Heart valve surgery

How heart valve surgery is carried out

         

About heart valve surgery

Heart valve disease may cause your heart to pump less efficiently. If blood doesn't flow through your heart properly, extra strain is put on it. This may cause you to have symptoms such as breathlessness, tiredness and swollen ankles.

Heart valve surgery is an operation used to treat leaking or narrowed valves. It can improve or get rid of your symptoms and may prevent permanent damage to your heart.

What are the alternatives?

If you have mild heart valve disease, medicines can be used to relieve your symptoms.

You can discuss the alternatives to heart valve surgery with your surgeon or cardiologist (a doctor specialising in conditions of the heart and blood vessels).

Preparing for heart valve surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

Heart valve surgery is usually done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, it's important to follow your anaesthetist's advice.

In hospital, your nurse may check your heart rate and blood pressure, and test your urine. You will have a chest X-ray and electrocardiogram (ECG), and may have a transoesophageal echocardiogram or an angiogram before your operation.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to maintain your circulation. You may also need to have an injection of an anti-clotting medicine called heparin to help prevent blood clots forming in the veins in your legs.

What happens during heart valve surgery

Heart valve surgery usually takes up to three or four hours.

Your surgeon will make a cut down the middle of your breastbone (sternum) to reach your heart. A bypass machine is used to pump blood around your body while your heart is being operated on.

There are different ways to mend a faulty heart valve.

  • If your valve isn't seriously damaged, it may be possible to repair it. A narrowed valve can be widened or an artificial support may be added to strengthen the valve.
  • If your valve is seriously damaged, it may have to be replaced.

There are two types of prosthetic (artificial) valves.

  • Mechanical valves. These valves can last a lifetime.
  • Biological valves. These valves are made from human or animal tissue and wear out faster than mechanical valves, so they may need to be replaced every 10 to 15 years.

Your sternum will be rejoined using wires and the skin on your chest will be closed with dissolvable stitches.

Keyhole surgery

It may be possible for your surgeon to carry out the operation using keyhole surgery, which means your breastbone won’t be cut. Instruments and a camera are passed through several small cuts made in your skin. Your surgeon uses the camera to guide him or her through the operation.

There is also a technique available called percutaneous valve replacement. A tube is passed through a blood vessel in your groin or neck to replace or repair the heart valve. This technique can also be used to stretch a valve if it isn’t opening properly, or to put a support in to keep a valve open. You may not need to have a general anaesthetic for this procedure.

These types of surgery aren’t suitable for everybody. Your surgeon will be able to advise you about which procedure is most suitable.

What to expect afterwards

After the operation, you will be taken to the intensive care unit (ICU) of the hospital and closely monitored for about 24 hours. When you wake up, you will be connected to machines that record the activity of your heart, lungs and other body systems. These might include a ventilator machine to help you breathe.

You will need pain relief to help with any discomfort as the anaesthetic wears off. You may be given patient controlled analgesia (PCA) once you have woken up. This is a pump connected to the drip in your arm that allows you to control how much pain medicine you have.

A thin, flexible tube (catheter) may be passed into your urethra (the tube that carries urine from your bladder and out of your body), which drains urine from your bladder into a bag. You may also have tubes running from the wound to drain any fluid into a bag. These are usually removed after a day or two.

You will be encouraged to get out of bed and move around as soon as possible because this helps prevent chest infections and blood clots in your legs. A physiotherapist will visit you regularly from the second day after the operation to help you do exercises to aid your recovery.

After about a week, you will be able to go home. You will need to arrange for someone to drive you home and try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The wires holding your sternum together are permanent. Dissolvable stitches closing your skin wound will slowly dissolve over several weeks and don’t need to be removed.

If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Recovering from heart valve surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Don't take ibuprofen if you’re taking warfarin. You should always follow the instructions in the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you have a mechanical valve replacement, you will need to take medicine called an anticoagulant, usually warfarin, for the rest of your life to prevent blood clots forming around the new valve. If you have a biological valve replacement you may need to take these medicines for a few months after the operation.

A full recovery from heart valve surgery can take two to three months. Your surgeon will give you advice about how soon you can return to work.

