Background Information:

What are the other Names for the Procedure?

• Heart Valve Prosthesis
• Valve Repair
• Valve Replacement

What is Heart Valve Replacement surgical procedure?

• Heart Valve Replacement is a procedure that surgically replaces one or more damaged or diseased heart valves, with different types of artificial valves
• The 4 types of heart valves, and these are: Aortic valve, mitral valve, tricuspid valve, and pulmonary valve
• Artificial valves are of 2 types: Mechanical valves and biologic valves
• Mechanical valves are made of metal or ceramic
• Biologic valves are made of human or animal tissue

What part of the Body does the Procedure involve?

A Heart Valve Replacement procedure involves any valve that separates the main chambers of the heart.

Why is the Heart Valve Replacement surgical procedure Performed?

A Heart Valve Replacement is performed for the following reasons:

• To prevent complications associated with valvular heart disease
• To prevent congestive heart failure
• To prevent endocarditis (inflammation of the heart layer)

What are some Alternative Choices for the Procedure?

Some of the alternatives to a Heart Valve Replacement procedure include:

• Repair of the affected heart valve is an alternative procedure, which may be performed instead of replacement of the valve
• In valve repair, the leaflets that open and close the valve, is trimmed or shaped so that the normal function is restored
• In ring annuloplasty, the ring-like part around the valve, is repaired by sewing a ring of tissue or plastic

What are the Recent Advances in the Procedure?

A less invasive approach is the recent advancement in the procedure. Minimally invasive valve surgery is done through smaller incisions or with a long narrow tube, called catheter, inserted through the skin. The different techniques used are:

• Laparoscopy
• Percutaneous surgery (through the skin)
• Robot-assisted surgery

What is the Cost of performing the Heart Valve Replacement surgical procedure?

The cost of Heart Valve Replacement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Heart Valve Replacement procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/002954.htm

http://www.medtronic.com/patients/heart-valve-disease/getting-surgery/heart-valve-replacement/surgery/index.htm

Prior to Heart Valve Replacement surgical procedure:

How is the Heart Valve Replacement surgical procedure Performed?

A Heart Valve Replacement procedure is done under general anesthesia, as outlined below:

• The surgeon makes an incision on the chest
• The incision is then deepened and the chest opened
• The outermost layer of the heart, called pericardium, is opened
• In a majority of the procedures, the heart is stopped temporarily and the patient is placed on a heart/lung machine, or a bypass pump. This will take over the function of breathing and blood circulation
• Some procedures are performed on a ‘beating’ heart
• The heart is opened and the affected valve removed and replaced with an artificial valve
• The artificial valve is then sewn in place
• The heart that was stopped temporarily, is then restarted to work
• Finally, the chest is closed in layers

Where is the Procedure Performed?

A Heart Valve Replacement procedure is performed at a hospital.

Who Performs the Procedure?

A cardiovascular surgeon performs the Heart Valve Replacement surgical procedure.

How long will the Procedure take?

The procedure to replace the heart valve, may take anywhere between 4 to 8 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Heart Valve Replacement procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Heart Valve Replacement surgical procedure?

Prior to a Heart Valve Replacement procedure, the individual may have to undergo certain tests, such as:

• Routine blood and urine analysis
• Chest x-ray
• Electrocardiography (ECG)
• Echocardiography
• Cardiac catheterization or angiogram

The physician may suggest further tests depending on the health of the individual and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Heart Valve Replacement procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Heart Valve Replacement surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered for a Heart Valve Replacement procedure.

How much Blood will you lose, during the Procedure?

A Heart Valve Replacement is a highly invasive procedure. The blood loss could sometimes be substantial; hence, blood products should be readily available for the procedure.

What are the possible Risks and Complications during the Heart Valve Replacement surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Formation of blood clots
• Infection in the surgical wound
• Infection of the heart valve
• Kidney damage; kidney failure
• Anesthetic complications
• In rare cases, failure of the heart to pump normally (primary graft dysfunction)

What Post-Operative Care is needed at the Healthcare Facility after the Heart Valve Replacement surgical procedure?

• After the surgical procedure, the patient shall be sent to a cardiovascular intensive care unit.
• The patient’s blood pressure, heart rate, and respiration cycle, will be closely monitored
• Any additional pain associated with the procedure, will also be treated
• Patients are usually discharged from the hospital, 5-7 days after the surgery is performed

After the Heart Valve Replacement surgical procedure:

What are the possible Risks and Complications after the Heart Valve Replacement surgical procedure?

Post Heart Valve Replacement procedure, the following complications may arise:

• Excessive bleeding
• Formation of blood clots
• Obstruction within the heart valve
• Myocardial infarction (heart attack)
• Cerebrovascular accident (CVA), also known as a stroke
• In rare cases, failure of the heart to pump normally (primary graft dysfunction)

What is the Prognosis after the Surgery?

• A Heart Valve Replacement procedure usually has a good prognosis
• After surgery, the patient’s symptoms are improved, and so as the quality of life
• An artificial valve usually lasts an average of 1-2 decades, depending on the type of the valve
• Blood clots may form on the valve; hence, the patients are instructed to take blood-thinners, especially if they have mechanical artificial valves

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Bleeding or fluid drainage around the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, and constipation
• Reduced urination; urine containing blood
• Abnormal or unexpected pain within the chest
• Abnormal swelling
• Asymmetrical heartbeat
• Partial paralysis on one side of the body
• Speech difficulties
• Sudden development of nosebleeds
• Exhaustion, dizziness
• Signs of an infection
• Headache, muscle aches
• Feeling sick; fever
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Heart Valve Replacement surgical procedure?

At home, the following post-operative care is recommended, after a Heart Valve Replacement procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Avoid taking baths until the surgical wound is completely healed. Resume showering and keep the wound clean and dry, after advise from physician
• Gently wash the surgical wound with soap and water
• Take stool softeners to prevent constipation
• Take antibiotic medication to help combat or prevent infection, as prescribed by the physician
• Take anticoagulant medications to prevent the possibility of blood clots, as prescribed by the physician
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, per advice from the physician
• Elevate legs while resting to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication under advice of the physician
• Avoid sex till complete healing has taken place, or follow physician’s advise

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 4 to 6 weeks to recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Heart Valve Replacement surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• An anesthesiologist (if anesthesia was administered)
• Cardiovascular surgeon
• Pathologist

Individuals are advised to inquire and confirm the type of billing, before the Heart Valve Replacement procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA