During The Surgical Heart Valve Replacement Procedure
During the procedure, the surgeon opens your chest to get to your heart and the diseased valve. The procedure varies from patient to patient, lasting a minimum of two hours and often longer. During this time, you are asleep under general anesthesia.
The surgeon will remove any tissue and calcium deposits that are interfering with the normal function of the valve. Your damaged valve may be completely removed. Then, the new valve will be sewn into the space where your own valve used to be. After the surgeon makes sure your valve is working properly, blood flow will be restored to your heart and the incisions will be closed. Your surgery is performed while the function of your heart is taken over by a heart-lung machine called cardiopulmonary bypass or CPB.
What Happens During Open
Heart surgery is complex. Some surgeries may take six hours or longer. You will receive anesthesia and be asleep during the procedure.
Surgery steps vary depending on the heart condition and procedure. In general, your surgeon:
- Makes a 6- to 8-inch long incision down the middle of your chest.
- Cuts the breastbone and spreads your ribcage apart to reach your heart.
- Connects the heart to a heart-lung bypass machine, if youll have an on-pump surgery. An anesthesiologist gives IV medication to stop your heart from beating and monitors you during the surgery.
- Repairs your heart.
- Restores blood flow to your heart. Usually, your heart starts beating on its own. Sometimes, the heart needs a mild electrical shock to restart it.
- Disconnects the heart-lung bypass machine.
- Closes the breastbone or other incision with wires or sutures that remain in your body.
- Uses stitches to close the skin incision.
Recovering From An Aortic Valve Replacement
You’ll usually need to stay in hospital for about a week after an aortic valve replacement, although it may be 2 to 3 months before you fully recover.
You should take things easy when you first get home, but you can start to gradually return to your normal activities over the next few weeks.
You’ll be given specific advice about any side effects you can expect while you recover and any activities you should avoid.
You won’t usually be able to drive for around 4 to 6 weeks and you’ll probably need 6 to 12 weeks off work, depending on your job.
Read more about recovering from an aortic valve replacement.
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What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
How Should I Prepare For Open
To prepare for open-heart surgery, you should follow your healthcare providers recommendations about:
- Medications: You may need to stop taking certain medicines a week or two before surgery. People often stop blood thinners and nonsteroidal anti-inflammatory drugs . These medicines can increase bleeding risk.
- Food and drink: Your healthcare team will ask you to fast before your surgery. Anesthesia is safer on an empty stomach.
- Smoking and alcohol: Cut back on alcohol and quit smoking. Both can slow postsurgical healing and increase the risk of complications.
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After You Leave The Hospital:
- Make sure you have someone to drive you home from the hospital. You will also need some help at home for a while.
- You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
- You may tire easily after the surgery, but you will gradually start to recover your strength. It may take several weeks to fully recover from your surgery.
- After you go home, take your temperature and your weight every day. Tell your doctor if your temperature is over 100.4°F , or if your weight changes.
- Ask your doctor when it is safe for you to drive.
- Avoid lifting anything heavy for several weeks. Ask your doctor about what is safe for you to lift.
- Follow all the instructions your healthcare provider gives you for medications, exercise, diet, and wound care.
- Make sure all your dentists and doctors know about your medical history. You may need to take antibiotics before certain medical and dental procedures to prevent getting an infection on your replacement valve.
After The Surgical Heart Valve Replacement Procedure
When your heart valve has been replaced and the surgery is completed, your heart will be beating on its own and all incisions will be sewn or stapled closed.
Following the surgery, you’ll spend some time in the ICU, where you will be closely monitored to make sure there are no complications. Family and friends will be able to visit while you are in the ICU.
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Types Of Replacement Valves
Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve. Theyre created from carbon and polyester materials that the human body tolerates well. They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. If you receive a mechanical heart valve, youll need to take blood thinners for the rest of your life to reduce your risk of stroke.
Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. There are three types of biologic heart valves:
- An Allograft or homograft is made of tissue taken from a human donors heart.
- A porcine valve is made from pig tissue. This valve can be implanted with or without a frame called a stent.
- A bovine valve is made from cow tissue. It connects to your heart with silicone rubber.
Biologic valves dont increase your risk of developing blood clots. This means you most likely wont need to commit to a lifetime of anti-clotting medication. A bioprosthetic doesnt last as long as a mechanical valve and may require replacement at a future date.
