Friday, January 27, 2023

Recovery From Valve Replacement Heart Surgery

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Preparing For Your Aortic Valve Surgery

Jens Story: Recovering From Heart Valve Surgery

Before having an aortic valve replacement, you will attend a pre-admission clinic. Here, you’ll be seen by a member of the team who will look after you in hospital.

At the clinic, you will have a physical examination and will be asked for details of your medical history.

Any investigations and tests that you need will be arranged. For example, these will include a blood test or an X-ray. This is a good time to ask questions about the procedure, although you can discuss your concerns with your doctor at any time.

You will be asked if you are taking any tablets or other types of medication. These might be prescribed by your GP or bought over-the-counter in a pharmacy. It helps if you bring details with you about any medication you are taking, for example by bringing the packaging with you.

You will be asked about any previous anaesthetics you have had, and whether you had any difficulties or side effects with these, such as nausea. You will also be asked whether you are allergic to anything. This is to prevent you having an allergic reaction to any medication you might need.

If you smoke, you will be advised to stop. Quitting smoking will lower the risks of complications occurring after surgery, such as chest infection or blood clots.

It is likely you will be in hospital for 5 to 7 days, so you will need to make some practical preparations. These include bringing clothes, toiletries and any equipment you use, such as a walking stick or hearing aid.

Youll Play A Key Role In Managing Your Pain

Post-surgical pain is unavoidable but can be managed in a variety of ways. Because of recent national legislation changes, physicians can prescribe no more than a seven-day supply of opioids to patients at the time of their hospital discharge.

Weaning yourself off opioids as soon as possible is important. You may need less than a seven-day supply, depending on your condition. Some patients do not require any opioids for pain management.

Other options for pain management include:

  • Oral and topical analgesics such as acetaminophen and Salonpas patches

  • Applying a warm cloth to the area, using caution near the incision because nerve sensitivity may be decreased, causing the skin to burn

  • Relaxation techniques such as meditation and guided imagery

If you are on long-term opioids, you should meet with your prescribing physician to begin to wean down to the lowest dose possible before surgery.

What Happens Before Heart Valve Replacement

Your healthcare provider may take a chest X-ray and do an electrocardiogram a day before your operation.

Avoid eating or drinking anything during the night before or the day of your surgery.

Follow your providers instructions about which medications to take or stop taking before your operation.

Take comfortable clothes with you to the hospital, along with shoes you can slip into instead of tie. Your relative or friend who drove you to your appointment can hold your belongings for you during surgery.

Your provider will prepare your incision site by shaving and cleaning it.

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When Is A Heart Valve Replacement Necessary

A heart valve replacement is necessary when valve repair surgery isnt a treatment option. Valve replacement surgery is most often used to treat people with aortic valve disease, particularly aortic stenosis .

Other conditions that may require a heart valve replacement include:

  • Mitral, pulmonary or tricuspid valve stenosis .

What Happens During Heart Valve Repair Or Replacement Surgery

Recovery after bypass surgery

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

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

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

  • You will change into a hospital gown and empty your bladder.

  • The surgical team will position you on the operating table, lying on your back.

  • A healthcare professional will start an intravenous line in your arm or hand for injection of medicine and to give IV fluids. More 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.

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

  • Your doctor will put a breathing tube through your mouth into your lungs and connect you to a ventilator, a machine that will breathe for you during the surgery.

  • Your doctor will place a transesophageal echocardiogram probe into your esophagus so he or she can monitor the function of the valves.

  • A soft, flexible tube will be put into your bladder to drain urine.

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

  • Someone on the surgical team will clean the skin over your chest with an antiseptic solution. If there is a lot of hair at the surgical site, it may be shaved off.

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    Aortic valve replacement has few complications, but the procedure is believed to be safe and very much effective. The death rate of the surgery is estimated to be below one percent, proving the efficacy of the surgery. However, if the patient feels any discomfort, then a medical expert must be consulted immediately.

    How Surgery Is Performed

    An aortic valve replacement is carried out under general anaesthetic. This means you will be asleep during the operation and will feel no pain.

    The surgeon will begin the operation by making a large incision down the centre of your breastbone . The incision will be around 25cm long. This is known as a sternotomy and it allows the surgeon access to your heart.

