Heart Valve Replacement Surgery - Procedure and Recovery

1. The four valves present in a human heart are - Tricuspid, Pulmonary, Mitral, and Aortic valves. 
2. These valves are nothing but strong flaps of tissue that open and close to maintain the blood flow in the right direction. 
3. The Tricuspid valve opens the blood flow from the right atrium to the right ventricle. 
4. The Pulmonary valve takes the blood further from the right ventricle to the pulmonary artery, oxygenating the blood in the lungs. 
5. The Mitral valve regulates the blood flow from the left atrium.
6. The Aortic valve does the final job of regulating the blood flow from the left ventricle to the aorta, which supplies blood to the entire body. 

Doctors advise patients diagnosed with the following conditions to get their heart valves replaced:

1. Stenosis - A condition wherein the spaces within a valve is narrowed 
2. Regurgitation - A leakage in the valve which could lead to blood flowing backwards 

Before Surgery

1. The healthcare provider will briefly explain the surgical procedure step-by-step, along with the duration and estimated costs.
2. A pre-anaesthesia checkup and other diagnostic tests are advised based on the patient’s medical history. 
3. The patient needs to declare any previous medications, vitamins, supplements, or herbs that they are consuming. Allergies to any medicines or anaesthetic agents should also be informed.
4. The patient is advised not to take any blood-thinning medicines, aspirin, or other medicines that may prevent blood clotting before the surgery. 
5. The patient cannot eat or drink for eight hours prior to the procedure.
6. Quitting smoking (if a smoker) increases the chances of a successful recovery from the surgery. 

What to expect on the day of surgery?

1. The patient will be told to remove jewellery, dentures, contact lenses, eyeglasses or any other item that can cause hindrance to the procedure. 
2. They will be required to change into a hospital gown and empty the bladder. 
3. The surgical site will be cleaned and shaved if needed.
4. The anesthesiologist will monitor the vitals and transfer the patient to the OT room. 

What happens during the surgery? 

1. The anesthesiologist induces general anaesthesia to get the patient unconscious. 
2. The healthcare team then places the patient in a supine position (face up) on the operating table.
3. The anesthesiologist starts an intravenous (IV) line in the arm and hands to supply IV fluids and medications to the body. 
4. Other catheters might be put in the blood vessels in the neck and wrist to monitor the blood pressure, heartbeat, breathing, and blood oxygen levels during the surgery. 
5. Surgical site is cleaned with an antiseptic solution.
6. The surgeon makes a long incision from just below Adam’s apple to the right above the naval in case of open-heart surgery and one or more small incisions in case of minimally invasive surgery.
7. Once the surgery is complete, the heart is brought back to life by delivering minor shocks. 
8. The surgeon closes the incision with sutures and stitches after draining extra blood and other fluids from around the heart. 

The surgery is performed under general anaesthesia with either conventional or minimally-invasive techniques. 

1. In open-heart surgery, the surgeon makes an incision in the patient’s chest to cut the breastbone (sternum) in half (lengthwise). 
2. They then separate the halves to expose the heart. 
3. The patient's heart needs to be stopped for valve replacement. So, a heart-lung bypass machine is connected to the heart using tubes to divert the blood to the machine, which performs the job of the heart.
4. Once the blood is diverted, the surgeon stops the heart with a cold solution. 
5. He/She removes the damaged valve and replaces it with an artificial one. 
6. Minimal invasive surgery, also known as thoracoscopic surgery, takes a shorter time than open-heart surgery. 
7. In this, one or more small incisions are made in the chest to insert an instrument that replaces the valve. 
8. Once the surgery is completed, the surgeon delivers minor electric shocks to restart the heart. 
9. Excess blood and other fluids are drained around the heart using tubes. 
10. The surgeon then sews the incisions with sutures or surgical staples. 

