Valve Replacement Surgery

About the Procedure

Valve Replacement Surgery is a procedure performed to replace a poorly functioning heart valve with either a real tissue valve or a mechanical device to improve blood flow through the heart. A failed valve may be a congenital malformation, the result of disease such as rheumatic fever, a restriction resulting from stenosis, a weak and leaky valve, or due to an unknown cause. Replacement valves can be taken from a human cadaver or an animal, or it can be manufactured. In the Ross Procedure, a person's own pulmonary valve may be removed and used to replace their aortic or mitral valve, and then a cadaver or mechanical valve replaces the patient's own pulmonary valve. The success of valve replacement surgery is excellent. With the exception of very young patients, a second replacement is rarely needed. The procedure is performed through open heart surgery, minimally-invasive laparoscopic procedures, or the relatively new technique known as robot-assisted laparoscopic surgery. The less invasive options offer smaller incisions, shorter hospital stays, and quicker recovery time.

A cardiac surgeon performs a valve replacement in a hospital where the patient is given general anesthesia and is connected to a respirator and a stomach tube. An incision is made in the sternum (breastbone) and the heart is accessed. With the assistance of a perfusion technologist, the patient is put on a cardiopulmonary bypass machine - a heart-lung machine - and the heart is stopped and cooled. The doctor replaces the valve and then restarts the heart. When the cardiopulmonary bypass machine is disconnected, the doctor may perform tests to confirm the valve is working well. Tubes are inserted into the area around the heart to drain fluid and blood from the body and the chest is closed. Surgery can take two to four hours or longer, depending on the number of valves which need replacement. Minimally-invasive techniques do not require a heart-lung machine but the heart is cooled to slow it down, making it easier for the doctor. The incisions are much smaller than in an open chest procedure.

What to Know Before the Procedure

The risks in valve replacement procedures involve anesthesia, general surgery, and cardiac-specific surgery complications. Bleeding, infection, embolisms, stroke, heart attack, and damage to nearby organs and vessels are possible. The age and health of the patient is a significant factor in the risks and the success of surgery.

An EKG, blood and urine tests, a chest x-ray and a complete review of the patient's medications are usually done during the week prior to surgery. The surgeon will discuss the necessity (or not) of discontinuing any medications prior to the operation and provide instructions on food and water intake before surgery. Plan ahead to have a driver available at discharge and for assistance for a few days afterwards.

What to Know After the Procedure

Post-operative recovery time is 12 to 36 hours in the Intensive Care Unit where the tubes are removed when no longer needed. For some patients, particularly those who've had a minimally-invasive procedure, discharge can be directly from ICU. Other patients may remain in the hospital for a total of one week. Because valve replacements are not always successful and the heart does not always respond well to surgical procedures, complications can occur during the first few weeks, so patients need to increase their activities at a slow pace and to report any irregularities to the physician. Heavy lifting must be avoided for six to eight months to allow healing of the breastbone. It is not uncommon for a complete recovery from the procedure to take as long as a year. It's possible to return to work in four to six weeks if the job is sedentary, but patients whose jobs are strenuous should consult with the doctor before returning to work. A program of cardiac rehabilitation to strengthen the heart is a common follow-up to cardiac surgery.

If you Need to Travel Outside of your Local Hospital

A valve replacement, whether an open chest or a less invasive procedure, does not appear to present unreasonable risk in an otherwise healthy patient. The skill of the surgeon is a significant concern when cardiac surgery is needed and, if traveling to employ that person is necessary, then it may be a worthwhile pursuit. However, considering the requirements for post-op rest and a slow return to normal activities, allowing extra time before scheduling a return trip would be advisable. Like with all surgeries on vital organs such as the heart, the skill and reputation of the surgeon should be the primary concerns in where to have this procedure done.