Open Heart-Valve Surgery
Although there is some evidence that older women who undergo open heart-valve surgery require fewer re-operations and have better overall long-term survival than men, mitral valve replacement is riskier for women than for men.
We are still studying why that is, but until we have those answers, if you and your doctor have determined it is a necessary risk, it is important to follow all the preparation steps.
If your heart valve disease cannot be treated medically, you’ll need surgery to repair or replace the damaged valve or valves. You and your surgeon will decide which procedure is best for you, taking into consideration your age, medical history, the nature of your heart disease, your lifestyle and your ability to take the medications that prevent your blood from clotting.
What to Expect:
- Follow your pre-op instructions carefully.
- There’s nothing to pack for surgery.
- You’ll sleep comfortably during surgery.
- You should be out of the ICU in 2 to 3 days.
- You’ll stay in the hospital about a week.
Some valves can be surgically repaired to help them open or close more efficiently. Two common surgical repair procedures are ring annuloplasty, in which the valve is tightened by placing a ring of metal, cloth or tissue around it, and reconstruction, in which the leaflets, tendons or muscles of the valve are repaired. Traditionally, repair or replacement of heart valves has involved open-heart surgery. The procedure is similar to that for coronary artery bypass surgery: the chest is opened in the operating room and the heart stopped for a time so that the surgeon may repair or replace the valve.
Preparing for Surgery
In most cases, surgery is scheduled several weeks in advance, so you’ll have a little time to get ready. Because it helps to go into surgery in the best condition possible, you should try to follow a healthful diet, exercise as much as you can, get adequate rest and, if you’re anxious about having heart surgery, do exercises to reduce stress. If you’re a smoker, this is a good time to stop, or at least cut down. If you drink alcohol daily, you might want to cut down to avoid the effects of alcohol withdrawal after surgery. You may have the opportunity to bank your blood, should you need a transfusion during the procedure.
A few days before surgery, you will meet with an anesthesiologist or nurse anesthetist, who will determine which type of anesthesia is best for you. You’ll answer questions on your health history and have a brief physical exam that may include ECG, blood work and urinalysis. You should bag all the medications—both prescription and over-the-counter—that you take regularly and bring the bag with you to the visit. The anesthesiologist or surgeon may want you to change the dose of, or even stop taking, some medications. The anesthesiologist will explain the type of anesthesia that you will receive, including the risks and benefits associated with it. You’ll read and sign a form consenting to the anesthesia to be used.
You will be asked not to eat or drink anything the night before surgery. You can take any drugs prescribed for surgery with a little water the morning of the procedure. You may be asked to wash your chest area with a special disinfecting soap.
You should arrive at the hospital without make-up, nail polish or jewelry, and dressed in clothing loose enough to fit over the surgical dressings you’ll be wearing when you go home. When you check in, you’ll be given an identification bracelet to wear during your stay. You’ll be given a hospital gown to wear and your clothes, handbag and other possessions will be tagged and taken to the room you will stay in after surgery.
A surgical attendant will explain what will happen during surgery as well as the slight risks involved. You’ll sign a second consent form, giving your permission to operate. Your anesthesiologist will greet you and might give you a sedative to relax you. You may be asked to remove any dental devices that can interfere with the tube that will be installed in your trachea to help you breathe during surgery. You will be transferred to a gurney and wheeled into the surgical suite.
Generally, heart valve repair or replacement follows this process: In the operating room, you’ll meet the surgical team, who will make you comfortable on the table. An intravenous (IV) line will be started in your arm or hand. Additional catheters will be inserted to monitor the status of your heart and blood pressure and to obtain blood samples. The anesthetist will place a clear mask over your nose and mouth and ask you to count backward from 10. You’re likely to be asleep before you finish counting. Once you are sedated, a breathing tube will be inserted through your throat into your lungs and you will be connected to a ventilator, which will breathe for you during the surgery. A catheter will be inserted into your bladder to drain urine. The skin over the surgical site will be cleansed with an antiseptic solution. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level during the surgery.
The surgeon will make an incision (cut) down the center of the chest from just below the Adam’s apple to just above the navel. The sternum (breastbone) will be divided in half with a special operating instrument. The physician will separate the two halves of the breastbone and spread them apart to expose the heart.
In order to perform the valve repair or replacement, the heart must be stopped to allow the physician to perform the very delicate procedure. Tubes will be inserted into the heart so that the blood can be pumped through your body by a cardiopulmonary bypass machine. Once the blood has been completely diverted into the bypass machine for pumping, the heart will be stopped by injecting it with a cold solution.
If a valve is being repaired, the procedure performed will depend on the type of valve problem. For example, the surgeon may separate fused valve leaflets, repair torn leaflets and/or reshape valve parts to ensure better function. To replace a valve, the surgeon will remove the diseased valve and put in the replacement valve.
Once the procedure has been completed, the blood circulating through the bypass machine will be allowed back into your heart and the tubes to the machine will be removed. Your heart will be restarted. Temporary wires may be fixed to your heart. They can be attached to a pacemaker if needed to stabilize your heart rhythms during the initial recovery period.
The sternum will be reattached with small wires and the skin over it will be sewn back together. Tubes will be inserted into your chest and connected to a suction device to drain blood and other fluids from around the heart. A tube will be inserted through your mouth or nose into your stomach to drain stomach fluids. Your chest will be wrapped in a sterile dressing.
You will be taken to the recovery room or to the intensive care unit (ICU) to be closely monitored. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate and your oxygen level. You will have a tube in your throat that is connected to a ventilator until you are able to breathe on your own. As you awake from the anesthesia, the ventilator will be adjusted to allow you to take over more of the breathing. When you can breathe on your own and are able to cough, the breathing tube will be removed. The stomach tube will also be removed at this time.
Your nurse will have you cough and take deep breaths every two hours to keep mucus from collecting in your lungs and possibly causing pneumonia. Coughing will be uncomfortable because your chest will be sore, but your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
You may be on special IV drips to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these drips will be gradually decreased and turned off.
The surgical incision may be tender or sore for several days after surgery, so your doctor will prescribe a pain reliever. Be sure to take only recommended medications, because aspirin and other pain medications may increase the chance of bleeding.
When your physician determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. As you recover, you will be encouraged to get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as you tolerate them.
When your doctor decides that you can go home, you’ll be given instructions for taking care of yourself. If you don’t have anyone to help you, you may be able to arrange for a nurse to visit.
Date Last Modified: January 21, 2011
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