Newer surgery options include

1. ROSS procedure: This surgery is for adults and children with aortic valve disease. It involves the replacement of the damaged aortic valve with the patient’s healthy pulmonary valve. Then a healthy donor valve is implanted in the place of the pulmonary valve. 
2. TAVI/TAVR procedure: The transcatheter aortic valve replacement is a minimally invasive surgery to treat aortic valve stenosis. Aortic valve stenosis is a condition when the aortic valve narrows down reducing the blood flow to the body. 

In the hospital

1. The patient is shifted to the recovery room for monitoring of the vitals and the after-effect of anaesthesia. 
2. Later, the patient is transferred to the ICU to be closely monitored. 
3. Open-heart valve replacement surgery requires the patient to stay in the hospital for several days. 
4. The doctors constantly monitor the blood pressure, heart rate, blood oxygen level, and ECG tracing. 
5. Medicines and fluids are administered through an IV line. 
6. The doctor provides oxygen through a mask or nasal prongs. 
7. The patient might be connected to other tubes to drain urine from the bladder, and blood and other fluids from the chest. 
8. Once the doctors decide that the patient is ready, they shift him/her to a private room or general ward for recovery. 
9. The duration of the stay depends on the surgery and the recovery rate.
10. Once the patient’s condition improves, doctors arrange for home care and provide follow-up instructions. 

At home

Wound care

1. The surgical site to be kept clean and dry.
2. Specific bathing instructions given to avoid water touching the incision site. 

Exercises Suggested

1. Long walks 
2. Breathing control
3. Cough by holding a pillow against the chest to get rid of the mucus.

Restrictions

1. Driving and other strenuous activities for at least the initial six weeks post-surgery. 
2. Consumption of tobacco and alcohol for up till two weeks after the surgery. 

The first follow-up appointment.

1. The patient needs to visit for follow-up appointments as per the doctor’s instructions, who removes the sutures or surgical staples and monitors the recovery to give follow-up instructions. 

Instructions for recovery

1. Look for signs of infection or bleeding from the incision site. 
2. Taking the medications on time.
3. Keeping the surgical site clean and dry.

Damage in one or more valves can stop the heart from pumping blood, which is life-threatening. Depending on the seriousness of the patient’s condition, doctors suggest repairing or replacing the heart valve.In the replacement surgery, the damaged valves are replaced with either a mechanical or a biological valve that helps improve the blood flow and eventually prolongs the life of the patient. 

1. Biological valve
   
   Advantage: The patients need to take blood-thinning medicines only for the first few months to avoid blood clotting. 
   Disadvantage: Biological valves can last 10-20 years. As they are made of human or animal donor tissue, they break down over time and need to be replaced. 
    
2. Mechanical valve
   
   Advantage: These valves have long-term durability and can last for a lifetime. 
   Disadvantage: Mechanical valves made of either metal or plastic come with an increased risk of blood clotting, requiring the long term use of blood thinners. 

Risks of heart valve replacement

1. Blood clots: Can further lead to stroke, heart attacks or lung problems 
2. Increased risks of infection
3. Bleeding during and after the surgery from taking blood-thinning medications 
4. Breathing problems
5. The replaced mechanical valve can make a clicking noise 
6. The replaced biological valve might break down over time and stop functioning properly
7. Pneumonia

When to consult a doctor?

1. Irregular breathing
2. Persistent nausea or vomiting
3. Pain, swelling, or drainage around the incision site
4. Fever or chills
5. Swelling in legs or abdomen
6. Weakness in arms and legs

Patients with mild issues only require certain lifestyle changes, and the risks can be avoided. But if the valve is seriously damaged and not functioning properly, it can lead to life-threatening risks if not replaced in time, like:

1. Increased risks of blood clotting
2. Sudden cardiac arrest
3. Heart failure
4. Death 

If the patients get their surgery done in time, their chance of survival improves dramatically, and they often return to normalcy after the surgery. But any delay in the surgery can cause irreparable damage to the heart.

Types of valve replacement surgery

1. Aortic Valve Replacement 
2. Mitral Valve Replacement
3. Double Valve Replacement
4. Pulmonary Valve Replacement