Valve Repair or Replacement
Treating Cardiovascular Diseases in Wisconsin and Northern Illinois
Valve repair and valve replacement are types of open-heart surgery that are performed to correct problems with any of the heart’s four valves. These valves are known as the aortic, mitral, tricuspid and pulmonic.
With each squeeze of the heart muscle, your valves open to allow blood to flow through your heart’s chambers and close to prevent blood from flowing backward (known as regurgitation). This allows blood to flow into, through and out of your heart, propelling blood from the upper chambers to the lower chambers and from left to right through the valve system.
There are two common types of valve disease:
- Regurgitation occurs when valves lose their shape and do not close properly, allowing blood to back up in a chamber instead of flowing completely through it.
- Stenosis usually stems from calcium build-up and the aging process, which causes valves to narrow, making it difficult for blood to flow through them freely.
When these problems become severe, you may require surgical valve repair or replacement. The surgeon will take many factors into consideration when deciding whether to repair or replace your valve, including your:
- Past medical history
- Risk of taking blood thinners
- Severity of the problem
- Type of valve problem
Valve repairs are performed to restore the valve shape and help it work more efficiently. In the case of regurgitation, a valve repair can be performed with special stitches or a ring to tighten the valve. This is known as a ring annuloplasty.
Valve replacements can be performed with two types of valves:
- Mechanical valves are metal and require lifelong use of Coumadin, a medication to prevent blood clots
- Tissue valves, also known as bioprosthetic, are made from cow or pig tissue
Valve repair and replacement procedures are performed with an incision through your breastbone. You can expect to remain in the hospital for 4 – 6 days for heart valve surgery recovery.
Preparing for Heart Valve Surgery
In the days or weeks before your heart valve surgery, your doctor is likely to request the following pre-operative tests:
- Cardiac catheterization to check for blockages in the blood vessels of the heart (if not recently done)
- Carotid ultrasound to check the arteries in your neck for blockages, which could potentially interfere with blood flow to the brain and increase your stroke risk
- Chest X-rays to help identify lung/heart abnormalities before your surgery
- Dental examination if you haven’t had one recently
- Echocardiogram (cardiac ultrasound testing) to check your heart muscle strength and the function of your heart valves
- Electrocardiograph testing (EKG) to check your heart rate and rhythm
- Lab testing to check your kidney function, liver function, blood count, urine, thyroid function and blood type (in case a transfusion is needed during your surgery)
On the day before your heart valve surgery:
- You will be asked to wash your chest and legs using a special soap that helps kill bacteria to prevent infection. You may also be instructed to clip your chest and/or leg hair.
- You will be given instructions on which medications to STOP taking and which medications you can take the morning of surgery. Check with your physician about medications for diabetes, blood thinners, medications that make you urinate more frequently and blood pressure medications.
On the morning of your heart valve surgery, you will be asked to:
- Arrive at the hospital as directed, usually about 2 hours before your scheduled surgery
- Bring all your medications with you to ensure that your home medication list is correct
- Have your blood pressure and vital signs checked when you are admitted
- Refrain from eating or drinking after midnight
- Take only those medications your doctor has allowed with only a sip of water
Immediately before your heart valve surgery:
When you are ready for surgery, you will be taken to the pre-op holding area where you will meet the anesthesiologist. As you wait, a nurse will be available to answer any questions.
You will have an IV placed in your arm that will deliver antibiotics. The anesthesiologist will give you medicine to help you relax and make you sleepy.
You may feel cold when you are moved to the operating room and will receive extra blankets to keep warm. You will be transferred to a hard table and, once in position, will receive anesthesia and be prepared for surgery.
During Your Heart Valve Surgery
Once anesthesia is given, you will be completely asleep. Your anesthesiologist will put in a central line, which is a large IV for delivering medications. Another line will be used to monitor your heart function.
To help with breathing during the surgery, you will have a breathing tube that is connected to a ventilator (breathing machine). You will also have a bladder catheter.
In addition to your anesthesiologist and surgeon, you will have surgical assistants, nurses and a physician assistant helping with your procedure. The average surgery takes about 3 – 5 hours, depending on the amount of work that needs to be done.
During your procedure, your surgeon will make an incision down the middle of your breastbone, approximately 7 – 8 inches long. You will be connected to a heart-lung bypass machine, which allows the surgeon to stop your heart from beating and moves the blood away from your heart.
You will have an echocardiogram probe placed in your esophagus to look more closely at the functions of the valves and to help monitor the valve and heart function throughout the operation. Your heart valve will be repaired or replaced by the surgeon and a follow-up echocardiogram will check its function. If valve replacement is indicated, a new valve will be put in place after your old valve is removed.
After surgery is complete, your breastbone will be put back together with metal wires. Your skin will be closed with sutures and, in some cases, staples. Drainage tubes will be put in your chest cavity to drain blood and fluid. Also, temporary pacemaker wires will be placed in case your heart rate becomes too slow or requires assistance with rhythm.
Heart Valve Surgery Risks
Like all surgeries, there are potential heart valve surgery complications. Some risks are higher in older adults and people with other health concerns. Your doctor will explain your risks in greater detail. Potential heart valve surgery risksinclude:
- Breathing/kidney problems
- Heart arrhythmias (irregular heartbeat)
- Infection (resulting from surgical wounds, pneumonia or a bladder catheter causing a urinary infection)
- Stroke (with possible short- or long-term effects, depending on its severity)
Heart Valve Surgery Recovery
After your open-heart surgery, you will be taken from the operating room to the intensive care unit (ICU). You will have a breathing tube in place until you wake up from general anesthesia. After surgery, wires and tubes, including your breathing tube, will be removed as your condition stabilizes.
Once your breathing tube is removed, your heart rhythm and blood pressure stablize, and special intravenous medications are no longer needed, you will be moved out of the ICU. Chest drainage tubes and temporary pacing wires are removed in the days after surgery, once it is deemed safe.
You will work with cardiac rehab and possibly physical and occupational therapy to increase your strength and mobility. This activity also helps to prevent complications like pneumonia and blood clot. You will be transitioned from intravenous pain medication to pain pills. These will be decreased as your pain improves.
You can expect to remain in the hospital 4 – 6 days following surgery. Blood pressure, oxygen levels, temperature and heart rhythm will be monitored. You will be deemed ready to leave the hospital once you have a stable blood pressure, heart rate and rhythm, are able to ambulate safely, have adequate pain control and are weaned from oxygen. Medication adjustments will be made while in the hospital.
Depending on the type of valve repair or replacement, you may require short- or long-term anticoagulation with Coumadin. This will be started after surgery and you will receive instructions prior to discharge.
Other prescriptions, including pain medication, will also be given at discharge.
Nationally Recognized for Heart Valve Surgeries
Aurora Health Care has extensive experience performing all types of open-heart surgeries. Our teams include a surgeon, anesthesiologist, operating room nurses, surgical techs, physician assistants, nurse practitioners and nurses, who are specially trained and experienced in valve repair and valve replacement surgeries. As experts in all types of valve surgeries, they can provide you with the best options for your individual needs.
You will see members of your team at your doctor’s visit before surgery, during your surgery and hospital stay, and afterward at follow-up visits. This teamwork helps make sure you get the care you need before, during and after your surgery.
Many Aurora surgeons are involved in research and clinical trials to stay on the cutting edge of surgical technology and techniques. To take care of your other medical needs, our surgeons work closely with other specialists, including cardiologists and doctors who specialize in diabetes, lung conditions and other disorders.
Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.