Contact your GP if you have:

  • new or severe heart palpitations (a sensation of a skipping or thumping heart beat)
  • shortness of breath
  • sweating more than normal
  • chest pain
  • a high temperature (fever)
  • problems with your eyesight
  • dizziness
  • swelling or a discharge coming from your wound

What are the risks?

Heart valve surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment – for example, feeling sick as a result of the general anaesthetic.

After heart valve surgery it's normal to feel some wound discomfort. You may have some fluid, which may be blood-strained, coming from the wound in your chest. A dressing will be placed over this area.

You are likely to have permanent scars on your chest. The scars will be red at first, but should fade over time.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in your leg (DVT).

Specific complications of heart valve surgery are rare, but can include the following.

  • Infection of your wound. Your wound may become swollen, red and tender to touch. Seek medical help if you develop these symptoms. Your doctor may prescribe you antibiotics or you may need to have the infected fluid released from your wound.
  • A blood clot. If this forms, it could block a replacement valve. You may need to take blood thinning medicines (anticoagulants), such as warfarin, for the rest of your life to prevent this.
  • Heart block. When the valve is replaced, the conducting system (electrical function) of your heart may become damaged and you may need a pacemaker fitted.
  • Endocarditis. Your replaced heart valve can become infected and so because of this, you will need to make sure you maintain good dental hygiene to prevent bacteria entering your body through your mouth.
  • Cardiac tamponade. This is a condition where fluid gathers in the sac around your heart and impairs its pumping ability. It requires emergency treatment.
  • Aortic dissection. This is a tear in your aorta (the blood vessel that carries blood out of your heart). It also requires emergency treatment.
  • Irregular heartbeat. You may develop an abnormal heart rhythm after the surgery. This can usually be treated with medicines.
  • Heart attack.
  • Stroke.

In operations where a bypass machine is used to pump blood around your body, there is a risk of a condition called post perfusion syndrome. This is rare but can cause problems with your kidneys, lungs, heart and the way in which your blood clots.

If you have keyhole surgery, there's a chance your surgeon may need to convert your keyhole procedure to open surgery. This involves making a bigger cut in your chest. This is only done if it's not possible to complete the operation safely using the keyhole technique.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you. 

Will I need to continue with any treatments after I have heart valve surgery?

Answer

Yes, usually, but this depends on the type of surgery you had and your health before the operation. You may need to take medicines called anticoagulants after your surgery. You may also need to continue taking other medicines for your condition, such as ACE inhibitors (eg ramipril) and diuretics (eg furosemide).

Explanation

After surgery, you may need to take anticoagulants such as warfarin. These medicines help stop blood clots from forming. The length of time you will need to take these for depends on the type of replacement valve that you had.

If you had a biological valve, you may only need to take anticoagulants for a few months. Whereas if you had a mechanical valve, you will need to take anticoagulants for the rest of your life. This is because these valves are made from artificial material and so clots are more likely to form around them.

While you’re taking anticoagulants, you will need to have regular blood tests to ensure you’re on the correct dose. It's very important that you’re on the correct dose of anticoagulant as too much of these medicines can lead to bleeding.

Your surgeon will advise you about taking anticoagulants after your operation.

Will I need to make any lifestyle changes after heart valve surgery?

Answer

If your heart valve disease was caused by coronary heart disease, which reduced the blood supply to your heart and caused the valves to stop working as they should, then you will need to take measures to stop this getting worse.

Explanation

Damage to your heart valves can be caused by coronary heart disease. If this has happened to you, you will need to change your lifestyle to prevent the condition getting worse. You should:

  • stop smoking (if you smoke)
  • eat a healthy, balanced diet
  • maintain a healthy weight
  • stay active
  • stick within the recommended alcohol limits
  • ensure that your blood sugar levels are well controlled if you have diabetes

Eating a healthy, balanced diet can help reduce your cholesterol levels and high blood pressure. You should change your diet to a low fat, low salt diet that includes plenty of fruit and vegetables.

If your repaired valve becomes infected, the infection can spread to the lining of your heart (this is known as endocarditis). Endocarditis is a serious condition that can be life-threatening. After a heart valve repair operation, and for the rest of your life, you will need to take measures to prevent infection. The most common way for bacteria to get into your blood is from your mouth when you have dental treatment. To help prevent infection, you should practice good dental hygiene and have regular dental checkups. This stops the bacteria in your mouth from entering your bloodstream.

