What to Expect During Heart Valve Procedures
If you will be having surgery to repair or replace your heart valve, a nurse, patient advocate or your doctor will discuss the procedure with you. The length of the procedure varies for each patient. Be sure to ask questions if you do not understand or want to know more.
Repairing a heart valve
In some cases, your doctor may find that repairing your heart valve is the best way to treat your heart valve disease. Repair procedures involving mitral and tricuspid valves are more common than are procedures involving aortic or pulmonary valves. A cardiac surgeon may use one of several techniques to repair your malfunctioning heart valve.
Common heart valve repair techniques include:
- Valvuloplasty: A technique aimed at ensuring the leaflets of the heart valve close properly, preventing blood from backing up into the atrium.
- Commissurotomy: A type of valvuloplasty used when leaflets of the valve become stiff and actually fuse together at the base, or ring portion (annulus) of the valve.
- Annuloplasty: A technique aimed at repairing fibrous tissue at the base of a heart valve, or annulus. Sometimes the annulus becomes enlarged or dilated, allowing blood to back up into the left atrium. Sutures are placed around the ring to make the opening smaller, creating a purse-string effect around the base of the valve. The repair usually requires the implantation of a ring to support the annulus.
Procedure risks for heart valve repair
As with any surgery, there are also risks involved with heart valve repair surgery. Though rare, some of the potential complications include:
- Abnormal heart rhythms
- Narrowing of the valve opening
- Heart attack
In some cases, your replacement heart valve may not function as needed. This is not typical, but you may need another surgery to treat it.
Ask your doctor for more information about heart valve repair procedure benefits and risks.
Replacing a heart valve
If your heart valve cannot be repaired, your doctor may recommend that your heart valve be replaced. With heart valve replacement, your surgeon will remove your heart valve and implant an artificial (prosthetic) valve in its place.
Implanting a heart valve typically involves these steps:
- You will receive a general anesthetic that will put you to sleep so you do not feel any pain during the surgery.
- Your surgeon will make an incision in your chest to access your heart. Your medical team will stop your heart temporarily and place you on a heart-lung machine so your surgeon can implant the prosthetic valve.
- Your surgeon will then remove your diseased valve and determine the correct size of your replacement valve.
- Next, your surgeon will position the new valve in the original valve location and firmly sew it into place.
- Then, your surgeon will close the incision, restart your heart and close all the other incisions. Your medical team will then remove the heart-lung machine and your natural heart rhythm will return.
Procedure risks for heart valve replacement
As with any surgical procedure, heart valve replacement comes with some risks. The risks may include, but are not limited to:
- Blood cell damage (hemolysis)
- Low red blood cell count (hemolytic anemia)
- Clotting in or on the valve (thrombus formation)
- Tissue on the valve (valvular pannus)
- Loose clots in the blood stream that may block an artery in your arms, legs or brain (thromboembolism)
- Valve failure (which may include structural damage)
- Leakage around the edge of the valve (paravalvular leak)
- Need for reoperation
- Heart failure
Generally, risks depend on your age, general health, specific medical conditions and heart function. Talk to your doctor or surgeon to better understand the potential benefits and risks of your situation.
Immediately after your procedure
After your heart valve repair or replacement surgery, you will be placed in the intensive care unit (ICU) where you can be monitored. The typical length of stay in the ICU is one or two days.
During your time in the ICU:
- You may have a tube in your throat that was positioned in your lungs to help you breathe during surgery. It will be 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.
- You will have tubes from your chest near the heart to drain extra blood and fluid from the surgical area.
- Intravenous lines will give you fluid, blood and medications as needed.
- You will have a bladder catheter to drain urine.
- You will be hooked up to a monitor that shows your heart rate, heart rhythm, blood pressure and other measurements that the nursing staff will use to assess your recovery status.
- You will receive medications to ease your pain and anxiety as needed.
The nursing staff will monitor your recovery and remove the tubes as appropriate. From the ICU your health care team will move you to a cardiac medical-surgical floor where the medical staff will continue to monitor your heart; however, you may be more independent and active here. Your health care team will monitor your progress and give you instructions to follow in the hospital and at home to help with your recovery.