Heart Valve Surgery: Repair and Replacement

Your heart contains 4 chambers, two “atria” at the top half and two “ventricles” at the bottom. Between each atrium (singular for atria), ventricle, and the vessels that lead to or leave them, there are valves that open and close with every beat of your heart. If one of these valves fails to function properly, you might need to repair or replace it. These problems mostly occur for the valves of the left side of your heart such as the mitral and aortic valves. A cardiologist takes the condition of your general health, the level of valve dysfunction, and other clinical symptoms into consideration before prescribing a heart valve surgery for you.

During this surgery the valve is either repaired or completely replaced. Whether it will be repaired or replaced depends on the type and severity of the dysfunction. A balloon valvuloplasty is a procedure that uses a balloon to relieve tightness in the valve. It is the best repair method for patients whose valve has become tight. Other repair and replacement procedures are more invasive and are usually open-heart surgeries.

In a valve replacement surgery, we can use two types of valves. One is mechanical, it lasts longer but increases the risk of blood clot formation. This means that the patient has to take blood thinners for the rest of their life. The other, called a “biological valve”, comes from a human donor or an animal. It doesn’t last as long as its mechanical counterpart but it comes with a lower risk for blood clots. Your physician will decide which is the best option based on your age and medical condition.

Treatment duration

A heart valve surgery typically takes 2-4 hours. Of course that time may vary depending on the type of surgery.

Paraclinical testing

Prior to the procedure you will have to get a full physical examination. Afterwards, you’ll need a complete assessment of your heart’s condition which includes: an EKG, a chest image, echocardiography and a blood test.

Preoperative care, the procedure, and postoperative care

Before the surgery

Tell your physician about your medical history and inform them of any allergies you have, specially allergies to certain drugs. Provide a list of all the medication, supplements, vitamins, and herbal medicines that you might be taking. Consult your physician about taking blood thinners like aspirin before the procedure. Stop smoking from two weeks before the surgery. Don’t eat anything from the midnight before the surgery.

The heart valve surgery

A heart valve replacement surgery is performed under general anesthesia. The surgeon will make an incision on your chest and separate the breastbone and any vessels that are in the way to gain access to your heart. A heart-lung machine will be attached to your heart, this machine provides oxygen and pumps blood throughout your body during the surgery.

The medical team will use cold and chemicals to stop your heart from beating. Now that your heart is motionless, the surgeon will make a small incision on the heart to access the required valve. This allows the surgeon to replace your old valve with the new one. Finally, the pump is detached and your heart can start pumping again.

After the procedure

Your cardiologist will prescribe several new drugs for you after the surgery, the most important of which are blood thinners. If a mechanical valve was placed, you’ll be taking them forever but if a biological valve was placed you’ll be taking them for at least 3 months. Patients who had a replacement surgery will have to take blood tests regularly to check for clotting factors.

Remember, you must always take the prescribed antibiotics before invasive medical procedures or visits to the dentist after a valve replacement. Antibiotics prevent infection of the implanted valve. Your breastbone will heal 6-8 weeks later but it will take at least 1-4 months before you can return to your normal daily life. Meanwhile you will be undergoing a heart rehabilitation process.

Important notes regarding heart valve surgery

Keep in mind that you won’t feel well in the first few weeks after the surgery. Feelings of fatigue might make you upset but these will go away and you will feel better.

Who would benefit from a heart valve surgery?

Patients that suffer from valve tightness or failure may need to undergo this surgery. Clinical symptoms such as shortness of breath and chest pain and paraclinical testing are the deciding factors for the necessity of this procedure. Sometimes the symptoms don’t appear until it’s too late and the procedure becomes an emergency.

Duration of hospitalization

After regaining consciousness you will be moved to the CCU. You will stay there for 1-3 days. If your condition is stable you will be moved to the ward. You will remain hospitalized for 1 week.