Heart Valve Repair

Heart valve Repair surgery is used to repair or replace diseased heart valves. Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve. These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

About the procedure

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain. In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

Minimally invasive valve surgery is done through much smaller cuts than open surgery. There are several different techniques used:

Laparoscopy or endoscopy
Percutaneous surgery (through the skin)
Robot-assisted surgery

If your surgeon can cover your aortic valve, you may have:

Ring annuloplasty — The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
Valve repair — The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one into place. There are two main types of new valves:

Mechanical — made of man-made materials, such as cloth, metal (stainless steel or titanium), or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
Biological — made of human or animal tissue. These valves last 12 – 15 years, but you may not need to take blood thinners for life.

Why is it performed?

You may need heart valve surgery for these reasons:

Changes in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason.
Your heart valve has been damaged by infection of the heart valve (endocarditis).
You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.
Some of the heart valve problems treated with surgery are:

Before the procedure

Always tell your doctor or nurse:

If you are or could be pregnant
What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

You may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood. For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.

Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.

During the days before your surgery:

Ask your doctor which drugs you should still take on the day of your surgery.
If you smoke, you must stop. Ask your doctor for help.
Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.

After the procedure

After your operation, you will spend 3 to 7 days in the hospital. You will spend the first few hours in an intensive care unit (ICU). Nurses will monitor your condition constantly. Usually within 24 hours, you will be moved to a regular room or a transitional care unit in the hospital. You will slowly resume some activity. You may begin a program to make your heart and body stronger. You may have 2 to 3 tubes in your chest to drain fluid from around your heart. These are usually removed 1 to 3 days after surgery.

You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines for fluids. Nurses will closely watch monitors that display information about your vital signs (pulse, temperature, and breathing). You will have daily blood tests and EKGs to test your heart function until you are well enough to go home. A temporary pacemaker may be placed in your heart if your heart rhythm becomes too slow after surgery. Once you are home, recovery takes time. Take it easy, and be patient with yourself.

Risks

The risks for any anesthesia include:

Problems breathing
Reactions to medications

The risks for any surgery include:

Bleeding
Blood clots in the legs that may travel to the lungs
Infection, including in the lungs, kidneys, bladder, chest, or heart valves

The risks for cardiac surgery include:

Death
Heart attack
Irregular heartbeat (arrhythmia)
Kidney failure
Post-pericardiotomy syndrome — low-grade fever and chest pain that can last for up to 6 months
Stroke
Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.

Outlook (Prognosis)

The success rate of heart valve repair surgery is high. The operation can relieve your symptoms and prolong your life. Mechanical heart valves do not often fail. Artificial valves last an average of 8 – 20 years, depending on the type of valve. However, blood clots can develop on these valves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare. The clicking of mechanical heart valves may be heard in the chest. This is normal.

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