A B C D E F G H I J K L M N O P R S T U V W

HEART VALVE REPLACEMENT

Why is Heart Valve Replacement performed ?

There are four valves within the heart. Normally these allow blood to pass freely through the heart, but prevent backward flow. One or more valves may, however, be diseased. Should this happen, the diseased valve may impede forward flow and/or allow backward leakage. Eventually, symptoms may develop, such as shortness of breath, which indicate the development of heart failure. Sometimes treatment with drugs will control the symptoms. If control with drugs is unsuccessful or if there are signs of damage to the heart, surgery may be advised. In some patients, repair of the damaged heart valve(s) is possible. More commonly the valve(s) will have to be replaced.

Preparations needed for a Heart Valve Replacement

It is important for you to give up smoking. Your teeth must be checked before heart valve replacement. Any problems should be treated. This is because bacteria can enter the bloodstream from diseased teeth. If a new valve is present, the bacteria might settle on it and cause infection (infective endocarditis). Such infection can be difficult to treat and could even require a further operation on the heart. You can continue to take tablets right up to the day of surgery. Normally you will be admitted the day before operation. Among the people that you will see is a physiotherapist who will prepare you for the deep breathing and coughing which must continue after the operation. You will normally remain in hospital for about 1 week after surgery. Employers should be warned that you will need to be off work for about 3 months in total.

What Happens during a Heart Valve Replacement

An hour before the operation, you will have an injection, or pre-medication . This will cause drowsiness and a dry mouth. In the operating theatre you will be put to sleep completely. The cut will commence at the top of the breastbone and end in the upper part of the abdomen. To permit surgery on the valves, which are inside the heart, you are attached to a heart lung machine . This takes over the work of the heart and the lungs. It is then possible to stop the heartbeat and open the heart. The diseased valve is repaired, or if this is not possible it is cut out and a new one sewn in. The surgeon may select a mechanical heart valve. These are made of synthetic material. They should last indefinitely, but there is a tendency for blood clots to form on them. For this reason, you will need lifelong blood-thinning drugs and regular blood tests. Alternatively a pig's heart valve may be chosen. Surprisingly, this will not be rejected by the body. Blood clots are much less likely to form on this type of valve and long-term blood-thinning is not necessary. However, they tend to wear out. A further operation may be required after a number of years, to put in another valve. Once the valve is replaced, the heart is closed and allowed to take over from the heart lung machine.

Possible Complications during a Heart Valve Replacement

At the end of the operation, the heart may have difficulty in taking over from the heart-lung machine . The problem can usually be overcome by drugs which stimulate the heart. Sometimes a device to assist the beating action of the heart is temporarily placed into an artery in the groin. A moderate amount of bleeding from the wound is expected. If too much blood is being lost, the surgeon may decide to take the patient back to theatre to locate and treat the bleeding point. In the first few days after surgery, the heart may beat rapidly and irregularly; you might feel sweaty and uncomfortable. Tablets will be given to slow down the heart. Infection of the lungs may occur. Infection of the chest wound should only rarely be a problem.

After a Heart Valve Replacement

After the operation you will be nursed in the intensive care unit (ICU) for one or more days. On awakening, you will still be connected to a breathing machine via a tube in the mouth. There will be a number of drips or tubes in the arms and in the neck and a tube in the bladder to drain urine. Two or more tubes or drains will emerge from below the wound. These allow any blood that gathers inside the chest after the operation to be drained away. By the following morning you should be freed from these attachments and can return to the ordinary ward. The wound is fortunately not usually too painful, and strong painkillers are rarely required. Many patients notice marked mood swings, especially in the early days. Discharge from hospital is about a week after surgery. Activity may increase over 3 months. After 1 month, you should be walking about a mile per day. Driving should be possible after 6 weeks. Strenuous exercise must be avoided for the full 3 months. After that time, there need be no restrictions. If a mechanical valve has been used, you will need to take lifelong blood-thinning tablets (anticoagulant therapy). Blood tests are performed until the correct dose is found. Eventually a test will be required only once every 6 weeks or so. In all patients with artificial valves, it is vital that the teeth are kept in good condition. This is because of the risk of infection on the new valve. If any dental treatment is required, antibiotics should be given at the time. For similar reasons, all doctors treating you should be told about the valve surgery.

If Heart Valve Replacement is not performed

The doctor may have advised the operation because of symptoms that are not controlled with tablets. Should the operation be declined, there would be little further scope to improve these symptoms. Occasionally the valve may be severely diseased, yet symptoms are mild or even absent. Without surgery, there could be progressive damage to the heart, and perhaps death.