Heart valve surgery

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who are planning to have heart valve surgery, or who would like information about it.

Heart valve surgery treats heart valve disease. It involves repairing or replacing one or more heart valves that may be diseased or damaged.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

How heart valve replacement surgery is carried out

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About heart valve surgery

Heart valve disease causes your heart to pump less efficiently. Blood doesn't flow through your heart properly, which puts extra strain on your heart. This causes symptoms such as breathlessness, chest pain, tiredness and swollen ankles.

Heart valve surgery treats leaking or narrowed valves to eliminate or improve your symptoms. It may prevent permanent damage to your heart.

Getting advice about heart valve surgery

If you have mild heart valve disease, medicines (eg diuretics, angiotensin-converting enzyme (ACE) inhibitors, digoxin) can relieve symptoms.

You can discuss alternatives to heart valve surgery with your GP.

Preparing for heart valve surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

You will generally stay in hospital for up to ten to 12 days. This operation is usually done under general anaesthesia, so you will be asleep during the operation.

In hospital, your nurse may check your heart rate and blood pressure, and test your urine. You may have a breathing test to check your lung function. You will have an X-ray, electrocardiogram (ECG) or echocardiogram before the operation.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, it's important to follow your anaesthetist's advice.

You may be asked to wear compression stockings to maintain your circulation. You may also need to have an injection of an anti-clotting medicine called heparin.

What happens during heart valve surgery

Heart valve surgery can take up to three hours.

The surgeon will make a cut, about 25cm (10 inches) long, down the middle of your breastbone (sternum) to reach your heart.

There are different ways to mend the valve.

• If your valve isn't seriously damaged, it may be possible to repair it.
• A narrowed valve may be widened.
• An artificial ring may be added to strengthen the valve.
• If your valve is seriously damaged, it may be replaced.

There are two types of prosthetic (artificial) valve.

• Mechanical valves are made of carbon fibre. Sometimes, they make a clicking sound but most people quickly get used to this. These valves can last for a lifetime.
• Biological valves are made from human or animal tissue. Biological valves wear out faster than mechanical valves, so the surgery may need to be repeated every eight to 10 years.

Your surgeon will advise you about the type of heart valve surgery that you're having.

Your sternum will be rejoined using wires and the skin on your chest will be closed with dissolvable stitches.

Keyhole surgery

Your surgeon may do the operation using keyhole (minimally invasive) surgery. Instruments and a camera are passed through smaller cuts and the surgeon uses the camera as a guide during the operation.

There is also a technique called percutaneous valve replacement. A tube is passed through an artery or in your groin, or a vein in your leg to replace a heart valve.

Keyhole surgery isn't suitable for everybody. Your surgeon will advise you on what is best for you.

What to expect afterwards

You will be taken to the intensive care unit (ICU) of the hospital and will be closely monitored for about 24 hours.

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.

A catheter may be placed to drain urine from your bladder into a bag. You may also have tubes running from the wound to drain any fluid into a bag. These are usually removed after a day or two.

You will be encouraged to get out of bed and move around because this helps prevent chest infections and blood clots in your legs. A physiotherapist will visit you regularly from the second day after the operation to help you do exercises to aid your recovery.

After about a week, you will be able to go home. You need to arrange for someone to drive you home and try to have a friend or relative stay with you for the first 24 hours. Tell your GP when you're discharged from hospital, so he or she is aware of your care needs.

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.

The wires holding your sternum together are permanent. Dissolvable stitches closing the skin wound will disappear in seven to 10 days.

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. If you drive a lorry or a bus, you need to notify the DVLA about your operation.

Recovering from heart valve surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Don't take ibuprofen if you are taking warfarin.

Always follow the instructions in the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

A full recovery can take two to three months. Your surgeon will give you advice about how soon you can return to work.

Go to your GP if you have:

• new or severe heart palpitations
• shortness of breath
• sweating - more than normal
• a high temperature
• eyesight problems
• dizziness
• swelling or a discharge oozing from your wound

What are the risks?

Heart valve surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly mild and temporary effects of a successful treatment - for example, feeling sick as a result of the general anaesthetic.

After heart valve surgery, it's normal to feel some discomfort. You may have some fluid, which may be blood-strained, coming from the cut in your chest. A dressing may be placed over this area.

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

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).

Specific complications of heart valve surgery are rare but can include:

• a heart attack
• a stroke
• there is a risk of death but this is rare - however, it's important to consider that having no treatment or having an alternative treatment may have a higher risk
• a blood clot may form which could block a replacement valve - you may need to take blood thinning medicines (anticoagulants), such as warfarin, for the rest of your life to prevent this
• heart block - when the valve is replaced, the conducting system of the heart may become damaged and you may need a pacemaker fitted

If you have keyhole surgery, there's a chance your surgeon may need to convert your keyhole procedure to open surgery. This means making a bigger cut in your chest. This is only done if it's not possible to complete the operation safely using the keyhole technique.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.