Your doctor will recommend which type of heart valve you get based on:
- your age
What Are The Risks Of An Open Mitral Valve Replacement
Most people who have an open mitral valve replacement have a successful outcome, but there are certain risks. Your particular risks will vary based on your overall health, your age, and other factors. Be sure to talk with your doctor about any concerns that you have. Possible risks include:
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What Is Recovery Like After Open
Recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take 6 to 12 weeks to recover from an open-heart procedure.
Your surgeon will let you know when you can return to work and other activities. Typically, you shouldnt drive or lift anything heavy for the first six weeks.
Some people need to take blood thinners after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehabilitation. This medically supervised program can help you regain strength and stamina and improve overall heart health.
What Happens During An Open Mitral Valve Replacement
Check with your doctor about the details of your procedure. In general, during your open mitral valve replacement:
- A doctor will give you anesthesia before the surgery starts. This will cause you to sleep deeply and you will not feel pain during the operation. Afterwards you wont remember it.
- The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
- Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
- The surgery team will attach you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
- Your surgeon will remove your current mitral heart valve and replace it with a new valve.
- The surgery team will remove the heart-lung machine.
- The team will wire your breastbone back together.
- The team will then sew or staple the incision in your skin back together.
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How Is An Aortic Valve Replacement Carried Out
An aortic valve replacement is carried out under general anaesthetic.
This means you’ll be asleep during the operation and won’t feel any pain while it’s carried out.
During the procedure:
- a large cut about 25cm long is made in your chest to access your heart although sometimes a smaller cut may be made
- your heart is stopped and a heart-lung machine is used to take over the job of your heart during the operation
- the damaged or faulty valve is removed and replaced with the new one
- your heart is restarted and the opening in your chest is closed
The operation usually takes a few hours. You’ll have a discussion with your doctor or surgeon before the procedure to decide whether a synthetic or animal tissue replacement valve is most suitable for you.
What Are Heart Valves And How Do They Work
The heart is a pump that keeps blood flowing throughout your body. At different points, the blood flows through valves. Each valve has leaflets, or flaps that act like small gates. These leaflets open to let blood flow into the hearts chambers or to the bodys arteries, and close to keep the blood from flowing backward. Altogether, there are four valves in the heart. Defects in these valves can be critical, because they can inhibit the bloods flow, leading to blood clots, heart attacks, and strokes.
Two valvesthe aortic and mitral valvesare the most common ones that need repair or replacement surgery. Defects are less common in the two other valves, but they can also develop problems that require surgery.
Aortic valve: This is located between the hearts lower left pumping chamber and the aorta, which is the largest artery in the body. The aorta carries blood out of the heart and regulates its flow to the rest of the body. Because of the aortas size, it is the most likely place for a valve defect to develop. Valve replacement is a common surgery for patients who have aortic stenosis, a narrowing of this valve. Aortic valve surgery also may be done to treat aortic regurgitation, a condition in which the valve doesnt close tightly. A leaky aortic valve can sometimes be repaired instead of being replaced.
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Transcatheter Aortic Valve Implantation An Innovative Approach To Replace Heart Valve Without Open
Heart valve replacement with an innovative approach like TAVI is a minimally invasive heart surgery that reduces pain and has faster recovery period, allows patients to return to the life they were previously accustomed, in less time.
Dr. Anuruck Jeamanukoolkit specialized in interventional cardiology at Vejthani Hospital, explains that heart valves are tissues that separate the chambers in the heart for blood to flow in right direction. If heart valves have problem functioning, whether it is a narrowing of the valve, blockage, leaking, degenerative or calcified, it will prevent valves from opening or closing properly. This will result in poor blood circulations, which will force the heart to work harder and eventually leads to a life-threatening condition.
Valvular heart disease can be caused by calcifications on valves and lead to degeneration over time, which will lead to cardiac valvular dysfunction and results in severe valve stenosis. This condition often happens in Aortic valve that separates the left ventricle from the main artery that supplies blood to the rest of the body, known as aorta. Aortic valve stenosis restricts heart from pumping sufficient blood and supply to different organs. This makes the patients tired, frequently fainted and fatigued. If the condition is left untreated, the heart wall will be enlarged and thickened from extra work and eventually lead to heart failure, explained Dr. Anuruck.
