Aortic Valve Replacements: Mechanical vs. Tissue

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Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Echocardiogram—a test that uses sound waves to visualize functioning of the heart, including the valves
• X-ray—a test that uses radiation to take a picture of structures inside the body
• Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
• Cardiac catheterization (possibly)—the insertion of a tube-like instrument into the heart through an artery (usually in the leg) to detect problems with the heart and its blood supply. It can also accurately define the valve problem.
• Have blood ready for surgery

In the days leading up to your procedure:

• Do not take aspirin or other anti-inflammatory drugs for two weeks before surgery, unless told otherwise by your doctor.
• Stop all blood thinners a week before surgery.
• See a dentist and get your teeth checked out.
• Arrange for a ride to and from the hospital.
• Arrange for help at home after returning from the hospital.
• The night before, eat a light meal and do not eat or drink anything after midnight, unless told otherwise by your doctor.

During Procedure

IV fluids, oxygen, anesthesia, and diversion of blood circulation through a heart-lung machine

Anesthesia

General

Description of the Procedure

The surgeon cuts through the skin and breastbone, opens the chest, and connects your heart to a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation.

The surgeon stops the heart, makes an incision, and removes the damaged valve. The new valve is stitched into place and checked to make sure it opens and closes properly. The incision in the heart is closed and the heart restarted. Once the heart is working fine, you will be removed from the heart-lung machine and your chest will be closed with wires. The skin will be closed with absorbable sutures.

After Procedure

You'll be closely monitored in the intensive care unit with the help of the following devices:

• Heart monitor
• Breathing tube until you can breathe independently, then an oxygen mask
• Chest tubes to drain accumulated fluids from the chest
• A line into an artery in your arm to measure pressure
• A tube through your nose and into the stomach (a nasogastric tube) to keep the stomach drained of accumulated fluids and gas
• Bladder catheter

How Long Will It Take?

3-5 hours, depending on how many valves are being replaced

Will It Hurt?

Anesthesia prevents pain during surgery. You may experience some pain during recovery, but will be given pain medication to relieve the discomfort.

Possible Complications

• Infection
• Blood clots around the valve, which can cause a stroke, kidney damage, or damage to the extremities
• New valve does not work properly
• Sac around the heart may become inflamed and painful
• Excessive bleeding
• Pneumonia
• Phlebitis (blood clots of a vein)
• Anesthesia-related problems
• Infection of breast bone
• Death

Average Hospital Stay

2-5 days—The first day is usually spent in an intensive care unit. Over the next few days, all the lines and tubes are removed. As you start to walk and eat a regular diet, you may be sent for rehabilitation therapy

Postoperative Care

• Breathe deeply and cough 10-20 times every hour.
• Two to three days after surgery, you may be able to walk with help.
• You may be started on anticoagulant medications (blood thinners) to prevent blood clots from forming around the valve. If you have a tissue valve, you will not require a blood thinner after surgery. But, if you have a mechanical valve, you will be placed on a blood thinner for the rest of your life.
• Only take medications approved by your doctor.