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Having your heart valve replaced

Your operation involves replacing a damaged valve in your heart with one made of synthetic material (a mechanical valve) or animal tissue (usually from a pig).

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. 

Your operation involves replacing a damaged valve in your heart with one made of synthetic material (a mechanical valve) or animal tissue (usually from a pig).

Heart valves open and close to make sure blood flows in and out of the four chambers of the heart in the correct direction. If they are damaged (through infection or disease) they either do not open properly or do not close tightly enough. Both problems mean the heart has to pump harder. A new valve will relieve this strain and ease symptoms such as breathlessness and angina.

The operation is performed under a general anaesthetic, which means you will be asleep during the procedure. You will need to stay in hospital for about a week after your operation.

heart valve replaced

Your specialist or hospital will give you some information about when and how to check into hospital.

Before you come into hospital, you may also be asked to:

  • Attend a pre-assessment clinic for routine tests two or three weeks before your operation,
  • Have a bath or shower on the day of your operation,
  • Remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with sticky tape,
  • Follow the fasting instructions in your admission confirmation letter. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand,
  • Inform the hospital if you are taking anticoagulant medication such as warfarin – you will need to stop taking this before surgery.

After you have been shown to your room, your nurse will check you have been well since the pre-assessment. Your specialist and anaesthetist will also visit you. This is a good time to ask any outstanding questions about your treatment.

The nurse will help you prepare for theatre and will do some tests such as taking your blood pressure and pulse, and may ask you for a urine sample. You may also have a chest X-ray and an electrocardiogram (ECG) – this measures electrical activity in the heart. Men may be asked to shave their chest to prevent hairs getting caught in the wounds. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

Consent

Before going to the theatre, you will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

About the operation

Typically, your specialist will make a cut, about 25 cm long, down the middle of your sternum (breastbone) and open your rib cage to reach the heart. The heart is slowed or stopped (using medication) and blood is re-routed to a heart-lung machine. The machine takes over the pumping action of the heart, maintaining blood circulation and adding oxygen to the blood.

Next, your specialist will open the heart chamber, remove the faulty valve and sew an artificial one in its place. Blood is then redirected back to your heart and the heart is restarted. Your rib cage is rejoined with wires and your chest is closed with dissolvable stitches.

The operation usually lasts about two to three hours.

After your operation

You will be taken from the operating theatre to the intensive treatment unit (ITU) where you will be closely monitored for around 24 hours. You will be connected to machines that record the activity of your heart, lungs and other body systems.

A tube in your mouth passes through to your lungs and is connected to a ventilator to help control your breathing until your lungs have recovered from the procedure. It is uncomfortable but not painful, and you will still be quite sleepy while it is in place. This will be removed once you are alert and can breathe by yourself.

There will be tubes in your chest to drain fluid and blood into a bag beside your bed. These will be removed after a day or two. You will also have drips in your arms or neck providing you with fluids and medication, including antibiotics and pain relief. Another tube (catheter) will drain your urine into a separate bag. These tubes will be taken out after a couple of days.

Once the medical team are happy with your progress, you will return to your room.

Back on the ward

A nurse will make you comfortable. He or she will continue to monitor your blood pressure, temperature and pulse at regular intervals. You may need to inhale oxygen through a mask to help you breathe comfortably. When you feel ready, you can begin to drink and eat.

Your anaesthetist will discuss pain relief with you. You'll have tests on your heart during this time. You will be asked to wear compression stockings to help prevent blood clots forming in your legs.

A physiotherapist will visit you daily and encourage you to do gentle exercises and to take deep breaths and cough up any fluid in your lungs. These will help speed up your recovery and prevent chest infections. After four or five days, you will need to increase your activity and may be shown exercises in the gym. The physiotherapist will recommend exercises for you to do at home.

Going home

You will need to make arrangements to be driven home. Before you go home, a nurse will advise you about caring for surgical wounds, and bathing. A follow-up appointment in the outpatient clinic will be made for you for about six weeks later.

After you return home

If you need them, continue taking painkillers as advised.

You will need to take it easy and should expect to feel tired and a little breathless at first. Avoid strenuous exercise and lifting as these may strain the healing sternum. You can take baths and showers as usual.

If you have a synthetic valve, you will need to take anticoagulant medication as instructed. This may be daily, for life.

You should not drive until you feel confident that you could perform an emergency stop without discomfort – probably after about one month.

The wires holding your chest together are permanent and the stitches will dissolve. Your breastbone takes up to three months to heal.

