HEART-VALVE REPLACEMENT

General Information

DEFINITION--Replacement of one or more diseased heart valves with porcine (derived from swine) or mechanical valves.

BODY PARTS INVOLVED--Valves that separate major sections of the heart.

REASONS FOR SURGERY--Prevention of complications resulting from valvular heart disease, especially congestive heart failure and bacterial endocarditis.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity.
• Smoking.
• Poor nutrition.
• Recent illness such as acute upper respiratory infection.
• Alcoholism or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--Cardiovascular surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of kidneys and chest; ECG; echocardiogram (See Glossary for both).
• During surgery: ECG monitor.
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the chest, and the breastbone is divided. The chest is opened to expose the heart.
• A heart-lung machine circulates enough blood to sustain life.
• The diseased heart valves are located through delicate incisions made in the heart.
• Diseased valves are removed and replaced with mechanical valves.
• The incisions in the heart are closed with fine sutures, and the chest cavity is reconstructed with wire sutures. The skin is closed with lighter sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Failure of the heart to resume normal heartbeat (rare).
• Complications from blood used in the heart-lung machine, including hepatitis and AIDS (rare).
• Kidney damage or kidney failure.
• Heart attack; congestive heart failure; cardiac arrest; deep-vein blood clots; stroke; or breathing difficulties.

AVERAGE HOSPITAL STAY--20 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 4 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while in bed to decrease the chance of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Stool softeners to prevent constipation. > Antibiotics to fight infection.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Resume driving 5 weeks after returning home. > Resume sexual relations when your doctor determines that healing is complete.

DIET--Clear liquid diet until the gastrointestinal tract begins to function again. Then eat a well--balanced diet to promote healing.

Call Your Doctor If

Any of the following occurs:

• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• Nausea, vomiting or constipation.
• Heartbeat irregularities.
• Decreased urine output.
• Sudden chest pain.