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Heart valve surgery

Heart valve surgery is an operation to treat leaking or narrowed valves (heart valve disease). It involves repairing or replacing one or more of your heart valves with the aim of improving your symptoms or even curing them. It may also prevent permanent damage to your heart, which could increase your life expectancy.

During the operation, your valve will either be repaired or replaced with a new prosthetic (artificial) one.

There are two types of prosthetic valves.

  • Mechanical valves. These are made from man-made materials, such as carbon and titanium, and last for around 20 to 30 years.
  • Biological valves. These are made from human or animal tissue and wear out faster than mechanical valves. They may need to be replaced every 10 to 15 years.

Before your operation you will meet the surgeon who is going to do the surgery so you can talk through everything that will happen. The procedure may be a little different from the way we describe it here as it will be adapted to meet your individual needs.

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Heart valve replacement surgery
How the operation is carried out
An image showing the types of heart valve replacement

Details

  • Preparation Preparing for heart valve surgery

    Your surgeon will explain how to prepare for your operation – if you smoke, you will be strongly advised to stop. This is because smoking increases your risk of getting a chest or wound infection, which can mean it takes longer to recover after the operation.

    You’ll usually have heart valve surgery done under general anaesthesia. This means you’ll be asleep during the operation. A general anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist or surgeon’s advice. If you have any questions, just ask.

    You may need to wear compression stockings to keep your blood flowing. You may also need to have an injection of a medicine called heparin to help prevent blood clots forming in the veins in your legs.

    Your surgeon will talk to you about will happen before, during and after your procedure. They should also give you an idea of any pain you might have at any stage. Take this as an opportunity to ask any questions you have so you can really understand what will happen. You may find it helpful to prepare questions in advance, for example about the risks, benefits and any alternatives to the procedure. It’s important that you feel fully informed as you’ll be asked to sign a consent form.

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  • Alternatives What are the alternatives to heart valve surgery?

    If you have mild heart valve disease, medicines may relieve your symptoms.

    You can discuss the alternatives to heart valve surgery with your surgeon or cardiologist (a doctor who specialises in conditions that affect the heart).

  • The procedure What happens during heart valve surgery?

    Heart valve surgery usually takes around four to six hours.

    Your surgeon will make a cut down the middle of your breastbone (sternum) to reach your heart. Your heart can’t work as it would usually while it’s being operated on so a bypass machine will be used to do this instead. This will make sure that blood continues to be pumped around your body.

    There are a number of different ways to mend a faulty heart valve.

    • If your valve isn’t seriously damaged, it may be possible to repair it in different ways. For example, 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.

    After your operation, your surgeon will rejoin your breastbone using wires. They will then close the skin on your chest with dissolvable stitches.

    Keyhole surgery

    It may be possible for your surgeon to do the operation using keyhole surgery. This means you won’t need to have a cut in your breastbone. Instead your surgeon will make several small cuts in your skin and pass instruments and a camera through these. They will use the camera to guide them through the operation.

    There is also a technique available called percutaneous valve replacement, such as transcatheter aortic valve implantation (TAVI). This involves your surgeon passing a tube through a blood vessel in your groin or neck to replace or repair the heart valve. This procedure can also stretch a valve if it isn’t opening properly, or be used to put a support in to keep a valve open. You usually need to have a general anaesthetic for this procedure.

    These types of surgery aren’t suitable for everybody. Talk with your surgeon about the best procedure for you.

  • Aftercare What to expect afterwards

    After the operation, you may be taken to the intensive care unit (ICU) of the hospital and carefully monitored for around 24 hours. When you wake up, you’ll 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’ll need pain relief to help with any discomfort as the anaesthetic wears off. You may be given patient controlled analgesia (PCA) once you wake up. This is a pump that’s connected to a drip in your arm and allows you to control how much pain medicine you have. There are safety features built into the system so you won’t be able to take too much by accident.

    You may have a catheter (a thin, flexible tube) to drain urine from your bladder into a bag. You may also have tubes running from your chest wound to drain any fluid into a bag.

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

    After about 10 days, you’ll be able to go home. Make sure someone can take you and stay with you for a day or so.

    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.

    If you have wires in your breastbone from the operation, these will be permanent. The dissolvable stitches your surgeon used to close your skin wound will slowly dissolve over several weeks and don’t need to be removed.

  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Recovery Recovering from heart valve surgery

    A full recovery from heart valve surgery can take two to three months.

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read 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’ll need to take medicine called an anticoagulant (usually warfarin). You’ll need to take this for the rest of your life to prevent blood clots forming around the new valve. If you have a biological valve replacement, you only need to take these medicines for a few months after your operation.

    You can probably start driving after about six weeks. 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.

    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 that doesn’t get better if you rest
    • chest pain
    • a high temperature or fever
    • feel faint
    • persistent bleeding or discharge coming from your wound
  • Risks What are the risks?

