Before Heart Valve Surgery
As you prepare for surgery, take the time to think of any questions you would like to ask your physicians/nurses. Below are some questions you may want to ask your surgeon or his/her associates and a reasonable answer for each. Be sure that you write down your surgeon’s answers so you can review them as needed.
How long will I be in the hospital?
Usually 5-10 days after the procedure
How long will my surgery take?
Typically between 3 to 5 hours
How long will surgery for reoperation of a failed tissue valve take?
Typically between 4 to 7 hours or longer depending on the amount of scar tissue in the chest
What tests will I receive before and after the procedure?
There will be blood tests before and after, heart tests unless you already had them prior to your hospital admission for surgery (echocardiography, catheterization, stress test, EKG, others). You may receive more heart tests after surgery including EKG and possibly echocardiography.
When will I wake up?
You may wake up shortly after the procedure. The medicines you receive during the procedure and afterward may cause you to have amnesia about waking up. The pain medications you take will cause you to sleep much of the time during the first day.
What can I expect when I wake up?
You may wake up with a breathing tube in place that is attached to a respirator (breathing machine), this can be removed as soon as you start to breathe on your own.
How many tubes/bandages will there be attached to me?
You will have a large bandage on your chest wound. If you have had coronary bypasses, you may have dressings on your leg wounds. Besides the breathing tube, you may have some or all of the following tubes: several intravenous (IV) and pressure monitor lines in your veins and arteries including the upper chest/neck and arms/legs, urinary catheter, tube(s) from your chest cavity and wound, temporary pacing wires from your chest wall. These are routine and will be removed as you improve, usually within 2 or 3 days. All are necessary and normal for your surgery and recovery. Pain medications may lower your awareness of these tubes.
Will I be able to see my family when I wake up?
You may see your family as hospital rules permit and as early as immediately postoperative when you are in the recovery area or the Intensive Care Unit.
How much pain will I have and where will it be?
You will have pain in your chest that ranges from mild to severe depending on your individual pain tolerance. You will feel pressure in the center of your chest and bone and rib pain. If you have coronary bypasses at the same time, you may have leg incisions that will also cause pain.
What pain medication will I be receiving?
In the beginning, you will receive strong pain medications that will also affect your ability to stay awake. After two or three days as you adjust to the pain, you will receive medications that relieve pain but allow you to stay awake. If you have moderate to severe pain after taking the medications at any time, you should notify your nurse/physician.
Will I be receiving antibiotics?
It is routine for heart surgery patients to receive antibiotics in surgery and afterward for a short period.
When will I be able to eat?
As soon as you are fully awake and are able to sit up, you may be able to eat a liquid or light diet and then advance to a regular diet. This usually occurs within one to three days after the procedure.
When will I start taking blood-thinning medicine?
You will receive medication during your procedure and afterward to prevent clotting on your valve whether it is a tissue product or a mechanical valve. When you awaken and can eat and drink, you will start receiving oral medication to prolong your clotting time. The generic name for this medicine is warfarin sodium and the most common brand name is Coumadin® (Figure 7).
When will I be able to walk and go to the bathroom on my own?
As soon as you are fully awake and many of the tubes have been removed, you should be able to walk and will be encouraged to do so.
How long will it be until I can shower/bathe?
Your surgeon will give you instruction on this, but it is generally as soon as your wounds are well sealed (10 days to two weeks). In the meantime, thorough sponge baths will be encouraged taking care to keep your bandages dry.
When will I be “normal” again?
As long as you do not have complications, and most people do not, you will start feeling “normal” within a few weeks after surgery. It is very dependent on your motivation to return to your daily routine and your physical response to the surgery. This is highly individual and will vary.
Are there any diet restrictions after I return home?
The action of anticoagulant medication can be diminished by certain foods containing Vitamin K such as spinach, broccoli, brussels sprouts, lettuce, peas, etc. Other foods such as cranberry juice can counteract the effects of anticoagulants. Eating these foods increases the risk of lowering INR and allowing clots to form. For more information on a proper diet after valve implant and treatment with anticoagulants, please refer to The Coumadin® Cookbook by Dr. Rene Desmarais and colleagues.69 A website for more information about this important book is http://members.aol.com/cmcookbook/index.htm. An additional helpful website is www.PTINR.com and the Vitamin K Registry.
Will I hear my heart valve?
Patients who receive mechanical valves can hear a “click” related to valve closure. All mechanical valves cause this sound, some more than others. It also depends on patient size/shape and hearing ability. Larger patients and those with hearing problems tend to hear less of the click. The click can be reassurance that the valve is functioning. Tissue valve recipients do not usually hear their implanted valves.
What are the complications that are common to valve surgery patients and how often do they occur?
Reoperation of a failed tissue valve will always occur if you outlive the life of the valve. Some of the following complications are rare but should be expected from valve surgery: 1) minor or major bleeding 2) minor or major clotting 3) leaking around the valve 4) infection of the wound or valve 5) fluid and/or infection in the lungs or heart cavity 6) irregular heart beat 7) anemia. It is best to thoroughly discuss these complications with your surgeon and cardiologist prior to surgery. These complications are described in detail in the Glossary of Medical Terms in the following pages and in the preceding section called Problems with Prosthetic Heart Valves.