The benefits of a heart valve replacement in terms of prolonged life and improved symptoms are generally greater than the disadvantages. However, it is a major operation with some element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment. Examples of side-effects include feeling sick as a result of the general anaesthetic and painkillers. Your chest area may be painful. Mechanical valves are made of a hard material so you may hear a clicking sound as it open and shuts.

Complications

This is when problems occur during or after the operation. Most patients are not affected.

Possible complications of any surgery are excessive bleeding during or soon after the operation, infection, and an unexpected reaction to the anaesthetic. Its also possible for blood clots to form and block the valve. These clots can break off and block an artery (blood vessel) which can lead to a heart attack or stroke. If you develop a clot you may need further surgery or medication through a drip to dissolve the clot (thrombolytic therapy). Clots are more likely if you have a mechanical valve, but taking anticoagulants help prevent them.

It's possible that you may have an irregular heart beat (arrhythmia), which can be treated with drugs and is usually temporary. Your new valve can become infected and inflamed ("endocarditis"). This can damage your heart and you will be given antibiotics in hospital to help prevent such infection.

Replacement valves can wear out or become damaged. Although the type of valve you have is unlikely to affect your long-term survival, tissue valves tend to wear out sooner than mechanical valves making further surgery more likely.

There is around 1-2% risk of death during or soon after this procedure. The risk depends on the exact operation performed and your general health.

1. Will I need to continue with any treatments after I have surgery?

Yes usually, but this depends on the type of surgery you have and your health before the operation. You may need to take medicines such as antibiotics and anticoagulants after your surgery. You may also need to continue taking other medicines for your heart valve disease such as ACE inhibitors (eg ramipril) or diuretics (eg furosemide).

After your valve replacement surgery you may need to take anticoagulants such as warfarin. These medicines help stop blood clots from forming. The length of time you will need to take these for depends on the type of replacement valve that you had.

If you had a biological valve, then you will only need to take anticoagulants for a few weeks. After this, you will need to take aspirin to reduce the risk of clots forming around your replacement valve.

If you had a mechanical valve, then you will need to take anticoagulants for the rest of your life. This is because these valves are made from artificial material and so clots are more likely to form around them.

You may also need to take anticoagulants for a few weeks if you have a specific form of arrhythmia (a disturbance of the normal electrical rhythm of your heart) called atrial fibrillation. You may be prescribed anticoagulants if you have had, or are at increased of, a stroke. While you are taking anticoagulants, you will need to have regular blood tests to ensure that you are on the correct dose. It's very important that you are on the correct dose of anticoagulant as too much of these medicines can lead to bleeding.

If you are at risk of infection, your doctor or surgeon may give you antibiotics before and after your operation to prevent your valve from becoming infected. If your valve becomes infected, the infection can spread to the lining of your heart (endocarditis). Endocarditis is a serious condition that can lead to damage to the heart valves.
To help prevent infection, you should practice good dental hygiene and have regular dental checkups. This stops the bacteria in your mouth from entering your bloodstream.
Your GP will advise you about taking anticoagulants after your operation. For information about preventing endocarditis, consult your GP.

2. Is there anything I can do to speed up my recovery?

Yes, there are some things you can do. You can take measures such as joining a cardiac rehabilitation programme to help your recovery. It will take up to three months to recover completely, so you will need to take things easy until then.

It can take up to three months to recover fully from heart surgery and during this time you will need to build yourself back up to normal.

For the first six weeks after your operation, you should limit the amount of alcohol you drink. One unit per day is a sensible limit. The effects of alcohol can be greater if you are taking certain medicines, and alcohol can interfere with certain medicines. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

You may be recommended to take part in a cardiac rehabilitation programme. This will cover exercise, relaxation and lifestyle changes that can help you recover. For example you may get advice on:

  • diet and healthy eating
  • how to recognise stress
  • how to stop smoking
  • medicines
  • returning to work

For advice on cardiac rehabilitation programmes, ask your GP or contact the British Heart Foundation.

3. When can I start exercising after surgery and what is suitable for me?

Your physiotherapist will help you to start moving about two days after your surgery. Once you get home, you should build your activity levels up slowly until you are back to your usual level of activity.

It's important to keep active when you get home after your surgery. Try to do the same amount of exercise at home as you did with the physiotherapist at the hospital.

It's important to rest properly too. When you sit down, make sure that you have your feet raised, on a stool for example. Your legs should be supported, so don't sit too far away from the stool. You should set aside specific times to rest and make sure that you stick to them.