    As with every procedure, there are some risks associated with heart valve surgery. We haven’t included exact statistics as they are specific to you and your circumstances. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after the operation.

    After heart valve surgery it’s normal to feel some discomfort from your wound. There may be some fluid, which may be stained with blood, coming from the wound in your chest. But you’ll have a dressing over it.

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

    Complications

    Complications are when problems occur during or after the operation. Possible complications of heart valve surgery can include the following.

    • An infection in your wound. Your wound may become swollen, red and tender to touch. Seek medical help if you develop these symptoms – you may need antibiotics to treat the infection.
    • A blood clot. If this forms, it could block a replacement valve. Blood thinning medicines (anticoagulants) can prevent this.
    • Heart block. When the valve is replaced, the conducting system (electrical function) of your heart may be damaged and you may need to have a pacemaker fitted.
    • Endocarditis. Your replacement heart valve could get infected if bacteria get to it. One way of reducing the risk of this is to make sure you look after your dental hygiene. This will mean bacteria are less likely to enter your body through your mouth.
    • Cardiac tamponade. This is a condition where fluid gathers in the sac around your heart and affects how well it can pump. You’ll need to have emergency treatment.
    • Aortic dissection. This is a tear in your aorta (the artery that carries blood out of your heart) and if it happens, you’ll need immediate medical treatment.
    • Irregular heartbeat. You may develop an abnormal heart rhythm after the surgery. This can usually be treated with medicines.
    • Heart attack.
    • Stroke.
  • FAQs FAQs

    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 as well as continuing with any you already took for your condition.

    Explanation

    After surgery, you may need to take an anticoagulant medicine, such as warfarin. These medicines help stop blood clots from forming. How long 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. But if you had a mechanical valve, you’ll 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’ll need to have regular blood tests to ensure you’re on the correct dose. This is very important because if you have too much of these medicines, it can lead to severe bleeding.

    Talk to your surgeon for more information about what medicines you need to take 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, you’ll need to take measures to stop this getting worse. You may also need to take steps to prevent infection.

    Explanation

    Damage to your heart valves can be caused by coronary heart disease. This reduces the supply of blood to your heart and stops the valves working as they should. If this has happened to you, you may need to make some lifestyle changes to prevent the condition getting worse. Aim to:

    • stop smoking (if you smoke)
    • eat a healthy, balanced diet
    • maintain a healthy weight
    • stay active
    • make sure that your blood sugar levels are well controlled if you have diabetes

    After your operation, it’s really important to be careful about how much alcohol you drink. The effects of alcohol can be greater if you’re taking certain medicines and it can affect how they work. For example, alcohol increases the effect of warfarin. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    If you have a heart valve repaired and it gets infected, the infection can spread to the lining of your heart. This is known as endocarditis and it’s a serious, potentially life-threatening condition. After you have a heart valve repair operation, and for the rest of your life, you’ll 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. So it’s important to look after your teeth and gums and have regular checkups with your dentist to reduce any need for this.

    For more information about lifestyle changes after heart valve surgery, 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 help yourself recover – for example, you can join a cardiac rehabilitation programme.

    Explanation

    It can take up to three months to fully recover from heart valve surgery. During this time, you’ll need to build up your activities gradually to get back to normal.

    After your surgery, your doctor may recommend you 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 reduce and manage stress
    • how to stop smoking
    • medicines
    • returning to work

    For advice about cardiac rehabilitation programmes, ask your surgeon or contact your GP or the British Heart Foundation (see Resources).

    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 a couple of days after your surgery. Once you get home, build your activity levels up slowly until you’re back to normal.

    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 how much you do. Gentle walking is a good way to do this.

    It’s very important to increase your levels of physical activity gradually. Don’t do any strenuous or vigorous activity immediately as this may put a strain on your heart. Don’t do any heavy lifting for around six weeks after surgery if your surgeon cut through your breastbone (sternum) during your operation. This will allow time for the bone to heal.

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

    Stop exercising immediately if you feel:

    • any pain in your chest
    • dizzy or faint
    • your heart beating irregularly
    • short of breath

    If you develop any of these symptoms and they don’t go away within 20 minutes, contact your GP.

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

    Answer

    Around two in every 100 people have a mitral valve that is slightly misshapen and leaks, which is called mitral prolapse. You won’t usually need treatment unless you have symptoms, such as palpitations (a sensation of a skipping or thumping heart beat).

    Explanation

    A mitral valve prolapse can be a cause of a heart murmur but it doesn’t usually cause serious problems. A heart murmur is noise from your heart caused by irregular blood flow. If you have a heart murmur, your GP will refer you to a cardiologist to find out exactly what is causing it. A cardiologist is a doctor who specialises in conditions that affect the heart.

    A mitral valve prolapse doesn’t usually cause 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 medicines called 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’re recovering. It’s best not to make any plans until your surgeon advises you it’s safe to do so.

