What is Aortic Valve Replacement Surgery?
If valve repair is not an option, your surgeon may replace the valve.
Replacement means your diseased valve is removed and a new valve is inserted in its place. During Aortic valve surgery, one or more valves may be replaced at one time.
Two kinds of prosthetic heart valves are available: Biological and Mechanical:
Biological Valve Replacement
Bioprosthesis Valve
The majority of Aortic Valves are replaced with a bioprosthesis. Biological valves (also called tissue or bioprosthetic valves) are made of tissue, but they may also have some artificial parts to provide additional support and allow the valve to be sewn in place. About 80% of Aortic Valves are replaced with a bioprosthesis.
Biological valves can be made from pig tissue (porcine), cow tissue pericardial (bovine), or pericardial tissue from other species. These valves are safe to insert, durable (lasting from 15 to 20 years), and allow patients to avoid lifetime use of anticoagulants (blood thinning medications). At the Cleveland Clinic the risk of death is less than one percent for isolated Aortic valve replacement and has consistently been better than predicted mortality based on the Society of Thoracic Surgeons (STS) national data.
Human Homograft (also called allograft)
A homograft is an Aortic or pulmonic valve that has been removed from a donated human heart, preserved, treated with antibiotics, and frozen under sterile conditions.
Homografts are used especially when the Aortic root is destroyed by endocarditis (infection). Seesurgery for endocarditis.
Mechanical Valves Replacement
Mechanical valves are made completely of mechanical parts, which are non-reactive and tolerated well by the body. The bileaflet valve is used most often.
It consists of two pyrolite (qualities similar to a diamond) carbon leaflets in a ring covered with polyester knit fabric.
All patients with mechanical valve prostheses need to take an anticoagulant medication, Warfarin (Coumadin), for the rest of their life to reduce the risk of blood clotting and stroke. This increases the risk of bleeding.
There are also two approaches used to perform Aortic Valve Surgery:
TRADITIONAL AORTIC VALVE SURGERY
During traditional Aortic valve surgery, a surgeon makes a 6- to 8-inch incision down the center of your sternum, and part or the entire sternum (breastbone) is divided to provide direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.
MINIMALLY INVASIVE AORTIC VALVE SURGERY
Minimally Invasive Aortic Valve Surgery is performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay. Your surgeon will review your diagnostic tests prior to your surgery to see if you are a candidate for Minimally Invasive Surgery.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work. In some cases an Angiogram is required.
Although not all the tests may be required for each patient, they usually include:
All of this information will allow the doctors that we work with to determine your eligibility for the procedure. Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.
Tell your surgeon what medications you are taking, especially aspirin or an anticoagulant ("blood thinner"). Your surgeon will tell you if you should stop taking them. Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
If you smoke, stop immediately to improve your blood flow and breathing.
If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and a coronary angiogram, which is a special type of X-ray procedure that uses dye to visualize the arteries that feed your heart.
Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
Your surgical nurse will provide you with these instructions the night before surgery:
Morning of surgery
On the day of your surgery, your designated SALUS Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the SALUS team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.
You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
When it is time for you to go to surgery, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your surgery is done.
RECOVERY AFTER SURGERY
After surgery, the patient is moved to the Intensive Care Unit where family members can visit the periodically.
Heart rate and blood pressure monitoring devices continuously monitor the patient for 24 hours. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). A breathing tube (endotracheal tube) will stay in place until our surgical team is confident that the patient is awake and ready to breathe comfortably on his or her own. The patient may feel groggy and disoriented, and sites of incisions may be sore. Painkillers are provided as needed.
Patients usually stay in our partner hospitals for about one week or longer if necessary, after surgery. This time is much longer than what is normally necessary, however, it does give our surgeon adequate time to monitor post operative recovery. During this time, some tests will be done to assess and monitor the patient’s condition.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
You will remain hospitalized for about 7-10 days while your heart is monitored and your vital signs are checked frequently.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your
care after you leave the hospital. Be sure to follow your doctor’s discharge
instructions if they are different from what is listed here.
Periodically, depending upon its location, your physician may schedule you for an imaging study to make sure that your aneurysm is not redeveloping and that the graft, patch, or clips are functioning correctly.
YOUR ACTIVITY
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.
