Heart Valve Surgery

Undergoing Heart Valve Surgery
at Mayo Clinic in Rochester

Before surgery

Mayo Clinic patients who are good candidates for open heart surgery to repair or replace heart valves meet with members of the specialized team that will be assisting in their care. Patients receive specific instructions to help prepare for the surgery. Information about eating, drinking and taking medications before the surgery is explained. Patients are encouraged to ask questions about the surgery and anything relating to their experience at Mayo Clinic.

In addition:

• An echocardiogram (ultrasound of the heart) is done to evaluate the structure and function of the heart. This test is standard for heart valve evaluation.
• A cardiac catheterization may be done to check for coronary artery disease or other cardiovascular disease that could complicate surgery. It is routinely done for patients over 40 years old. Patients with coronary artery disease would undergo coronary artery bypass grafting during the operation on their valve.

The need for other specialized tests such as an EP/electrophysiology study (studies the electrical system of the heart) is determined on an individual basis.

During surgery

The time in the operating room varies with the type of operation and the number of valves involved. Generally, the time a patient is away from his or her family averages four hours, but each person is unique, and it's not unusual for the surgical process to last three to six hours.

A heart-lung machine is used to oxygenate the blood and circulate it throughout the body during the operation so the surgeon can repair or replace the valve.

When the surgical team is satisfied that the valve and heart are functioning properly, the patient is weaned from the heart-lung machine. The incisions are then closed (sutured).

The sternum will heal in 6-8 weeks and will be just as strong once the healing process is complete.

Immediately following surgery

When patients awake from the anesthesia, they are generally groggy and somewhat disoriented. The area of the incisions may be sore. Pain medication is available and patients are encouraged to take it as needed.

Patients are in the cardiac intensive care unit for about one to two days, and the remainder of the time is spent on a regular hospital unit. Typically, once patients are moved to the regular unit, they are able to walk while attached to a small heart monitor.

Patients are in the hospital an average of 7-10 days. Much of that time is spent waiting for the tissue swelling to decrease and to ensure that the valves are functioning properly. In the hospital, tests are conducted to assess and monitor the patient's condition.

After leaving the hospital

In general, recovery is complete about 4-6 weeks after surgery. During that time, patients are usually given aspirin to reduce the risk of blood clot formation.

Full energy levels usually start to return in about three months. Most patients can expect to feel more tired than usual and their stamina may not yet be completely normal. After six months, most patients are back to normal.

The decision as to when to assume a full work schedule varies with the individual. For patients with physically demanding jobs, the recovery may take longer than 3 months.

Many patients have benefited from the structured workout of a cardiac rehabilitation program while recovering from surgery. The program starts with a walking schedule for the first 6 to 8 weeks and progresses to more vigorous, supervised training.

Follow-up care

Generally, patients return to their local doctor a week after being discharged from the hospital and are examined to ensure that they are healing properly. An appointment with the cardiologist takes place within 5 weeks of being discharged to check the functioning of the repaired or replaced valve.

The Mayo Clinic staff works with patients, their local doctor and local cardiologist to assist with a full and smooth recovery following surgery.

Because patients who have a mechanical valve need to take blood-thinning medication for the rest of their lives, they are advised to wear a medical alert bracelet. It is also important for patients who have had heart valve surgery to tell their doctor and dentist. Patients should take an antibiotic before any dental or surgical procedure, because bacteria can enter the bloodstream during these procedures and get into a repaired or artificial valve. This could lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.

Patients who have mechanical valves may notice a soft clicking sound in their chest. The noise is created by the new valve opening and closing, and is a sign that the new valve is working properly.

Complications

Major complications are rare, and with improvement in technology and surgical techniques, occurrences continue to decrease. However, every open-heart surgery entails some risk. Potential complications include infection, bleeding, stroke and heart attack. The death rate varies depending on the heart valve affected and averages 2 to 5 percent.

While most valve repair and replacement surgeries are successful, over time a valve repair may fail and another operation may be required.