    Explanation

    After heart surgery, it’s usually safe for you to fly around 10 days later but always check with your surgeon before you book a flight. If you get any complications after your surgery, such as an infection or symptoms such as chest pain, you may need to wait longer.

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

    Always speak to your surgeon before flying and follow their advice. It’s also a good idea to check with your airline for their recommendations and to make any special arrangements you may need.

  • Resources Resources

    Further information

    Sources

    • Percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction. National Institute for Health and Care Excellence (NICE), January 2013. www.nice.org.uk
    • Prosthetic heart valves. Medscape. www.emedicine.medscape.com, published 4 February 2014
    • Overview of cardiac valvular disorders. The Merck Manuals. www.merckmanuals.com, published July 2014
    • Orlando R, Pennant M, Rooney S, et al. Cost-effectiveness of transcatheter aortic valve implantation (TAVI) for aortic stenosis in patients who are high risk or contraindicated for surgery: a model-based economic evaluation. Health Technol Assess 2013; 17(33). doi:10.3310/hta17330
    • Aortic regurgitation. The Merck Manuals. www.merckmanuals.com, published July 2014
    • Mechanical heart valves. Medscape. www.emedicine.medscape.com, published 14 March 2014
    • Map of Medicine. Valvular heart disease. International view. London: Map of Medicine; 2014 (Issue 1)
    • Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation 2014; 129(23):2440–92. doi:10.1161/CIR.0000000000000029
    • Your anaesthetic for heart surgery. Association of Anaesthetists of Great Britain and Ireland (AAGBI). www.aagbi.org, accessed 19 August 2014
    • Chacko M, Weinberg L. Aortic valve stenosis: perioperative anaesthetic implications of surgical replacement and minimally invasive interventions. Cont Edu Anaesth Crit Care and Pain 2012; 12(6):295–301. www.ceaccp.oxfordjournals.org
    • Sutureless aortic valve replacement for aortic stenosis. National Institute for Health and Care Excellence (NICE), July 2013. www.nice.org.uk
    • What is heart surgery? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 8 November 2013
    • Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease. Eur Heart J 2012; 33:2451–96. doi:10.1093/eurheartj/ehs109
    • Balloon dilatation of pulmonary valve stenosis. National Institute for Health and Care Excellence (NICE), June 2004. www.nice.org.uk
    • Schimmer C, Reents W, Berneder S, et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg 2008; 86(6):1897–904. doi:10.1016/j.athoracsur.2008.08.071
    • Thoracoscopically assisted mitral valve surgery. National Institute for Health and Care Excellence (NICE), December 2007. www.nice.org.uk
    • Percutaneous valve replacement. Medscape. www.emedicine.medscape.com, published 21 June 2012
    • Aortic stenosis. PatientPlus. www.patient.co.uk/patientplus, reviewed 30 October 2012
    • Transcatheter valve-in-valve implantation for aortic bioprosthetic valve dysfunction. National Institute for Health and Care Excellence (NICE), September 2014. www.nice.org.uk
    • Transcatheter aortic valve replacement technique. Medscape. www.emedicine.medscape.com, published 6 November 2013
    • What to expect after heart surgery. The Society of Thoracic Surgeons. www.sts.org, published 2009
    • Having heart surgery. British Heart Foundation. www.bhf.org.uk, published 2013
    • Wound healing and repair. Medscape. www.emedicine.medscape.com, published 3 April 2013
    • Scar assessment. Heart Online. www.heartonline.org.au, accessed 20 August 2014
    • Cardiac tamponade. PatientPlus. www.patient.co.uk/patientplus, reviewed 12 March 2014
    • Aortic dissection. Medscape. www.emedicine.medscape.com, published 27 March 2014
    • Czesla M, Götte J, Weimar T, et al. Safeguards and pitfalls in minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013; 2(6):849–52. doi:10.3978/j.issn.2225-319X.2013.07.26
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 20 August 2014
    • Mitral regurgitation. PatientPlus. www.patient.co.uk/patientplus, reviewed 30 October 2012
    • Infective endocarditis. Medscape. www.emedicine.medscape.com, published 21 April 2014
    • Overview of coronary artery disease. The Merck Manuals. www.merckmanuals.com, published May 2013
    • Risk factors for coronary artery disease. Medscape. www.emedicine.medscape.com, published 5 December 2013
    • What to expect during cardiac rehabilitation. National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 24 December 2013
    • Mitral valve prolapse (MVP). The Merck Manuals. www.merckmanuals.com, published July 2014
    • Mitral valve prolapse. PatientPlus. www.patient.co.uk/patientplus, reviewed 30 October 2012
    • Smith D, Toff W, Joy M, et al. Fitness to fly for passengers with cardiovascular disease. Heart 2010; 96(Suppl 2):111–ii16. doi:10.1136/hrt.2010.203091
    • General guidance for some common heart conditions. Civil Aviation Authority. www.caa.co.uk, accessed 21 August 2014
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