Valve replacement surgery is generally performed as an
open-heart procedure in the operating room of a hospital. It may also be done
as a minimally invasive surgery.
Although valve surgery is an intricate procedure, it is also common. In the majority of cases, valve replacement surgery is a
straightforward procedure with a high rate of success and a low risk of
complications. A cardiac surgeon, who specializes in heart surgery and has had
years of training, will do the surgery. A team of nurses, an
anesthesiologist, and possibly a surgical resident will assist the
In rare cases, a more complex operation is done. The aortic valve may
be replaced with one of the person's other heart valves (usually the pulmonary
valve between the lower right heart chamber and the opening to the artery that
goes to the lungs). Since the pulmonary valve is used in the heart to replace
the aortic valve, an artificial valve is implanted to replace the pulmonary
valve. This type of valve surgery may be used in people younger than 25 years
of age who are more likely to benefit the most from this difficult surgery. The
pulmonary valve is more durable, grows with the person, and has a lower risk of
Preparing for valve replacement surgery is similar to preparing
for other major surgeries. You will be asked to not eat before surgery to prevent the risk of vomiting while you are under
anesthesia. Your doctor may also have you stop taking certain medicines
When you are in the operating room, a nurse will attach a number of
monitoring devices, such as an EKG, to monitor the function of your heart and
other vital signs during surgery. The nurse also will insert an intravenous
(IV) line into your arm to deliver fluids and any necessary medicine.
Finally, the nurse will place sterile drapes over your body, shave your chest
if needed, and sterilize the area.
To help you breathe during surgery, you will be placed on a
respirator, which involves placing a tube down your throat and into your lungs.
This tube may be uncomfortable, but you will not be awake for most of the
time that the tube is in your throat.
An anesthesiologist will place you under general anesthesia so that
you do not see or feel anything during surgery. After you are unconscious, a
transesophageal echocardiogram, which is a type of ultrasound device, will be
inserted into your esophagus to display images of your heart during
The surgeon will use a marker to outline the incision on your chest
before making it. To gain access to the heart, the surgeon will typically cut
straight down the middle of your chest, from the top of your rib cage to just
above your belly button. The incision goes through your sternum, or breastbone.
Some surgeons are currently doing a new type of procedure called minimally
invasive surgery, which uses an incision that is about one-third the size of a
When your heart is visible, the surgeon will place you on a
heart-lung machine, which will take over the function of your heart and lungs
for the remainder of the operation by circulating oxygen-rich blood throughout
your body. To attach you to the heart-lung machine, the surgeon will insert a
tube into your right atrium, which receives oxygen-depleted blood from your
body. Instead of going to your lungs to receive oxygen, the blood travels to
the heart-lung machine to exchange carbon dioxide for oxygen. The blood then
travels through a tube back to your aorta, which supplies blood to your entire
During bypass, your aorta is clamped near your valve to prevent
blood from interfering with the surgery. To stop your heart temporarily, the
surgeon will flush it with cold salt water or with a medicine. The surgeon
will then bathe the heart in a solution that allows it to survive being
deprived of blood for a short time.
This bypass is needed because it is difficult to work on your
heart while it is beating. The bypass allows the surgeon to stop your heart
temporarily without interfering with the circulation of oxygen-rich blood to
your body. Bypass also reduces the risk of serious bleeding
After blood flow is diverted to the heart-lung machine, the surgeon
will make an incision in the aorta to expose the aortic valve. The surgeon will
inspect the aorta and the valve to evaluate the extent of disease. If only your
valve is diseased, the surgeon will cut out the valve leaflets. If the aorta is
also diseased, the surgeon may also cut out a portion of the aorta and replace
it with a graft, which may be part of the replacement valve.
After the old valve is removed, the surgeon will use a device to
measure the size of the valve opening to select the proper size for the
replacement valve. In general, the surgeon will choose the largest possible
valve to ensure the best possible blood flow through the valve. The surgeon may
then place the valve in the opening to make sure it fits correctly. After
properly aligning the valve, the surgeon will sew it in place.
The surgeon will then check the placement to make sure there is no
room for leaks. The stitches are then tied off and trimmed.
When the new valve is in place, the surgeon will allow some blood
to flow through the valve to check for leaks. The surgeon will sew up the
aorta, remove air bubbles from your heart, and restore blood flow. When blood
flows through your heart, it will typically start beating again. Sometimes,
though, the heart begins to beat erratically (fibrillate), and the surgeon
will give it an electrical shock to induce normal beating patterns.
When your heart is beating normally, your surgeon will close your
rib cage using heavy-gauge steel wire to sew the breastbone (sternum) together.
The surgeon then will use stitches to close the incision in your chest. In most
cases, you will have a visible scar on your chest.
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 they were kept in place to help your body perform vital functions and to provide
you intravenously with medicine (primarily painkillers) and nutrients.
The purposes of the wires and tubes include checking your heart and blood pressure, getting blood samples, draining fluid from your chest, and draining urine from your bladder.
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 breathing tube usually will be removed from your lungs soon
after you wake up.
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 you leave
You will likely
be able to eat solid foods within 24 hours after surgery and will be able to
get up and walk around within 48 hours after surgery. Your chest will, of
course, be sore for some time.
November 2, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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