After release from the hospital, the patient may experience side effects such as:
Many of these side effects usually disappear in four to six weeks, but a full recovery may take a few months or more. The patient is usually enrolled in a physician-supervised program of cardiac rehabilitation. This program teaches stress management techniques and other important lessons (e.g., about diet and exercise) and helps people rebuild their strength and confidence.
Patients are often advised to eat less fat and cholesterol and to walk or do other physical activity to help regain strength.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.
Lifting and Reaching
If your surgery required an incision on your sternum (breastbone), it will take about 6-8 weeks for your sternum to heal. During this time, you may do light household chores, such as laundry, shopping, cooking, light gardening, dusting, and washing dishes when you feel up to it.
Do not lift, push or pull objects heavier than 5 pounds until your doctor says it is okay to do so.
Try not to stand in one place for longer than 15 minutes. Do not sit for more than an hour; take a break for a few minutes and walk around or move your legs.
Physical Activities
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. Because you may be off-balanced after surgery, be careful and hold the handrail when walking up and down stairs. If you need to, stop and rest before you finish walking up or down a full flight. Try not to use the stairs immediately after surgery, and try to plan your activities so that you use the stairs only when necessary.
Fatigue
Fatigue is probably the number one patient complaint following surgery. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 3-4 weeks from the date of your surgery or while you are still taking narcotic pain pills. During this time your reaction time may be dulled, and if an incision was made on your sternum, your breastbone will still be healing. You may be a passenger in a car at any time. Make sure to wear your seat belt. You may cushion your incision with a soft towel or pillow.
Returning to Work
Returning to work depends upon the type of work you do and your energy level. It usually takes 4-6 weeks before most patients feel they have returned to their full energy level. The decision to return to work should be made jointly between you and your surgeon. You may want to consider working half days at first.
Traveling
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Sex
You may resume sexual activity after your surgery. In the first few weeks after surgery, however, you may find that pain along your incision may limit your activity to a certain extent. Just remember that during the first eight weeks after surgery, any activity or position that causes pain or pulling across your chest, such as bearing weight on your arms, must be avoided.
Exercise
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
Don't exercise if the weather is bad, or if it's too cold or too warm outside. Because of the controlled temperature, an indoor shopping mall is a good place to walk.
Make sure you are not exercising too hard. Stop if you are exhausted, short of breath, feel dizzy, or have discomfort in your chest. Call your doctor if these symptoms persist and you are not able to do your regular exercises.
YOUR DIET
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.
Tips to healthy eating:
Poor Appetite and Nausea
Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.
Constipation
Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.
Caloric Restriction
Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.
Cholesterol and Saturated Fat Restriction
Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."
In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after surgery. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.
MEDICATIONS
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.
For pain
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
For constipation
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
Call your surgeon right away if you have:
SLEEPING PATTERNS
You should return to your normal sleeping patterns within 2-3 weeks. Try these tips to help you sleep:
If you still have problems sleeping after 2-3 weeks, call your doctor.
Night Sweats
Patients often complain of night sweats for the first few weeks. Should you experience this, check your temperature to make sure that you do not have a fever. If your temperature is 101 degrees Fahrenheit or greater, call your doctor. If you do not have a fever, there is very little that can be done, but you should make yourself as comfortable as possible while waiting for the night sweats to go away. Change your linens and pajamas so you do not sleep in a damp bed. Night sweats usually disappear in a few weeks.
Disturbed Sleep
Following surgery, some patients experience nightmares or insomnia. This will also disappear with time. To help you sleep better, try shortening your naps during the day and/or increasing your afternoon activities so that you will feel tired in the evenings. It is OK to sleep on your back, side or stomach. You will not hurt your incisions.
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at SALUS are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
Surgery Post-Op Clinic: 1-2 weeks after surgery
One to two weeks after surgery, you will meet with a nurse practitioner who will check your incision and cardiopulmonary status. Your nurse will let you know if you need further tests or evaluation.
6-8 weeks after surgery
A report of your surgery and your progress during your hospital stay will be sent to your cardiologist after you leave the hospital. As soon as you return home from the hospital, call your cardiologist to make a follow-up appointment. Your appointment should be six to eight weeks after your surgery.
At this appointment, your cardiologist will determine how well you are healing, as well as give you instructions on medications, resuming activities, driving, and returning to work. You will also be scheduled for future follow-up visits.
Any time before your appointments, you should call your doctor if you: