Heart valve surgery
When your heart valves aren't working properly it can make your heart pump less efficiently. Heart valve surgery is used to either repair or replace poorly working heart valves. Find out the pros and cons of this surgery and what to expect if you have it.
Heart valves act as one-way doors ensuring that blood only travels in one direction through your heart. If you have a problem with one or more valves in your heart, blood doesn't flow through your heart correctly. This puts extra strain on your heart and can make your heart pump less efficiently. This can cause symptoms such as breathlessness and swollen ankles.
Heart valve surgery can stop or improve your symptoms, and may prevent permanent damage to your heart.
Types of valve surgery
There are two types of valve surgery:
Valve Repair: Often used for mitral valves which leak but are not seriously damaged.
Valve Replacement: The diseased valve is removed and replaced with a new valve. The most common types of replacement valves are a mechanical (manufactured) valve or a tissue (biological/animal) valve.
Whether you have a repair or replacement will depend on how damaged the valve is and the cause of the problem. Your surgeon will advise you which type of valve is appropriate for you.
Mechanical valves are artificial valves that can last a lifetime. Tissue valves are made from human or animal tissue. They tend to wear out faster than mechanical valves.
The average operation takes about three hours.
- Your surgeon will make a cut, about 25cm (10 inches) long, down the middle of your breastbone (sternum) and will open your ribcage to reach your heart
- Medication is used to temporarily stop your heart. Your blood will be diverted to a heart-lung (bypass) machine
- This will add oxygen to your blood and maintain your circulation
- Your surgeon will remove your diseased valve and sew in your new valve
- After your valve has been replaced, your surgeon will restart your heart and blood will be allowed to flow back through your heart
- Your sternum will be rejoined using wires and the skin on your chest will be closed with dissolvable stitches.
After your valve has been replaced, your surgeon will restart your heart and blood will be allowed to flow back through your heart. Your sternum will be rejoined using wires and the skin on your chest will be closed with dissolvable stitches.
Keyhole surgery isn't suitable for everybody - your surgeon will advise whether it's appropriate for you.
When you have keyhole surgery, instead of cutting down the chest, the operation is performed through small external cuts and through the top of the leg 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.
After heart valve surgery, you will be taken to the intensive care unit (ICU) and will be closely monitored for about 24 hours before you go back to your ward.
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 may need pain relief to help with any discomfort as the anaesthetic wears off. You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from the wound. These drain fluid into a bottle and are usually removed after a day or two.
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 you are ready to go home, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for 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 that hold your sternum together are permanent. Dissolvable stitches will disappear in seven to 10 days on their own.
The New Zealand Transport Agency medical guidelines state that you must not drive a car for at least four weeks following your surgery. You will need an assessment by a specialist to check on your condition before you return to driving.
Heart valve replacement surgery is commonly performed and generally safe. However, it's important that you understand the possible side-effects and the risk of complications of this procedure.
The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis [DVT]).
There is a small risk of death, haemorrhage, stroke and infection.
Specific complications of heart valve replacement surgery are rare but can include the following:
A blood clot may form which could block the replacement valve. You may need to take blood-thinning drugs (anticoagulants), such as warfarin, for the rest of your life to prevent this.
If you have keyhole surgery there is a chance your surgeon may need to convert your keyhole procedure to open surgery. This means making a bigger cut on your chest. This is only done if it's impossible to complete the operation safely using the keyhole technique.
The exact risks are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
After heart valve replacement 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.