed on the incision. If the bra bothers you, you may put a small piece of gauze under the bra for added comfort.
- For discomfort or soreness, you may use a heating pad. Apply it four or five times per day on the low setting for about 20 minutes each time. If needed, take pain medication prescribed by your doctor.
What Is The Recovery Time
Recovery time depends on the type of surgery you have, but for most types of heart surgery you are likely to spend a day or more in the hospitalâs intensive care unit. Then you will be moved to another part of the hospital for several days until you go home.
The National Heart, Lung, and Blood Institute notes that the length of your recovery time at home will depend on the type of surgery you had, your overall health before the surgery, and whether you experienced any complications from surgery. For example, full recovery from a traditional coronary artery bypass may take six to 12 weeks or more.
Physician anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management, and critical care medicine. They have the education and training that, in some circumstances, can mean the difference between life and death.
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How To Prepare For Open
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
Its important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.
Are Sternal Precautions Necessary
There is some debate as to whether sternal precautions are absolutely necessary to protect your breastbone as it heals after open heart surgery. There is a lack of evidence that indicates you are in danger if you do not follow sternal precautions, and some healthcare providers may recommend performing normal activities based on your own tolerance.
Feelings of crunching or popping in your breastbone are among the signs that your sternum could be moving a bit. If this happens, the activity that caused it should not be performed, and your healthcare provider should be notified.
Some healthcare providers argue that telling you to avoid lifting items and to keep your arms in can lead to fear-avoidance behaviors or avoiding moving because you are afraid of hurting yourself.
Regardless, if your healthcare provider recommends that you follow specific sternal precautions after open heart surgery, you should follow that advice. Your surgery may warrant that type of precautioneven if another person’s doesn’t. Talk to your physical therapist to make sure you are moving about properly and maintaining your prescribed precautions.
A new approach to precautions during sternotomy recovery, called Keep Your Move in the Tube, relaxes traditionally strict sternal precautions in favor of keeping arm motion within a small cylinder around your torso.
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What To Expect Of The Day Of Surgery
You should prepare to stay in the hospital for approximately seven days after your surgery. It is helpful to have someone at the hospital for support for some of this time.
After you check-in, you will go to a preoperative area where you will be instructed to change into a hospital gown.
You will meet with a member of the anesthesia team and surgical team to go over the procedure and sign consent forms. You may be asked to provide a urine specimen.
Intravenous access is started in the pre-operative area. This will be used for anesthesia, antibiotics, and blood products.
Coronary Artery Bypass Grafting
Coronary artery bypass grafting is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease .
CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture . Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina .
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.
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How Long After Open Heart Surgery Does It Take The Sternum To Heal Completely
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Why Might I Hug A Pillow As A Sternal Precaution
Some hospitals provide heart surgery patients with a pillowoften a heart-shaped oneupon discharge. The pillow is meant to be hugged while coughing or sneezing, which can put significant pressure on the chest and lungs. The pillow is believed to help stabilize the chest during the post-operative recovery period.
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Why Use Sternal Precautions
Open heart surgery usually requires that your cardiac surgeon divide your sternum to gain access to your heart and surrounding structures. After the surgery, your surgeon must repair your sternum by returning the bone to its proper place. Usually, a strong wire is used to hold the bone together while healing occurs.
During your recovery, your healthcare provider may instruct you to follow sternal precautionsa method to protect your sternum after you’ve had open heart surgery.
Sternal precautions are adjustments that you need to make in your day-to-day life to help prevent the separation of your breastbone as it heals. Separation of your sternum may slow the healing process of the bone, and sternal precautions also help to prevent excessive pulling on the surgical incision. This may help to keep the skin closed to prevent infection in your incision.
Excessive pulling on your breastbone while it is healing after open heart surgery can cause something called dehiscence, or a separation of the bone. This separation can become an opening for infection to enter into your body.
Can All Mitral Valves Be Repaired
The simple answer is no, however its important to remember that in the right hands, the majority of valves can be repaired. The things that may prevent a valve from being repaired include, too large a heart, a very degenerated and calcified valve and a rheumatic heart valve. There may be a lot of mitral annular calcification making it difficult. Experts can repair even some of those. Importantly some experts may say that a replacement is preferable because although the valve can be repaired in the short term, the likelihood of recurrence is so high that a replacement makes more sense. A surgeon with a proven track record of repair and appropriate experience should only make that decision.
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Give Your Heart Time To Heal
Its important to remember that not everyone heals at the same rate. Health conditions such as diabetes or if you are on steroids can increase the time it takes your body to heal after surgery. Complete recovery takes about three to six months.
At any phase in your recovery, using common sense is the best way to keep yourself from overdoing it, Dr. Tong says.
If an activity causes pressure or pain, stop. If your sternum doesnt heal properly after surgery, it can cause you a lot of pain and complicate the healing process.
If you arent sure an activity is safe, check with your surgeon first. Contact your doctor right away if you experience:
- Redness on your chest larger than a quarter or drainage that resembles pus .
- A clicking noise in your chest when you cough or breathe deeply .
- Abnormal pain.
Overall, give yourself time to heal, while gradually doing a little more each week. Continue to work with your doctor until youre up to speed on your normal activities.
Quit Your Breathing Exercises
If you’ve had surgery on your belly, heart, lung, or spine, your doctor may give you exercises to help your lungs recover from anesthesia, the medicine that kept you pain-free during the operation.
“Doing breathing exercises is very, very important,” Whiteson says. It expands your lungs and removes mucus that gathers there. Don’t quit until your doctor says you can stop.
To keep your recovery humming along, follow your doctor’s directions. As Saggio knows well, taking things into your own hands can slow down the healing.
“I was a little stoic. I definitely rushed my recovery,” he says. Next time, perhaps, he’ll take that extra week off.
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Why And When Open Heart Surgery Is Preferable
Cardiac surgeons recommend and prefer for open heart surgery when there is-
Severe Chest Pain: When patients experience severe chest pain because of narrowing of arteries responsible for the supply of heart muscles and thereby, leave such muscles short of blood even during any light physical exercise or when a person takes rest. Although, stents and angioplasty may give good results in some cases, but in case of complicated blockages, doctors consider open-heart surgery as the best option.
Improper Function of the Left Ventricle: When an individual has two or more than two coronary arteries in diseased condition and the main pumping chamber of the heart, i.e. the left ventricle fails to function in a well manner.
Blockage of Coronary Artery: When the left i.e. main coronary artery of a person blocks or narrows severely. This artery is responsible for supplying a majority of blood towards the left ventricle.
What Do We Do If The Bypasses Close Off
So far we have said that while LIMA-LAD grafts are an excellent option with great long term results, vein grafts are unfortunately no so good, and have an almost 1 in 2 chance of going down within several years of surgery. The good news is that the LIMA-LAD graft is the most important. And although the vein grafts may go down more frequently, if they do go down the chance of needing another heart operation is very, very low. If required, treatment can typically be undertaken using minimally invasive methods such as using stents.
The decision to treat blocked bypasses depends on many factors. Often the blockage may be silent and without symptoms, in which case no specific treatment is needed. Some bypass graft blockages will present with symptoms such as chest pain, shortness of breath or heart failure, in which case further evaluation can be undertaken and the decision made on the best treatment depending on the results of tests such as stress tests and angiograms. Finally some of these bypass blockages may present as a heart attack in which case often the blockages can be treated through the use of stents and medicines.
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