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    When Should You Call For Help

    911 anytime you think you may need emergency care. For example, call if:

    • You passed out .
    • You have severe trouble breathing.
    • You have severe pain in your chest.
    • You have sudden chest pain and shortness of breath, or you cough up blood.
    • You have symptoms of a stroke. These may include:
    • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.
  • You have symptoms of a heart attack. These may include:
  • Chest pain or pressure, or a strange feeling in the chest.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.
  • or seek immediate medical care if:

    • You have pain that does not get better after you take pain medicine.
    • You have loose stitches, or your incision comes open.
    • You are bleeding a lot from the incision.
    • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
  • Your heartbeat feels very fast, skips beats, or flutters.
  • You have signs of a blood clot, such as:
  • Pain in your calf, back of the knee, thigh, or groin.
  • Redness and swelling in your leg or groin.
  • How Long Does It Take To Recover From Heart Valve Replacement Surgery

    Day 4 recovery from open heart surgery for aortic valve repl

    Recovery after heart valve replacement surgery requires a relatively long time i.e. about a few months. During this period, a patient has to put limit on his activities, while simultaneously the patient experiences a few common emotional and physical changes.

    Moreover, in some cases, patients deal with difficulty in sleeping or experience chest pain. In addition, during this phase, the patients of heart valve replacement surgery require the necessary medicines, proper physical exercise and good amount of nutrition.

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    Traditional Surgery Vs Dr Doolabhs Approach

    Dr. Doolabh offers an approach to heart valve repair that is dramatically different from what is typically performed: He doesnt cut through the breastbone.

    Traditional heart valve surgery requires cutting through the breastbone while Dr. Doolabhs approach avoids the breastbone altogether with a small incision between the ribs.

    Transcatheter Aortic Valve Replacement

    Transcatheter aortic valve replacement is a minimally invasive procedure for treating aortic valve stenosis. As blood exits the heart, it passes through the aortic valve. In patients with aortic stenosis , the valve is stiff and narrow, and doesn’t open and close as it should, making it harder for the heart to pump blood to the body. As a result, patients feel short of breath and fatigued, and are at high risk for a heart attack.

    The only treatment for aortic valve disease is to replace the valve, which traditionally required open-heart surgery. For many patients, however, TAVR is an equally effective, much less invasive alternative. Instead of opening the chest to remove and replace the damaged valve, the doctor threads a catheter through a blood vessel to reach the heart, then inserts a new valve inside of the faulty one, restoring healthy blood flow. The procedure takes much less time than open-heart surgery, and patients recover more quickly, with less pain and scarring.

    UCSF has a comprehensive valve program that offers catheter-based treatment options for all four valves in the heart.

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    Benefits Of Heart Valve Replacement

    Damage in one or more valves can stop the heart from pumping blood, which is life-threatening. Depending on the seriousness of the patients condition, doctors suggest repairing or replacing the heart valve.In the replacement surgery, the damaged valves are replaced with either a mechanical or a biological valve that helps improve the blood flow and eventually prolongs the life of the patient.

  • Biological valveAdvantage: The patients need to take blood-thinning medicines only for the first few months to avoid blood clotting. Disadvantage: Biological valves can last 10-20 years. As they are made of human or animal donor tissue, they break down over time and need to be replaced.
  • Mechanical valveAdvantage: These valves have long-term durability and can last for a lifetime. Disadvantage: Mechanical valves made of either metal or plastic come with an increased risk of blood clotting, requiring the long term use of blood thinners.
  • Will I Need To Take Blood

    Recovery from Open Heart Surgery: Common Complications

    The need for anticoagulant medication after surgery depends on the type of surgery you have. The medication prevents blood clots from forming and causing problems with your heart valve. Currently, warfarin is the only approved blood thinner for mechanical heart valves.

    If you have a mechanical heart valve, youll need to take this medication for the rest of your life.

    If you have valve repair or a biological valve replacement, you may need to take this medication for several weeks after surgery, or maybe not at all.

    You may need to take an anticoagulant for a condition not related to your heart valves. This medication also treats:

    • An irregular heartbeat.

