Experiencing valve replacement surgery
Before you have surgery to replace a heart valve due to a condition such as mitral valve stenosis or mitral valve regurgitation, you will need to prepare for your hospital stay.
Hospital preadmission
You will have to visit the hospital or your doctor's office several days in advance of your surgery for a hospital preadmission session. During this session, your medical team will educate you about your upcoming surgery. They will also teach you how to prepare for your operation, explain what the procedure will be like, and give you instructions for a successful recovery. Some institutions even show a patient-education video about undergoing valve replacement surgery.
You should use this time to ask questions. It is natural for you to be anxious before your operation, so be sure to address issues that may be causing you particular anxiety.
Informed consent
One of the issues that your doctor or nurse will discuss with you during the preadmission session is informed consent. Your doctor or nurse will describe the risks associated with a valve replacement surgery. These include:
- Stroke.
- Bleeding.
- Infection.
- Heart attack.
- Kidney failure.
- Death.
You will then be asked to sign a consent form (waiver) that you should read carefully. Generally speaking, the consent form confirms that you understand the risks associated with the procedure and relieves the hospital or test center from any liability for complications that are not related to negligence. You should feel free to ask questions about the form if there is anything that you do not understand.
Preparatory procedures
During your preadmission session, you will undergo a range of preparatory procedures. Your hospital staff will give you a few preliminary tests, such as an EKG and a blood test, to make sure that your bodily functions are normal. You will also be asked to bathe or shower with an antiseptic soap, while a technician will shave any hair from your chest and abdomen, so that your body can be as clean as possible during surgery.
Anesthesia
One of the most important discussions you have prior to surgery will be with your anesthesiologist, who will administer anesthesia during your operation. Because general anesthesia carries significant risks, you will need to describe your past medical history, including other operations you have had and any allergies to food or medications. Mention any history, either personal or within your family, of adverse reactions to anesthesia. Bring a list of medications you are currently taking.
Before surgery
Because valve replacement surgery is a serious surgical procedure, you should begin preparing for it several days ahead of time. Try to get into good condition by eating healthfully, getting plenty of rest, and limiting vigorous physical activity.
Beginning at midnight the night before your operation, do not eat or drink anything (including water). Your doctor may also instruct you to take a laxative to clean out your system. If you need to take medications, have them with just a small amount of water.
During the operation
Before surgery begins, you will be put under general anesthesia, which will be administered both through an IV line and through a mask placed over your mouth and nose. When you are given general anesthesia, you will be unconscious during the entire operation and will not feel anything.
While you are unconscious, your surgeon will make an incision along the length of the breastbone and expose your heart. It will be hooked up to a heart-lung machine. After blood flow is directed to this machine, the surgeon will remove your damaged mitral valve and replace it with an artificial valve. Most surgeries will take an average of 3 to 5 hours.
Immediately after the operation
When you first wake up after your operation, you will be in an intensive care unit (ICU) so that your doctor can monitor your heart function to make sure that there are no complications. You will also find many wires and tubes inserted into different body parts. Most of these wires and tubes were inserted while you were in surgery, but were kept to help your body perform vital functions and to provide you intravenously with medication (primarily painkillers) and nutrients. See the chart at the end of this section for detailed information on these wires and tubes.
At first, you will feel drowsy and disoriented while the anesthesia wears off. You may also experience some pain, though you will be given painkillers. For the first few hours after surgery, you will be kept on a respirator or ventilating machine to help you breathe.
The average length of stay in the ICU is 1 day, but your doctor may keep you there longer if any complications develop.
Wires and tubes after heart valve surgery Wire or tube
Where it attaches to body
What it does
Heart monitor (EKG) wires Chest, arm, and legs Small, round sticky pads connected to an EKG machine to monitor the electrical activity of your heart Chest drainage tubes (usually 2) Just below your surgical incision Remove extra fluid, blood, and air that may collect in your chest Arterial line tube In an artery Used to continuously monitor your blood pressure and to obtain blood samples. This tube can leave long-lasting bruising at the insertion site. IV lines Generally in arms and neck Provide nutrients and medications intravenously (through your vein into your bloodstream) Bladder catheter In urethra Drains urine Temporary pacemaker wires In chest Used in case you need to be hooked up to a pacemaker Stomach drainage tube Through mouth or nose Drains waste that may be in your stomach. May be used to give medications directly into the stomach Breathing tube In mouth Helps you breathe and is left in until your doctor is sure that you can breathe on your own. You will not be able to speak while this tube is in your mouth. After this tube is removed, you will receive oxygen through a mask or nasal prongs for a few days. Recovery after you leave the ICU
When your condition stabilizes and you have been moved to a regular hospital room, you will continue to rest and recuperate while your doctor monitors your recovery. Your care will also include physical and respiratory therapy, emphasizing breathing exercises and simple exercise such as walking. You will also receive counseling about a heart-healthy diet and exercises that you should maintain after leaving the hospital.
The average length of stay in the hospital after valve replacement is 7 to 12 days, though different hospitals have different policies in this regard. Basically, before you are discharged and sent home, your doctor needs to make sure that you are mending well and that there are no complications.
| Author: | Kathe Gallagher, MSW Cynthia Tank | Last Updated: April 3, 2006 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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