Purpose of the operation
The main purpose is to relieve the symptoms of a narrowed or leaky valve. The usual symptoms are angina and breathlessness and dizzy or fainting spells, especially if they happen during exercise. Angina is a feeling of discomfort or pressure, usually felt in the middle of the chest, but sometimes in the arms, back, neck or jaw. It is an unpleasant feeling that occurs during exercise and goes away with rest. Because angina, breathlessness and dizzy spells occur on exertion, they can worsen a person’s quality of life, limiting what they can do and enjoy.
The other purpose of the operation is to cut down the risk of heart failure in the future. The heart can usually manage despite a leaky or narrowed valve, but it has to work much harder. When symptoms begin, or when the heart starts to stretch, it usually means that the heart is not coping and heart failure is possible in future. This operation can reduce that risk.
Effect on patients
This is a big operation. It is not terribly painful, but there is pain afterwards. Usually the chest, back, neck and shoulders can hurt, but this is easily treated with standard painkillers.
The operation also makes patients feel tired and lacking in energy for the first few weeks.
Usually, angina disappears completely immediately after the operation and stays away for years. Breathing is better and can get back to normal, and the risk of heart failure and death is also much less once the patient has recovered from the operation.
What happens during the operation?
The operation is done under general anaesthetic. The anaesthetic team will install tubes and drips to closely monitor the patient and to give appropriate anaesthesia. The chest is cut over the breastbone. A heart-lung machine, operated by the perfusionists, is used to keep the blood circulating while the heart is stopped for surgery. The surgeon then opens the aorta (the big artery coming out of the heart), takes out the old valve and stitches in the new one. The aorta is closed, the heart is restarted, the machine is stopped and the wound is closed.
What to expect afterwards
You stay overnight in the hospital's critical care unit and about four to eight days recovering on the ward. Most tubes are removed in the first two days. You can have food and drink the day after the operation, but your appetite may be poor at first. You may sit in a chair on the first day, walk to the toilet on the second and walk about the ward from the third or fourth day. Once you can climb a flight of stairs, it is nearly time to go home. If you have a mechanical valve, you will take a drug called warfarin for life. Warfarin is an anticoagulant, also known as a blood thinner.
You are encouraged to be active and to go for walks after leaving hospital. The general rule is that most things are allowed if you feel up to them, apart from activities which may delay the healing of the breastbone (heavy lifting or other activities which stress the upper arms are banned for three months after the operation). By six weeks, most patients feel almost normal and are active enough to appreciate that their angina or breathlessness are no longer there.