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    What Happens During A Minimally Invasive Aortic Valve Replacement

    Check with your healthcare provider about the details of your procedure. In general, during your minimally invasive aortic valve replacement:

    • An anesthesiologist will give you anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly 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.
    • There are several different approaches used in minimally invasive aortic valve replacement. These can include a small incision through your breastbone, to the right of your breastbone, or between the ribs on your side. Sometimes surgeons use special instruments and a camera to do the surgery. With this approach, your surgeon will make several small holes in your chest. Some surgeons use robot-controlled arms to perform the surgery. Your doctor will review all of your options with you along with their associated risks and benefits.
    • The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
    • Your surgeon will remove your current aortic heart valve and replace it with a new one.
    • The surgery team will remove you from the heart-lung machine.
    • The team will wire your breastbone back together .
    • The team will then sew or staple the incision in your skin in back together.

    What Should I Expect Immediately After Heart Valve Replacement

    Most patients can expect to spend time in the intensive care unit after the procedure so that we can carefully monitor how your new valve is functioning and how your body is responding. Youll likely sleep through your ICU visit though.

    You can expect to stay in the hospital for two to five days overall. During that time, well get you up and moving so you can begin to rebuild your strength. This may start with short trips to the bathroom and proceed to leisurely strolls in the hallway with a nurse or physical therapist at your side.

    Ill also stop by to see how youre feeling, leave orders for your care with the hospital staff, and evaluate your progress.

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    What Did It Find

    • Pooled data from 85 studies estimated that 89.7% of people survived for two years after surgery, 78.4% at five years, 57.0% at 10 years, 39.7% at 15 years, and 24.7% at 20 years. Subgroup analysis showed that five-year survival declined with increasing patient age .
    • The average estimated survival after surgery was 16 years for patients aged 65 or less. This compares to a life expectancy of 22.2 in the comparative general US population. In those aged 65 to 75 median survival was 12 years , seven years in those aged 75 to 85 , and six years in those aged more than 85 .
    • Structural valve deterioration was reported in 12 studies, including 7,703 people. There were 418 cases of valve deterioration during a median follow-up of 6.4 years, giving an estimated deterioration rate of 6% by 10 years, 19.3% by 15 years and 48% by 20 years.
    • Eight studies reported 64 strokes among 6,702 people. This gives a stroke rate of 0.26 per 100 person years , or less than one per 100 persons each year.
    • Two studies reported 21 cases of atrial fibrillation among 177 people. This gives a rate of 2.90 per 100 patient years , or about three per 100 persons each year.
    • The average length of hospital stay in these studies was 12 days as reported by seven studies including 6,405 people.

    Risks And Complications Of Heart Valve Replacement Surgery

    Recovery Day 1 after Aortic Valve Replacement surgery

    Risks of heart valve replacement

  • Blood clots: Can further lead to stroke, heart attacks or lung problems
  • Increased risks of infection
  • Bleeding during and after the surgery from taking blood-thinning medications
  • Breathing problems
  • The replaced mechanical valve can make a clicking noise
  • The replaced biological valve might break down over time and stop functioning properly
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    Eating For Your Heart

    Its hard to calculate the many benefits your heart gains when you make it a habit to choose healthy fare over convenient or processed foods such as chips, fries, and sugary snacks. Apple slices with a smear of peanut butter, for instance, are sweet, crunchy, and savory all at once and wont stress your hearts health.

    Other heart-healthy foods include:

    • Lean meats, poultry, fish, beans, and dairy products
    • Complex carbohydrates such as whole wheat pasta, sweet potatoes, and 100% whole grain breads
    • Healthy fats, such as nuts, seeds, avocados, and olive oil

    If youre not sure about how to prepare heart-healthy foods or would like added support in this new adventure, consider meeting with a registered dietitian for guidance and tips on menu planning and meal preparation.

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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:

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    Staying In Touch With Your Doctor

    After you leave the hospital, there are some important things to keep in mind:

    • You will need to take some steps to help your incision site heal.
    • You may have aches and pains, which is a normal part of the healing process. Your doctor may prescribe medication to help.
    • Make sure you continue your breathing and coughing exercises to keep your lungs clear and prevent complications.

    Your doctor will provide additional and more specific follow-up care instructions for you, which may include cardiac care rehabilitation. To ensure you are recovering as you should, you will have scheduled follow-up visits with either the doctor who performed your procedure or your general cardiologist, depending on the treatment plan recommended for you.

    As you recover, it is important to call or see your doctor whenever you have questions or concerns, especially if you experience any unusual problems such as bleeding, pain, other discomfort, or changes in your overall health.

    There are many free tools and resources available to learn more about aortic stenosis and its treatment options, including brochures, patient stories and procedure videos.

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