Heart Valve Surgery
Once a valve problem has been diagnosed and surgery scheduled, you’ll have some things to do. Some preparations will help make your surgery go smoothly. Some will help you get set up for your return home from the hospital. And others will help you feel more at ease. Your doctor will talk with you about the risks. Write down all your questions in advance so you don’t forget to ask them.
The Week Before Surgery
Steps you take before your surgery can help make both the surgery and recovery go smoothly. Follow your doctor’s instructions.
• Ask your doctor about scheduling any dental work you might need. Dental work could let bacteria into your bloodstream, which can cause infection on a new valve.
• Give your doctor a list of every medication you take, including supplements and over-the-counter products. Your doctor may have you stop taking some of them or start taking others before surgery.
• If you smoke, quit right away. You will do better during and after surgery.
• Arrange for an adult family member or friend to drive you home from the hospital. Have a helper available for your first week or two at home.
• Prepare and freeze food or arrange to have food brought in while you recover.
• Make adjustments around your home to simplify movements, such as reducing the need to climb stairs.
The Day Before Surgery
• You may be asked to wash with special soap the night before surgery. The morning of surgery, don’t use deodorant, lotion, or perfume.
• Don’t eat or drink anything after midnight, the night before surgery.
During Your Surgery
• Your surgeon will first gain access to your heart. To get to the heart, the surgeon usually makes an incision down the center of the chest. The breastbone (sternum) is then separated. (If your surgeon plans to reach your heart by a different means, he or she will discuss it with you.)
• A heart-lung machine will oxygenate your blood so your heart and lungs can be still during the surgery.
• The surgeon will either repair or replace the problem valve. If you have another heart problem, a second procedure may be done at the same time to take care of it, too.
• After surgery is done, the breastbone is rejoined with wires. The incision is then closed. In many cases, the breastbone heals in 6–8 weeks.
Three Ways to Treat Problem Valves
Different problems call for different treatments. Your doctor will talk with you in advance about the treatment that is best for you. In some cases, though, the plan may need to change once surgery has begun. The three basic ways to treat valve problems during surgery are:
• Repair of the valve: Whenever they can, surgeons prefer to repair a valve rather than replace it. The most common kind of repair involves sewing a ring around the entrance to a valve to improve its size or shape. Another involves cutting tissue to let leaflets open or close better. When repair isn’t possible, the valve will be replaced.
• Replacement with a mechanical valve: Mechanical valves are made of metal or hard carbon. There are many designs. Valves can last for decades. But blood tends to stick to them, forming clots. So if you receive a mechanical valve, you have to take Coumadin, an anticoagulant medication, for life to prevent blood clots.
• Replacement with a tissue valve: A tissue valve usually comes from a pig or a cow. Blood does not clot as easily on tissue valves. So patients getting tissue valves may need Coumadin for only a short time. Aspirin is sometimes used instead. Tissue valves may wear out faster than mechanical valves. So they may have to be replaced sooner. Recovering After Surgery: In the Hospital
After surgery, you’ll spend at least a day in the intensive care unit (ICU). Highly trained nurses will monitor you closely. When you’re ready, you will be moved to a general care room. You’ll stay there for 5–6 days. While there, you’ll recover further and prepare to go home.
Recovering After Surgery: At Home
You’ve just come through one of the major events of your life. So give yourself time to get better little by little. Expect good days and bad days. At first, you may tire easily. But being active will help you recover. Find the right balance between rest and activity. And follow all instructions you’re given.
Risks and Complications of Heart Valve Surgery
Most valve surgeries have an excellent outcome. But any major surgery carries risk. Valve surgery risks include:
• Bleeding; need for a transfusion
• Infection
• Blood clot
• Heart rhythm problems, stroke, heart attack, or death
• Problems in the lungs or kidneys
• Failure of the new or repaired valve
• Damage to the heart During Your Recovery, Call Your Doctor If You:
• Are short of breath while resting, or after only a little exertion.
• Notice your heart beating fast or slow or skipping beats (palpitations).
• Gain more than 2 pounds in 1 day(s) or 5 pounds in 7 days, or your legs swell (retaining fluids).
• Feel dizzy or lightheaded.
• Have fever of 100°F or higher.
• Notice changes in your incision, such as swelling, oozing, or getting red or tender. (Call your surgeon.)
• Have pain in your chest or shoulder that gets worse instead of better.
• Have clicking or grinding in your breastbone.

Discharge Instructions for Heart Valve Surgery: Repair and Replacement
Your doctor performed surgery to repair or replace one or more of your heart valves. These valves ensure that blood flows through your heart the right way. You had heart valve surgery to improve the flow of blood through your heart. It should also decrease or stop the symptoms you have been having.
Home Care
• Take your medications exactly as directed. Don’t skip doses.
• Avoid using very hot water while showering. It can affect your circulation and make you dizzy.
• Clean your incision every day with soap and water. Gently pat dry the area of the incision. Don’t use any powders, lotions, or oils on your incision until it is well healed. Healing takes several weeks.
• Weigh yourself every day, at the same time of day, and in the same kind of clothes.
• Tell your doctor if you feel depressed, have trouble sleeping, or have a persistent decrease in appetite. These are common problems after surgery, but they can slow your recovery. It’s important to seek help.
Activity
• Discuss with your doctor what you can and can’t do as you recover. You will have good and bad days. This is normal.
