Heart valve surgery

Open heart surgery is used to either repair or replace a heart valve. If you are having a valve replacement, you will either have a mechanical or tissue valve.

The average valve repair or replacement operation takes about three hours. Your surgeon will either repair your valve, or remove it and sew in your new valve.

Hospital recovery

After the operation, you will be taken to the intensive care unit (ICU) and closely monitored for about 24 hours before you go back to the ward. When you wake up you will be connected to machines that record your heart and lung activity. These might include a ventilator machine to help you breathe.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs. A physiotherapist will usually visit you every day to guide you through exercises designed to help your recovery. When ready to go home, you will need to arrange for someone to drive you home. A friend or relative will need to stay with you for at least the first 24 hours.

Your nurse will give you some 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 will disappear in seven to ten days on their own.

You will usually feel some discomfort and have some swelling around your chest for a few weeks. You're likely to have permanent scars on your chest; the scars will be red at first but should fade over time.

Valvuloplasty is a form of keyhole surgery that isn't suitable for everybody – your surgeon will advise whether it's appropriate for you.

When you have keyhole surgery, the operation is performed using small external cuts in the top of the leg or arm through a larger artery that leads up to the heart. In a similar manner to an angiogram, the surgeon reviews X-ray images on a monitor to assess, position and deploy a new valve on top of the old valve. Occasionally, the doctors need to convert from keyhole surgery to open surgery.

A transcatheter aortic valve replacement is a way of putting in a new valve without removing the old damaged valve. This procedure is used when open heart surgery may be too risky for an individual. The TAVI approach delivers a fully expandable replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve out of the way and the tissue in the replacement valve takes over working as a valve.

Occasionally after heart surgery you may experience some complications. If you experience any of the following, please contact your GP immediately:

• Temperature higher than 38°C
• Chills
• Flu-like symptoms
• Feeling hot and cold
• Heavy or night sweating
• Irregular heartbeats
• Increased shortness of breath
• Ankle or leg swelling
• Sudden weight gain
• Wound infection
• Pain that’s getting worse.

Heart valves can sometimes get infected during certain types of dental work and operations. You may need extra antibiotics to help protect your heart (from infections like endocarditis). This is why, before having any medical or dental testing or procedures, you need to tell your doctor, dentist, dental therapist or dental hygienist that you have had heart valve surgery.

Endocarditis is a rare but serious condition where the lining of the heart becomes infected after bacteria enter your bloodstream. It often affects the tissue surrounding a new heart valve.

Avoiding endocarditis

• Look after your teeth. Make sure you have regular six-monthly dental checks and brush your teeth with toothpaste twice a day.
• Avoid body piercing and tattooing.
• Don’t inject any drugs that have not been prescribed.
• If you have any signs of infection, report it to your doctor straight away so you can get treatment quickly.

If you experience flu-like symptoms with a high temperature, you should see your GP as soon as possible and tell them you have had a heart valve procedure. If not treated quickly, endocarditis can be life-threatening but with early diagnosis, most people recover well with antibiotics.

The New Zealand Transport Agency medical guidelines state that you may be fit to drive four weeks following a successful surgery. If you hold a vocational licence and if you drive passenger vehicles, trucks, forklifts, etc different rules may apply – you may have to have an assessment by a specialist before returning to driving. Anyone who holds a commercial licence must check their medical legal requirements are satisfied before returning to work.

How soon you can return to work depends on the nature of your job and your personal rate of recovery. Talk to your doctor about the timing that will work best for you.

Most commonly people return to work between six to twelve weeks after surgery.

It is worth taking some time to think about how your heart condition will affect you in the workplace. Will you be able to do exactly the same sort of work you used to do? Will you need to work fewer hours? Will you need to learn new skills?

It is normal to feel tired when you get back to work after your heart surgery. One way to reduce fatigue is to include the type of activity you do at work into your home physical activity programme. You may also wish to speak with your employer or occupational health team about other options, such as a gradual return-to-work programme.

The amount of metal used in mechanical and tissue valves is very small. Normally, if you pass through a metal detector it shouldn’t set off the alarm. Metal detectors will not harm your heart valve.

Mechanical heart valves are made of materials that will not be affected by CT scans, X-rays or MRI equipment. Other devices such as microwave ovens and mobile phones will not affect your new heart valve.