The Heart Valve Operation

Many aspects of heart valve operations are similar to those of other forms of cardiac surgery. The patient is usually admitted to the hospital the morning of the operation. The procedure is performed after general anesthesia is induced. Operations are performed through a midline chest incision (from the base of the neck to the upper abdomen) through the breastbone, although some surgeons prefer to use other incisions depending on the circumstances.

The pericardium is opened, and the patient is connected to the heart-lung machine. The heart or a major blood vessel is opened, and the heart valve is repaired or replaced. After that, the heart or blood vessel is sutured closed, and the patient is disconnected from the heart-lung machine. The chest incisions are closed in layers with stitches, and the skin is closed with stitches or staples.

Afterward, the patient is transferred from the operating room to the intensive care unit (ICU). At this point, a mechanical respirator is breathing for him or her, and will for at least several hours. The patient is typically in the ICU for a day or two. Discharge from the hospital typically occurs from four days to nine days after the surgery.

When the patient returns home, he or she will be able to go out for walks. It will be about a month before driving a car is recommended. By then, many patients are walking a mile or two a day. Some cardiologists feel that all of their patients should be enrolled in a cardiac rehabilitation program, whereas others feel that only more sedentary people need a formal rehabilitation program. Professional athletes might be able to resume normal strenuous activities, depending on a number of variables, about three months after heart surgery. Cardiologists determine when and what level of activity can be resumed and when it can be started after heart surgery.

The midline incision (through the breast bone) that is currently used for most valve replacement surgeries is not very painful for most people. Patients are usually discharged with a prescription for a relatively mild pain medicine.

So how many heart valves can be replaced in the same person? The aortic valve is the most commonly replaced. The second most commonly replaced is the mitral valve. Third is replacement of both the aortic and mitral valves during the same operation. Sometimes the aortic, mitral, and tricuspid valves are all replaced at the same time. More typically, the aortic and mitral valves are replaced, and the tricuspid valve is repaired. This treatment is usually reserved for long-standing aortic and mitral valve disease in which the tricuspid valve has become incompetent as a result of the other two valves causing stress on the right ventricle and tricuspid valve. Occasionally, the mitral and tricuspid valves are both replaced. Rarely, the aortic and tricuspid valves are replaced at the same time.

I am aware of one patient, a young girl, who had stenosis of all four valves related to rheumatic fever. All four valves were opened at surgery with a commis-surotomy procedure. She was alive and well one year later. I am also aware of one patient who underwent replacement of all four valves. This was at the Mayo Clinic. The patient survived for about six months and then died of unrelated complications.

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