|If you have been diagnosed with a valve problem, one of the four valves in your heart doesn't work properly and you may need treatment to feel better and reduce your risk of stroke, heart failure, and sudden cardiac arrest. The best treatment for you will depend on a number of factors: your age, type of valve disease, severity of the damage, symptoms, structure of your heart, other medical conditions, and your lifestyle. Surgery is the most common method for repairing or replacing a valve.
If you are having severe symptoms, a faulty heart valve may be an immediate threat to your health and possibly even your life. It is important to talk with your doctor to decide if surgery to repair or replace your heart valve is the best option for you or if there are less invasive, catheter-based alternatives.
What to Expect During Heart Valve Surgery
If you have open-heart surgery to repair or replace a valve, you will receive a general anesthetic and your heart surgeon will make an incision the length of your breast bone to expose your heart. You will be connected to a heart-lung bypass machine, which will take providing oxygen to your blood provide circulation during the surgery. The surgeon will intentionally stop your heart, make an incision to expose the valve and either repair it or replace it by cutting out the old valve and sewing in the new one. Once this is complete, your breast bone will be sutured back together using metal twist-ties.
What to Expect After Heart Valve Surgery
Recovery time in the hospital after valve surgery is approximately one week. The first part of that time may be in the intensive care unit (ICU) so members of your healthcare team can closely monitor your heart, blood pressure and oxygen, and heart sounds.
It takes time to heal from open-heart surgery. You will receive therapy to prevent complications such as pneumonia, collapsed lung or infection. A nurse or therapist may lead you in deep breathing exercises and coughing and encourage you to move your legs to reduce the chance of blood clots forming. Your therapy may also include gentle patting on the back to loosen secretions in the lungs.
Physical therapy will also be part of the recovery process. In the hospital, you will be encouraged to walk around as soon as possible, and you will be shown how to move your arms without hurting your breastbone. You will also learn how to do daily activities in ways that will not interfere with the healing process. Full recovery can take two months.
Risks of Heart Valve Surgery
Like any surgery or medical procedure, heart valve surgery has risks. Talk with your doctor to understand your risks, which will vary from one person to the next depending on your personal circumstances and characteristics.
- Mortality: The overall risk of death is about 1 to 2 out of 100 patients, depending on the type of surgery; however, it is important to keep in mind that your risk of death may be greater if you do nothing to treat the heart valve problem.
- Irregular heart beat (arrhythmia): Arrhythmia may need to be treated with blood-thinning medications to reduce the risk of blood clots.
- Infection—If bacteria enter the bloodstream they can infect heart tissue, putting you at greater risk for endocarditis (inflammation of the heart’s inner lining). You can learn more about endocarditis here. If an infection occurs in the area of the surgical chest incision, this is called mediastinitis. In both situations, extended antibiotic administration may be necessary.
- General risks associated with general anesthesia: The initiation of general anesthesia can be of higher risk if there is pre-existing severely diminished heart function. However, various types of specialized monitoring are used to assess a patient's response to anesthesia. In rare situations, an adverse reaction to anesthesia called malignant hyperthermia can occur. This tendency toward this reaction can be passed down through family members.
- General risks associated with surgery: These include infection in the surgical site (mediastinitis), pneumonia from being on a mechanical ventilator and excessive bleeding. In some situations, an inflammatory reaction involving the sac that surrounds the heart (pericardium) can occur after heart surgery (post-pericardiotomy syndrome). This results in fluid building up around the heart within the sac that sac; it may require drainage.
- Repeat surgery: Repeat surgery can be more complicated the more it has to be done. Scar tissue can develop around the heart and behind the breastbone (sternum) that can make it difficult for the surgeon to expose the heart tissue again. Repeat surgery in the same location can be more difficult if the tissue in the area does not hold structures well.
It is not unusual for people to say they feel worse immediately after surgery, but if you follow your doctor’s instructions and take good care of yourself after surgery it can make a big difference in how you feel and how quickly you recover.
Minimally Invasive Surgery
A relatively new development in valve repair and replacement is minimally invasive valve surgery (MIVS). Rather than opening the chest, it is now sometimes possible to perform this surgery from a much smaller incision in the side of the chest.
Explore Your Options
Talk with your doctor about your treatment options and consider getting a second opinion before you have surgery. Click here to learn more about the treatment of valve disease, so you can have an informed conversation with your doctor and ask questions. If you are not sure what to ask, see Questions to Ask Your Doctor About Heart Valve Disease, and take a copy with you to your next appointment.