For information about preventing endocarditis and about reducing cholesterol levels and high blood pressure, talk to your GP.

Is there anything I can do to speed up my recovery from heart valve surgery?

Answer

Yes, there are some things you can do to aid your recovery – for example, you can join a cardiac rehabilitation programme.

Explanation

It can take up to three months to fully recover from heart valve surgery and during this time you will need to build yourself back up to normal.

For the first six weeks after your operation, you should limit the amount of alcohol you drink. The effects of alcohol can be greater if you’re taking certain medicines and alcohol can interfere with certain medicines. You will have to be very careful if you drink alcohol and are taking warfarin because alcohol increases the effect of warfarin. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

After your surgery, you may be recommended to take part in a cardiac rehabilitation programme. This will cover exercise, relaxation and lifestyle changes that can help you recover. For example, you may get advice on:

  • diet and healthy eating
  • how to recognise stress
  • how to stop smoking
  • medicines
  • returning to work

For advice about cardiac rehabilitation programmes, ask your surgeon or contact the British Heart Foundation. If you don’t get enrolled soon after your surgery, speak to your GP for more information.

When can I start exercising after heart valve surgery and what is suitable for me?

Answer

Your physiotherapist or nurse will usually help you to start moving about two days after your surgery. Once you get home, you should build your activity levels up slowly until you are back to your usual level of activity.

Explanation

It's important to keep active when you get home after your surgery, as this will help you to recover. Try to do the same amount of exercise at home as you did with your physiotherapist at the hospital. After the first few days, you can start to increase the amount of exercise you do. Gentle walking is a good way to do this.

It's very important to increase your levels of physical activity gradually. You shouldn't do any strenuous or vigorous activity, such as weightlifting, as this can put a strain on your heart. Don’t do any heavy lifting for up to 12 weeks after surgery if your breast bone (sternum) was divided as it takes this long for the bone to heal.

It's important to rest properly too. When you sit down, make sure that you have your feet raised and supported, on a stool for example. Try to set aside specific times to rest and make sure that you stick to them.

You should stop exercising immediately if you feel:

  • pain
  • dizzy or light-headed
  • sick
  • unwell
  • very tired

If you develop any of these symptoms and they don't go away after a few minutes, contact your GP.

My doctor says I have a mitral valve prolapse. What is this and do I need treatment?

Answer

Between two and five in every 100 people have a mitral valve that is slightly misshapen and leaks. You won't usually need treatment unless you have symptoms such as palpitations (a sensation of a skipping or thumping heart beat) or chest pain.

Explanation

A mitral valve prolapse can be a cause of a heart murmur (a noise from your heart caused by irregular blood flow), but it doesn't usually cause serious problems. If you have a heart murmur, your GP will refer you to a cardiologist (a doctor specialising in identifying and treating conditions of the heart and blood vessels) to find out exactly what is causing it.

A mitral valve prolapse doesn't usually have any symptoms but you may have chest pain (angina), a fast heartbeat or palpitations.

You won't usually need treatment unless it's causing you problems. Your GP may prescribe you beta-blockers (eg bisoprolol) if your heart is beating too fast to help slow it down.

How soon after the operation will it be safe for me to fly?

Answer

This will depend on what type of procedure you had and how well you are recovering. You should not make any plans involving flights until your surgeon has advised you that it’s safe to do so.

Explanation

If you had open heart surgery without any complications afterwards, it’s usually safe for you to fly around 10 to 14 later, but always check with your surgeon. However, if any complications occur after your surgery, such as arrhythmias (an irregular heart beat), if your wound becomes infected or if you have any symptoms, such as chest pain, you will need to wait longer before you can fly.

If you’ve had percutaneous valve surgery rather than open surgery, you may be able to fly a few days after the operation depending on how well you’re recovering.

Always speak to your surgeon or GP before flying and follow their advice. If your doctor agrees that it’s safe for you to fly, make sure you have arrangements in place with your airline if you need assistance with your luggage.