Heart Valve Surgery
Use the links at left to learn more about surgeries and procedures we perform at the Alliance Heart Institute.
Before Surgery
In all likelihood you will have seen a cardiologist and have been evaluated before meeting with one of our surgeons. A physical examination is performed, with particular interest in listening to the heart for a murmur or irregular heart beat. The lungs are listened to for signs of fluid build-up, and the rest of the body is examined to find clues about your blood circulation and how the rest of your organs are functioning.
Diagnostic tests in addition to the usual chest X-ray and electrocardiogram are needed to confirm and evaluate the heart and its valves. Such tests include:
- Echocardiogram (ECHO): An ultrasound test of the heart which provides pictures of the heart, its valves, and how well things are working. Valve leakage or stenosis can be assessed, and pressures within heart chambers can be assessed.
- Transesophageal echocardiogram (TEE): In certain cases, a TEE is needed. This uses a flexible probe which is passed down into the esophagus (swallowing tube) and allows pictures to be taken from inside the body. The images are of much better quality and more details can be seen.
- Cardiac catheterization: This test involves placing a long, small diameter catheter or tube up one of the blood vessels in the groin and passing it into the heart. The coronary arteries can be examined for blockages. Pressures within the blood vessels and heart chambers can be directly measured.
- CT scan: This is primarily used to evaluate the aorta for aneurysms.
- MRI: This is occasionally used but not always necessary for most patients.
After meeting with one of our surgeons, surgery will be scheduled. You will need to go to the hospital to have bloodwork and a chest X-ray performed and go through the registration process. You will also meet with one of our anesthesiologists to discuss their procedures with you. The night before surgery you will not be allowed any food or liquids after midnight.
On the morning of surgery, preoperative medications including sedatives are given and the chest and leg areas are shaved and washed with antiseptic soap. An intravenous line is begun, and then you will be taken to the operating room. A small catheter is placed in an artery in the wrist to measure blood pressure and oxygen is delivered to your nose. After that, you will be given general anesthesia and go to sleep.
Once asleep, many different lines and tubes are inserted into various parts of the body to measure heart and lung function, kidney function and urinary output, and to place you on the respirator to breathe for you while you are asleep.
After making the necessary incisions, special lines and tubing are inserted into the heart to place you on the heart-lung machine (cardiopulmonary bypass). This machine drains blood out of the body and gives it oxygen and then returns it to the body. This allows us to stop using your own heart and lungs while we work on them. The heart is stopped by placing a clamp on the aorta which stops blood flow down the coronary arteries. A medicine called cardioplegia, which means “heart paralysis” is then given to stop the heart from beating. While the heart is stopped we do the necessary work, and when we are finished, the clamp is taken off the aorta and this allows blood to once again flow down the heart arteries. The heart resumes beating and the heart-lung machine is discontinued. Tubes are placed to drain out any blood that collects, and occasionally temporary wires are placed on the heart to be connected to a temporary pacemaker. The incisions are then closed.
After Surgery
Upon awakening in the intensive care unit, you will notice several lines and tubes in your body. There may be soft restraints on your wrists to keep you from pulling any of these out until you are fully awake. As you awaken and begin to breathe on your own, the breathing tube is discontinued. If all is going well, you may be out of bed into a chair that same day.
In uncomplicated cases, the next morning the heart and blood pressure monitoring lines are removed and you will be transferred out of the intensive care unit to a regular room on the floor. The urinary catheter is also removed. You may walk short distances that day. By the second day you should be walking in the hallway. The chest drainage tubes are removed on either the first or second day.
At the time of discharge, you will be given follow-up instructions and a prescription for any medicines. We usually see patients three weeks after surgery, and by that time they are walking daily, some up to a mile or more a day. Your cardiologist will also see you and arrange for cardiac rehabilitation as needed. Most people are back to near normal in a month and ready to return to work. Obviously, a great deal of recovery time depends on the individual patient and how sick they were before surgery.
Possible Complications
Bleeding
When we place the patient on the heart-lung machine, blood thinners must be given to keep the blood from clotting. At the end of the procedure, medicines are given to reverse this effect. Sometimes bleeding still continues, but it will usually stop. About 1-2% of the time, the patient will need to return to surgery to get it completely stopped.
Infection
Infection occurs in 1-2% of patients; antibiotics are given before and after surgery to help prevent this.
Stroke
Stroke can occur for many, many reasons during and after surgery, including blood clots and calcium particles from diseased valves as well as hardening of the arteries. The risk of stroke is quite variable and depends upon the nature of the patient's heart problem, the condition of the patient themselves (in particular, the patient's age) and the type of procedure being performed.
Heart attack
Heart attack rarely occurs with valve surgery, but may be due to difficulties with the coronary arteries when doing aortic valve surgery or due to tiny pieces of calcium or blood clot traveling down a coronary artery. The risk for such a problem is probably around 1%.
Pacemaker placement
Pacemaker placement is occasionally required after valve surgery. The risk depends on several factors, including the patient's age, any previous heart rhythm problems, and the type of valve surgery being performed. Older patients are more likely to require a pacemaker. The electrical conducting system of the heart runs near the aortic valve, and although it is not something that can be seen, it is occasionally disrupted with an aortic valve replacement and a pacemaker is required. When a pacemaker is required after heart surgery, it is usually done a few days later under local anesthesia.