90554

Having Open Mitral Valve Replacement

The mitral valve is on the left side of the heart between the left atrium and the ventricle. A mitral valve replacement is a surgery to replace a mitral valve that does not work well. It is replaced with a new valve. Open-heart surgery is a procedure for mitral valve repair. It is done with an incision in the middle of the chest that goes through your breastbone.

Choosing a new valve

Before the surgery you and your healthcare provider will talk about what kind of valve will work best for you. You may be given a biological valve made from cow or pig tissue, or you may be given a mechanical valve. A mechanical valve is an artificial valve made from metal and other materials.

Each type of valve has different risks and benefits. Biological valves need to be replaced in 10 to 15 years. Mechanical valves do not need to be replaced, but you need to take blood-thinner medicine for life. This is to help prevent clots that can form on the valve and may cause stroke. Make sure to talk with your doctor about the kinds of follow-up care needed for each type.

What to tell your healthcare provider

Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen (Motrin). It also includes vitamins, herbs and other supplements. And tell your healthcare provider if you:

• Have had any recent changes in your health, such as an infection or fever
• Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)
• Are pregnant or think you may be pregnant
• Take any blood thinning medications like aspirin. You may need to stop taking them before surgery. If your blood thinners are stopped, you may need to be admitted to the hospital for intravenous (IV) blood thinners before your surgery.

Tests before your surgery

Before your surgery, you may need tests such as:

• Chest X-ray
• Electrocardiogram (ECG), to check the heart’s rhythm
• Blood tests, to look at your general health
• Echocardiogram, to view heart anatomy and blood flow through the heart
• Coronary angiogram (cardiac catheterization), to look at blood flow in your heart’s arteries

Getting ready for your surgery

Talk with your healthcare provider how to get ready for your surgery. You may need to stop taking some medicines before the surgery, such as blood thinners and aspirin. If you smoke, you must stop smoking. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Also, make sure to:

• Ask a family member or friend to take you home from the hospital. You cannot drive yourself.
• Not eat or drink after midnight the night before your surgery, or as directed by your healthcare provider.
• Shower with chlorhexidine the night before and the morning of your surgery as directed by your healthcare provider. 
• Follow all other instructions from your healthcare provider.

You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions if something is not clear.

On the day of surgery

Your procedure will be done by a cardiac surgeon. This is a doctor who does surgery on the heart. He or she will work with a team of specialized nurses, fellows, and residents. The surgery will take several hours. In general, you can expect the following:

• You will have general anesthesia, medicine that allows you to sleep through the surgery. You will not feel any pain during the surgery.
• A nurse will apply a foam dressing to the bone on the lower base of your spine (sacrum) to protect your skin.
• A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
• You will be hooked up to a heart-lung machine. This machine will act as your heart and lungs during the surgery.
• The surgeon makes a cut (incision) down the middle of your chest. To reach your heart, the surgeon separates the breastbone.
• The surgeon takes out your mitral valve and replaces it with a new valve.
• The surgery team takes you off the heart-lung machine.
• The team wires your breastbone back together. They close the incision in your chest with stitches or staples. The team puts dressings on the incisions.

After your surgery

• After surgery, you will be taken to a recovery room or intensive care unit (ICU). Nurses will check your breathing, heart rate and blood pressure. You may have a tube draining fluid from your chest. You may have a tube in your throat to help you breathe. This may be uncomfortable, and you will not be able to talk. The tube is removed when you are able to breathe on your own, usually within 6 hours after surgery.

• Your hospital stay may be for about 3-5 days.

• You may have some pain at the incision site after surgery. You will be given pain medicines to help relieve it. Only take pain medicine approved by your healthcare provider.

• You will receive physical therapy and will be assisted out of bed as soon as you are ready-first to a chair, then walking- as your recovery allows (the breathing tube is out and your vital signs are stable).  This is usually on the first day after surgery.

• You will see a physical therapist and will work together to develop a mobility and rehabilitation program.  This is a program of exercises and education. It will help you recover after surgery and regain strength.

• You may need to do breathing therapy to help prevent or remove fluid building up in your lungs. A nurse or therapist will assist you with breathing exercises.

• You can go back to your normal food as soon as you feel able to.

• If possible, you should have someone to help at home for a few days. When you go home, it may take a little while for you to resume normal activities.

• Avoid vigorous exercise until your doctor says you are ready.

• Do not lift anything heavier than 5 pounds until your doctor says it is okay.

• Ask your healthcare provider when it is safe for you to drive.

• Take your temperature and weigh yourself every day. This is to check for infection and to make sure your heart is pumping normally. If it does not pump normally, fluid can build up in your body and quickly cause you to gain excess weight.

Follow-up care

• You may have your stitches or staples removed in 7 to 10 days. You will be given dates and times for follow-up appointments with your surgeon, cardiologist and primary care provider.

• You may be told to continue cardiac rehab after leaving the hospital to help you continue to get stronger. This may last several days up to several weeks.

• Make sure you keep all of your follow-up appointments and follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

• Make sure all your dentists and healthcare providers know about your new heart valve. You may need to take antibiotics before certain medical and dental procedures. This is to prevent getting an infection in your new valve.

• If you have a mechanical valve, you may need to take blood thinner medicine like Coumadin. This is medicine that helps prevent clots.