Heart valve replacement operation

What’s involved?

A heart valve replacement operation (aortic valve surgery) involves replacing a damaged valve in your heart with a mechanical valve (made from synthetic materials) or a tissue valve (usually taken from pig, cow, or human donors).

Heart valves open and close to allow blood to flow in and out of the four chambers of the heart in the correct direction. If they are damaged (through infection or disease) they either do not open properly or do not close tightly enough. Both problems mean the heart has to pump harder.

A new valve will relieve this strain and aims to ease symptoms such as breathlessness and chest pain due to angina.

The operation typically requires a hospital stay of six days and is done under general anaesthesia. This means you will be asleep during the procedure.

Your surgeon will explain the benefits and risks of having heart valve surgery, and will also discuss any alternatives to the treatment.

About the operation

Once the anaesthetic has taken effect, your surgeon will make a cut, about 25cm long, down the middle of your breastbone and open the ribcage to reach the heart. The heart is slowed or stopped (using medication) and blood is re-routed to a heart-lung machine. This takes over the pumping action of the heart and lungs, adding oxygen to the blood and maintaining the circulation.

Next, your surgeon will open the heart chamber, remove the faulty valve and sew in a replacement. Blood is then redirected back to your heart and the heart is restarted. The breastbone is re-joined using wires and your chest is closed using either dissolvable sutures, stitches or staples. The operation usually takes about two to three hours.

After your operation, you will be taken from the operating theatre to the ITU where you will be closely monitored for around 24 hours.  Once the medical team is happy with your progress, you will be taken back to your room on the ward. 

A physiotherapist will also visit you daily while your are in hospital and encourage you to do gentle exercises and to take deep breaths and cough up any fluid in your lungs. These exercises will help speed up your recovery and prevent chest infections. After four or five days, you will need to increase your activity and may be shown exercises in the gym. The physiotherapist will also show you exercises to do at home.

After surgery, your chest area may be painful to start with. Mechanical valves are made of a hard material so you may hear a clicking sound as it opens and shuts. You will also have a permanent scar down the length of your breastbone and your breastbone will take about 12 weeks to heal.

For most people, the benefits of having a heart valve replacement are far greater than any disadvantages. However, all surgery carries an element of risk.

The possible complications of any surgery include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot, usually in a vein in one of your legs (deep vein thrombosis, DVT). A blood transfusion may be required to replace the lost blood.

It’s also possible for blood clots to form and block the valve. These clots can break off and block an artery (blood vessel) which can lead to a heart attack or stroke. If you develop a clot you may need further surgery or medication to dissolve the clot (thrombolytic therapy). Clots are more likely if you have a mechanical valve, but anticoagulants can help prevent them.

It’s possible that you may have an irregular heart beat (arrhythmia), which can be treated with drugs and is usually temporary. Your new valve can become infected and inflamed (endocarditis). This can damage your heart. You will be given antibiotics to help lower this risk.

Replacement valves can wear out or become damaged. Although the type of valve you have is unlikely to affect your long-term survival, tissue valves tend to wear out sooner than mechanical valves, making further surgery more likely.

There is a small risk of death during or soon after this operation.

The chance of complications depends on the exact type of procedure you are having and your general health. Ask your surgeon to explain how any risks apply to you.

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