After the first few days, you can start to increase the amount of exercise you do. Gentle walking is a good way to do this. Ask your physiotherapist for information about suitable exercises and how to build up your levels of activity.

The best kind of exercise for your heart is aerobic activity. Aerobic activity can be any repetitive exercise that involves the large muscle groups of your legs, shoulders or arms.

It's very important to increase your levels of physical activity gradually. You shouldn't do any strenuous or vigorous activity such as weightlifting as this can put a strain on your heart.

With any exercise, you may want to involve your partner, family or friends to make it more fun.

You should stop exercising immediately if you feel:

  • pain
  • dizzy or light-headed
  • sick
  • unwell
  • very tired

If you develop any of these symptoms and they don't go away after a few minutes, you should see your GP.

4. My doctor says that I have a mitral valve prolapse. What is this and do I need treatment?

About five in every 100 people have a mitral valve that is slightly misshapen and leaks. You won't usually need treatment unless you have symptoms such as palpitations or chest pain.

A mitral valve prolapse can be a cause of a heart murmur (a noise from your heart caused by irregular blood flow) but doesn't usually cause serious problems. If you have a heart murmur, your GP will refer you to a cardiologist (a doctor specialising in identifying and treating conditions of the heart and blood vessels) to find out exactly what is causing it.

A mitral valve prolapse doesn't usually have any symptoms but you may have chest pain (angina) or palpitations (an unpleasant awareness of the heartbeat, often described as a thumping in the chest).

You won't usually need treatment unless it's causing you problems. Your GP may prescribe you beta-blockers (eg bisoprolol) to help with your chest pain and palpitations.

5. Will I need to make any lifestyle changes after heart valve surgery?

If your heart valve disease was caused by coronary artery disease, which reduced the blood supply to the heart causing the valves, to stop working as they should, then you need to take measures to stop this getting worse.

Damage to the heart valves can be caused by coronary artery disease. If this has happened to you, you should change your lifestyle to prevent coronary heart disease from getting worse. You should:

  • stop smoking if you smoke
  • eat a healthy, balanced diet
  • maintain a healthy weight
  • stay active

A healthy, balanced diet is part of reducing cholesterol levels and high blood pressure. You should change your diet to a low fat, low salt diet that includes plenty of fruit and vegetables.

If your repaired valve becomes infected, the infection can spread to the lining of your heart (this is known as endocarditis). Endocarditis is a serious condition that can lead to heart failure. After a heart valve repair operation, and for the rest of your life, you will need to take measures to prevent infection.

The most common way for bacteria to get into your blood is from your mouth when you have dental treatment. To help prevent infection you should practice good dental hygiene and have regular dental checkups. This stops the bacteria in your mouth from entering your bloodstream.

For information about preventing endocarditis and about reducing cholesterol levels and high blood pressure, talk to your GP.                         

Further information

Sources

  • At a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency (DVLA). www.dvla.gov.uk, accessed 14 January 2010
  • Balloon valvuloplasty for aortic valve stenosis in adults and children. The National Institute of Health and Clinical Excellence (NICE), July 2004. www.nice.org.uk
  • Balloon dilatation of pulmonary valve stenosis. The National Institute of Health and Clinical Excellence (NICE), June 2004. www.nice.org.uk
  • Having heart surgery. British Heart Foundation, January 2005. www.bhf.org.uk
  • Heart valve disease. British Heart Foundation, May 2009. www.bhf.org.uk
  • Joint Formulary Committee. British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009:100
  • Kumar P, Clark M. Clinical medicine. 6th ed. Elsevier, 2005:768
  • Percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction. The National Institute of Health and Clinical Excellence (NICE), November 2007. www.nice.org.uk
  • Personal communication, Dr Tim Cripps, Consultant cardiologist, Bristol Royal Infirmary, 10 February 2010
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford:Oxford University Press, 2007:354-55
  • Thoracoscopically assisted mitral valve surgery. The National Institute of Health and Clinical Excellence (NICE), December 2007. www.nice.org.uk
  • Tuladhar SM, Punjabai PP. Surgical reconstruction of the mitral valve. Heart 2006; 92:1373-77. doi: 10.1136/hrt.2005.067421
  • Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease. Eur Heart J 2007; 28:230-68.
  • Physical activity and your heart. British Heart Foundation. October 2009. www.bhf.org.uk
  • Heart valve disease. British Heart Foundation. August 2009. www.bhf.org.uk
  • Longmore M, Wilkinson I, Turmezei T, et al. Oxford handbook of clinical medicine. 7th ed. Oxford: Oxford University Press, 2008 

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