What to Expect After
Heart Valve Replacement
After surgery, you will be placed in the intensive care unit (ICU) where you can
be continuously monitored. Breathing during surgery, and for a while
afterwards, is assisted through a tube that has been placed down your throat
and positioned in your lungs. You will probably wake up with this tube still in
position. It is removed as soon as you are stable and awake enough to breathe
on your own. You will not be able to talk while this tube is in place. Other
tubes will protrude from your chest near the heart to drain extra blood and
fluid from the surgical area. Intravenous lines give fluid, blood, and
medications as needed. A bladder catheter drains urine. A monitor shows the
heart rate, heart rhythm, blood pressure, and other special pressures and waves
that the nursing staff watches closely to assess how the recovery is going.
Medications are given as needed to ease pain and anxiety.
Every patient recovers at a different rate. Tubes are removed as recovery
progresses. The ICU stay is usually a day or two. Then you will be moved to a
cardiac medical-surgical floor where your heart is still continually monitored,
but you can be more independent and active. The health care team continues to
support and instruct you in recovery care, rehabilitation, medications,
nutrition, and other needs.
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Returning Home
Just as the recovery from surgery in the hospital differs for each patient, so
will your recovery at home. Upon discharge, you will not feel fully recovered.
It will take, on average, six to eight weeks at home before you can return to
your normal routine. You will gain more energy and strength each day during
these weeks. Some days will be better than others. This is normal. Be sure to
rest when you get tired.
During those first weeks, you will visit your surgeon or physician to monitor
your recovery. You may undergo tests to assess how your new valve is working
(electrocardiogram, echocardiogram, or chest x-ray). Blood work may also be
performed to assess your medication levels.
Incision Care
It is normal to have some discomfort, bruising, numbness, and itching at your
incision site for several weeks after the surgery. Follow the instructions from
your physician for proper incision care. A shower or gentle washing of the
incision is usually all that's recommended. Tub baths are typically not allowed
because they can affect your circulation. To help prevent infections, avoid
using creams or lotions around your incision, until your physician allows it.
Exercise Program
A progressive increase in activity over time will improve your strength and
endurance. The goal is a well-conditioned heart muscle that pumps more
effectively. Walking is one of the simplest and most effective forms of
exercise you can do. More aerobic exercise, such as a brisk walk, swimming, or
bicycle riding, will provide cardiovascular conditioning. Talk with your
physician and follow his or her advice about the best exercise program for you.
Some activities, especially lifting, will be limited in the beginning to allow
adequate healing of your breastbone. As healing continues, your physician will
no longer find these restrictions necessary.
Fluid Retention
After surgery, some people experience fluid retention that can overload the
heart and make it work inefficiently. To prevent fluid retention, your
physician may recommend dietary changes and/or medications.
You can help monitor this at home by weighing yourself every morning. Report any
sudden weight gain of three pounds or more in one day, or five pounds in one
week. Also, contact your physician if you experience unusual shortness of
breath or observe swollen hands, ankles, or stomach.
Infection
Bacteria can enter the bloodstream during dental and some surgical procedures
causing an infection, known as bacterial endocarditis, in the tissue
surrounding the artificial heart valve. Although this occurs infrequently,
antibiotics taken before and after medical procedures are the best defense.
Consult your physician before you have any dental or surgical procedures done
so that antibiotics can be prescribed. Be sure to tell your dentist and any
other physicians that you had heart valve surgery.
Anticoagulants
If you received a mechanical heart valve, your physician may prescribe an
anticoagulant medication (blood thinner) to prevent blood clots from forming on
or around your new valve. The level of anticoagulation will be closely
monitored by blood tests. Your physician will determine the level of
anticoagulant that is right for you based on the guidelines and your medical
situation.
To maintain proper levels, take your medication as prescribed and follow-up with
blood tests as scheduled.
Other medications can affect your anticoagulation level, including
over-the-counter products. Tell your physician about any medications that you
take daily or use as needed for pain or other discomforts. Aspirin and
aspirin-containing products should be avoided because they greatly impact the
anticoagulation levels. Follow your physician's advice about taking other
medications with anticoagulant therapy.
Food and alcohol may also affect your anticoagulation level. Consult with your
physician about your dietary habits. He or she will let you know what specific
dietary guidelines to follow.
Before any medical procedure you are scheduled to have, notify your dentist and
any other physicians that you are on an anticoagulant. Adjustments in your
medication may be needed prior to any procedure.
When taking anticoagulant medication, consult your physician if any of the
following occur:
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Excessive bruising
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Excessive bleeding
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Blood in your urine
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Bloody or black, tarry stools
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Unusual nosebleeds
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Bleeding gums
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Pregnancy or planned pregnancy
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Fever or other illness, including vomiting, diarrhea, or infection
Emergency Identification
In an emergency situation, an identification bracelet, necklace, or wallet card
can alert hospital personnel to your specific medical needs. If you are
interested in registering for such a service, your physician will give you
information on the agencies and services available. Or, you can purchase a
medical identification bracelet or necklace from a jeweler or pharmacy. One of
the best-known bracelets comes from Medic Alert. In the United States, you can
reach Medic Alert at 800.432.5378.
Follow-Up
Long-term management of your health requires your active participation. Your
physician will follow your progress, but only if you visit him or her as
recommended and scheduled so that you receive the proper follow-up care.
Consult your physician about any concerns or questions you have. Work as a team
toward a healthy recovery.
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