• Let others drive for the first 3-6 weeks after your surgery.
• Ask someone to stand nearby while you shower or do other activities, just in case you need help.
• Don’t lift anything heavier than 5 pounds for 6-8 weeks.
• Until approved by your doctor, avoid mowing the lawn, vacuuming, or other activities that could strain your breastbone.
• Ask your healthcare provider when you can expect to return to work.
Lifestyle Changes
• Maintain a healthy weight. Get help to lose any extra pounds.
• Cut back on salt.
• Limit canned, dried, packaged, and fast foods.
• Don’t add salt to your food at the table.
• Season foods with herbs instead of salt when you cook.
• Break the smoking habit. Enroll in a stop-smoking program to improve your chances of success.
• Ask your doctor when you can start a walking program.
• If you haven’t already started a walking program in the hospital, begin with short walks (about 5 minutes) at home. Go a little longer each day.
• Choose a safe place with a level surface, such as a local park or mall.
• Wear supportive shoes to prevent injury to knees and ankles.
• Walk with someone. It’s more fun and helps you stay with it.
Follow-Up
Make a follow-up appointment as directed by our staff.
When to Call Your Doctor
Call your doctor immediately if you have any of the following:
• Chest pain or a return of the heart symptoms you had prior to surgery
• Fever above 100.0°F
• Redness, swelling, drainage, or warmth at the incision site
• Shortness of breath
• Fainting
• Weight gain of more than 3 pounds in 24 hours or more than 5 pounds in 1 week(s)
• New or increased swelling in your hands, feet, or ankles
• Pain that cannot be relieved or changes in the location, type, or severity of pain
• Fast or irregular pulse
• Unrelieved pain in your incision

Patient Education
Valvular Heart Disease
Valvular Stenosis
Stenosis means "narrowing". Mitral stenosis means narrowing of the mitral valve, and aortic stenosis means narrowing of the aortic valve. A stenotic valve results in a build up of pressure. Valve stenosis is caused by:
• a congenital birth defect
• progressive wear and tear or hardening of a valve from old age
• scarring from disease, including rheumatic fever as a child or young adult
• infection of a valve or heart muscle
Valvular Regurgitation
Regurgitation means "backward leaking". A regurgitant valve does not close properly so that blood leaks back into the chamber it is supposed to be leaving. For example, aortic regurgitation occurs when blood that is pumped into the aorta leaks back into the left ventricle during diastole, which results in decreased forward flow of blood into the rest of the body as well as diminished perfusion of vital organs.
Heart Valve Surgery
Heart valve disease occurs when a valve doesn't work right. A valve may not open all the way. Or, a valve may have problems closing. If this happens, blood doesn't move through the heart's chambers the way it should.
Problems with Your Heart Valves
If a valve doesn't open all the way, less blood moves through to the next chamber. If a valve doesn't close tightly, blood may leak backward. These problems may mean that the heart must work harder to pump the same amount of blood. Or, blood may back up in the lungs or body because it's not moving through the heart as it should.
Problems Opening
Stenosis occurs when a valve doesn't open fully. The valve may have become hardened or stiff with calcium deposits or scarring. So, it's hard to push open. Blood has to flow through a smaller opening, so less blood gets through the valve into the next chamber.
Problems Closing
Insufficiency (also called regurgitation) results when the valve doesn't close tightly. The valve's supportive structures may be loose or torn. Or, the valve itself may have stretched or thinned. Blood may then leak back the wrong way through the valve.
Heart Valve Surgery
During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means your diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can only be decided once surgery has begun. Your surgeon will talk with you about his or her plans for surgery and any other procedures you may need.
Repairing a Valve
During valve repair, a ring may be sewn around the opening of the valve to tighten it. Other parts of the valve may be cut, shortened, separated, or made stronger to help the valve open and close right.
Replacing a Valve
If a valve can't be repaired, it may be replaced with a prosthetic valve. Two kinds of prosthetic heart valves are available:
Mechanical valves are created from man-made materials. Lifetime therapy with an anticoagulant (sometimes called a "blood thinner") is needed when these types of valves are used. This medication prevents blood clots from forming on or around the valve.
Biological (tissue) valves are taken from pig, cow, or human donors. Xenograft valves are made from animal tissues, while homograft or allograft valves are retrieved from human cadavers. Pulmonary autograft valves are moved from the patient's pulmonary artery on the right side of the heart to the aortic position on the left. Biological valves don't last as long as mechanical valves, but the use of an anticoagulant often isn't needed.
Your doctor will talk with you about choosing the best valve for you. Factors weighed such as include your age, your occupation, the size of your valve, how well your heart is working, your heart's rhythm, your ability to take an anticoagulant, and how many new valves you need are important in the decision process .
Reaching Your Heart
To get to your heart, one or more incisions must be made in your chest. For minimally invasive valve surgery, these incisions are most often much smaller than those made for traditional valve surgery. One of two types of incisions may be used. Which type your surgeon chooses depends on the location of the valve and the method of surgery used. Your surgeon will talk with you about which incision you will receive.
Stopping Your Heart
During valve surgery, your heart must not beat. To keep your blood flowing, it is passed through a heart-lung machine. This machine gives oxygen to your blood and pumps the blood back through your body. Your surgeon may choose to connect your body to the machine through the vessels in your heart or through vessels in your groin. Once the valve surgery is done, your heart and lungs take over again.