Damage to one or more heart valves—the small “doors” that control blood flow between the chambers of the heart—can be caused by many diseases and disorders, including congenital heart disease, coronary artery disease, high blood pressure, heart attack, and cardiomyopathy. This damage is called heart valve disease.
If the symptoms of heart valve disease cannot be controlled with medication, surgery may be needed to repair or replace a defective valve in order to prevent damage to the rest of the heart (heart failure). If repair is possible, it is preferred over replacement because a repaired valve is stronger than a replacement valve.
There are two options for valve replacements, mechanical or tissue valves. Mechanical valves are made entirely of mechanical parts that are tolerated well by the body. Tissue valves (also called biologic or bioprosthetic valves) are made of human or animal tissue. Some valves may have some artificial parts to help give the valve support and to aid placement. Prior to the procedure, the surgeon will discuss with the patient the advantages and drawbacks of the different kinds of valves.
A recently developed non-surgical option for replacing the aortic valve in some patients is percutaneous aortic valve replacement.
- Blood tests, an electrocardiogram, and chest X-rays are done before the procedure.
- A consent form must be signed before the operation. Before signing, it is important to ask as many questions as possible.
- Once in the cardiac operating room, anesthesia is administered. This is so you will remain unconscious throughout the operation and not feel any pain.
- Incisions (cuts) are made in the chest and breastbone to allow the surgeons access to the heart.
- The heart’s blood vessels are connected to a heart-lung machine (also called a heart-lung bypass machine). This takes over the heart’s job of pumping blood to the rest of the body during surgery.
- Once the heart-lung machine is pumping blood, the heart is temporarily stopped.
- For valve repair, the surgeon cuts away the defective part of the valve and reshapes the existing tissue. Tissue from other parts of the body may be used to patch the existing valve.
- For valve replacement, the damaged valve is removed. It is then replaced with either a biological valve (from a human or animal donor) or a mechanical valve. The new valve is sewn into place.
- The heart is restarted with a small electrical shock, the heart-lung machine is removed, and all incisions are closed.
- The patient stays in the Cardiac Surgery Intensive Care Unit (CSICU) for 24 hours or until intensive care is no longer required.
- When medically ready (usually within one to two days), the patient is moved to a regular hospital room. The average hospital stay after valve surgery is five to seven days.
Before any scheduled heart valve operation, a full dental exam and cleaning must be completed. In the days before the scheduled surgery date, expect to attend the Pre-Admission Unit. The purpose of this appointment is to meet with the anesthetist, complete some routine pre-operative blood tests and chest X-rays, and to meet with the nurse for a final pre-operative teaching session.
On the day of surgery, bring all medications (including non-prescription drugs and supplements) to the hospital so that the nursing and medical staff can do a final medication check.
Do not eat or drink after midnight the night before surgery.
Patients and their families are asked to attend a class prior to discharge in order to obtain post-operative care instructions. They will also receive the Cardiac Surgery Patient Guide with information about their specific surgery.
A nurse will review with you all medications you will be taking once discharged.
Patients who receive a mechanical valve must take anticoagulant medications to prevent blood clots for the rest of their lives.
Biological heart valves may have to be replaced in 10 to 15 years.
Heart valve replacements may lead to an increased risk of developing an infection of the heart valve and surrounding tissue called endocarditis. Extra precautions such as antibiotics may need to be taken before some surgical and dental procedures.
It is important to carry notification with you at all times indicating that you have had a heart valve replacement procedure.