What is heart valve surgery?

Heart valve surgery repairs or replaces a damaged heart valve. There are four valves in your heart. They are the mitral, aortic, tricuspid, and pulmonary valves. These valves open and close to keep blood flowing in the proper direction through your heart. When you have a problem with a heart valve, blood does not flow through the heart the right way.

During the surgery, the doctor may repair your heart valve or replace it. The replacement valve may be made of plastic, metal, or animal tissue. Whether your heart valve is repaired or replaced depends on the type of heart valve problem you have.

You will be asleep during the surgery. In an open-chest surgery, your doctor will make a cut in the skin over your breastbone (sternum). The cut is called an incision. Then the doctor will cut through your sternum to reach your heart. In a less invasive surgery, your doctor will make a cut between your ribs. Your sternum is not cut.

The doctor will connect you to a heart-lung bypass machine. This machine adds oxygen to the blood and moves the blood through the body. It lets the doctor stop your heartbeat while working on your heart. While your heartbeat is stopped, the doctor will repair or replace your heart valve. The replacement valve may be made of plastic, metal, or animal tissue. You and your doctor can decide before surgery which type of valve is best for you.

After your heart valve has been repaired or replaced, the doctor will restart your heartbeat. Then the doctor may use wire to put your sternum back together. Stitches or staples will be used to close the incision. The wire will stay in your chest. The incision will leave a scar that will fade with time.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back while you heal. If your breastbone (sternum) was cut, healing usually takes about 4 to 6 weeks.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
• For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
• For at least 6 weeks, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• For at least 6 weeks, avoid pushing yourself up out of a bed or chair using your arms. Do not use your arms to pull yourself into or out of a vehicle.
• Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You may need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. A dietitian can help you plan meals and learn about healthy foods.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. Your doctor will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor may give you a blood thinner to prevent blood clots. If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• You can take showers with your back to the showerhead. Allow the warm and soapy water to run across your shoulders and down over the incision. Pat the incision dry with a clean towel.
• Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
• Do not swim or use a hot tub for at least 1 month, or until your doctor says it is okay.
• Do not use any creams, lotions, powders, ointments, or oils unless your doctor tells you it is okay.

Other instructions

• Keep track of your weight. Weigh yourself every day at the same time of day, on the same scale, in the same amount of clothing. A sudden increase in weight can be a sign of a problem with your heart. Tell your doctor if you suddenly gain weight, such as 3 pounds or more in 2 to 3 days.
• Be sure to tell all your doctors and your dentist that you have had a valve repaired or replaced. This is important because you may need to take antibiotics before certain procedures to prevent infection.