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What Are The Benefits And Considerations For A Tavi Or Other Minimally Invasive Procedure
Benefits of minimally invasive treatment options may include:
- Lower risk of infection
- Less trauma to the chest and heart muscle tissue
- Reduced length of hospital stay
Of course, everyone wants less pain and a shorter recovery time. But everyone also wants the best possible outcome and the longest, healthiest life as a result. Those factors along with a persons age, health history, type and severity of the valve problem and overall health will factor into selecting the best surgical option for any patient.
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Recovery: What To Expect
Things that can affect your surgery include your age, overall health, and the type of surgery. If you have a minimally invasive surgery you’ll be up and around in a few days.
If you have open heart surgery, your recovery will take longer. Your wound might be sore, swollen, and red. Youâll get tired easily. You might not feel like eating much, and you might find it hard to sleep. Thatâs all to be expected, and it gets better with time.
Your breastbone will take 6-8 weeks to heal, but it might be 3 months or so before you feel back to normal. Your doctor may suggest an exercise program or cardiac rehab to help.
As far as getting back to work, expect it to take 6-8 weeks for a desk job. If your work is more physical, it could take up to 3 months.
What Is The Success Rate Of Heart Valve Replacement Surgery
The success rate of heart valve surgery usually depends on various factors like the patients overall health, age and so on. Damage in the heart valve is primarily a serious condition and should be treated without much delay. Replacement surgery of the heart valve definitely increases the life expectancy of the patient, improving quality of life. Due to the advances in the medical field and use of latest technologies and heart care facilities, doctors have reported a success rate of around 94 to 97 percent of such a surgery. The mortality rate due to the heart valve replacement surgery has also decreased over the years of advancement.
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How Is Valve Disease Treated
Treatments for valve disease include:
- Protecting your valve from further damage by reducing the risk for endocarditis
- Medications to ease symptoms and reduce the risk of further valve damage
- Valve repair or replacement surgery, if needed
- Catheter based procedures, if needed
- Following up with your doctor for regular visits. Valve disease can get worse without any symptoms, so it is important to see your doctor as scheduled to checck your condition
The best treatment options for you depends on several factors, including the type of valve disease you have, the severity of damage, your age and medical history. Your health care team will talk to you about each option. It is important to see a cardiologist who can fully understand your condition and help you make the best choices for your treatment.
What To Ask About Your Doctors Experience
This procedure is still pretty new. Its not everyday stuff for every facility. Not every doctor can perform it. I feel bad when I talk with people whove had traditional heart valve surgery simply because they didnt know a minimally invasive option existed. Commonly, these people were treated in reputable medical centers. They simply didnt know to ask. I hope that changes soon and everyone who wants minimally invasive heart valve surgery can get it.
– How many minimally invasive surgeries have you performed?
– What are your results, including:
- Kidney failure rate
- Stroke rate
- Transfusion rate
If youre told you need heart valve surgery, ask about minimally invasive options. If your doctor doesnt offer them, ask for a referral or seek a second opinion. You may have to travel, but it will be worth it.
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Types Of Valve Replacement Surgeries
Biological valves are made of cow tissue , pig tissue or human tissue . Biological valves may have some artificial parts to give the valve support and to make placement easier.
A homograft is a human heart valve that comes from a donor after death. It is frozen and preserved under sterile conditions. A homograft is most often used to replace a diseased aortic valve in children or young adults, especially when the aortic root is diseased or there is infection . The homograft can also be used to replace the pulmonic valve during the Ross Procedure.
The Ross procedure involves switching your pulmonary valve to the aortic valve position and then placing a pulmonary homograft. This is a very complex procedure however it has many benefits, especially for young patients with aortic valve disease. Techniques, such as the Ross Procedure are examples of innovative ways surgeons are able to treat valve disease while protecting the heart’s natural functioning. Learn more about aortic surgery options in the young adult.
There are advantages and drawbacks to biologic valves.
Advantages: Most patients do not need to be on lifelong blood-thinner medication, unless they have other conditions which warrant it.
There are advantages and drawbacks to mechanical valves.
Advantages: Mechanical valves are very durable. They are designed to last a lifetime.
The choice is up to you.
Procedural Overview Of A Typical Open
You are then transferred to ICU and kept on a ventilator until you can fully breath on your own.
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