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1. Preparation

WHAT IS A HEART VALVE REPLACEMENT?

A heart valve replacement is a surgical procedure that is performed to replace a valve that is not functioning correctly.


Your heart has four valves that direct blood flow through the heart in one direction. Pressure changes on either side of each valve cause flaps to open and close with each heartbeat to regulate blood flow.


The four heart valves are:


  • Aortic
  • Mitral
  • Tricuspid
  • Pulmonary

Diastole – Blood is pumped from the atria into the ventricles.


Systole – Blood is pumped out of the ventricles to the lungs and the body.


In most cases the valves that require replacement are the aortic and mitral valves located on the left side of the heart. These two valves work harder than the tricuspid or pulmonary as they are responsible for controlling oxygen rich blood flow from the lungs to the rest of the body.


When having heart valve replacement surgery, your damaged valve or valves are removed and replaced with artificial valves. The three main classifications of artificial valves are:


  • Bioprosthetic – These valves come from animals and in order to avoid rejection, they are specially treated with chemicals.

  • Mechanical – These are valves made of materials such as metal, carbon or synthetics. To prevent blood clots when these types of valves are used, anticoagulation is required.

  • Biologic – These are valves taken from the human heart of deceased donors. Once the valves are removed from the donor, they are frozen for use at a later date.

There is a procedure performed where the patient’s own pulmonary valve is used to replace the diseased aortic valve and the pulmonary valve is then replaced by the donor valve.



heart-valve-replacement.gif

WHY IS IT DONE?

A heart valve replacement is required when the valve or valves are beyond repair due to the extent of damage caused by the following:


  • Damaged valves due to:

- rheumatic fever

- bacterial infection

- calcific degeneration


  • Degeneration from the normal ageing process
  • Abnormally formed valves due to birth defect

Stenosis and regurgitation are the two most common types of valve disease.


Stenosis – This is when the valve does not open completely, forcing the blood to flow through a narrowed opening.


Regurgitation – This is caused when the valve does not completely close and the blood flows backwards through the valve.


Because your heart pumps harder to compensate for the disease, insufficient circulation of the blood to the rest of the body occurs. Your heart can grow weaker and enlarge due to the additional work it needs to do, causing the following symptoms:


  • Increase in shortness of breath
  • Chest pain
  • Leg and ankle swelling
  • Increased fatigue
  • Dizziness
  • Fainting

HOW DO I CHOOSE A SPECIALIST?


Your GP or cardiologist will be able to recommend and refer you to a cardiothoracic surgeon who can perform the surgery.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.


The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of Cardio-thoracic Surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.


WHERE IS IT DONE?


A heart valve replacement is done in a hospital and the average length of stay is approximately 12 days.


HOW LONG IS THE PROCEDURE?

Depending on the number of valves being replaced, a heart valve replacement surgery can take two to four hours or more.


WHO IS INVOLVED?

The people involved in the procedure are:


  • The Cardio-thoracic Surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Perfusionist: a specially trained anaesthetist who operates the heart lung bypass machine
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Pathologist for blood tests and/or specimen samples
  • Radiologist for x-rays
  • You may see a physiotherapist after the procedure

HOW DO I PREPARE FOR THE SURGERY?

You will usually be required to attend a pre-admission clinic where you will undergo basic tests to assess your general fitness for surgery. These tests include an ECG (recording of your hearts’ rhythm), chest x-ray and blood tests.


If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.


The evening prior to your surgery, you will be asked to shower with an antiseptic soap and the operative area will be shaved or clipped. You may also be given a sedative that evening, and will usually have a pre-med before going to theatre the next day.


It is also important that you do not eat or drink anything from midnight prior to your morning surgery; if your operation is scheduled for the afternoon you shall be required to fast for at least 6 hours prior to surgery.


Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.


WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear warm comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans
  • You may also wish to bring something to read whilst you wait

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Heart Valve Replacement admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $31,790 $0 $31,637
1 Medical Services Component
Anaesthetic Services $4,660 $2,000 $2,537 $1,765 7.0% $0 93.0%
Assistant in Operations $671 $351 $293 $642 4.2% $0 95.8%
Cardio-Thoracic Surgical Services $4,116 $1,851 $1,697 $3,122 18.2% $0 81.8%
Diagnostic Procedures $254 $150 $104 $21 2.5% $0 97.5%
Miscellaneous Medical Services $2,554 $1,556 $887 $1,581 7.0% $0 93.0%
Pathology Services $1,522 $827 $632 $384 16.4% $0 83.6%
Specialist Consultation $926 $543 $371 $155 7.4% $0 92.6%
Radiology Services $1,240 $658 $473 $279 38.3% $0 61.7%
2 Total Average Medical Services $15,276 $7,587 $6,717 $1,973 49.1% $0 50.9%
Hospital and Medical Services Average for Heart Valve Replacement Admissions $47,066 $7,587 $38,354 $1,973 49.1% $0 5 50.9%

Heart Valve Replacement FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 116 overnight admissions with an average length of stay of 12.5 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) - covered under Medicare item 38488.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 These medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($15,276) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as as shown in the table.

4 Doctors' charges vary so always ask your doctor whether he/she will participate in HCF's No Gap arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all heart valve replacement admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

In most cases you will be admitted to hospital the day before your surgery. When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.


On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. Once this admission procedure is completed, you will be taken to the ward, where a nurse will perform a series of basic tests and assessments. You may be started on a blood thinning medication such as heparin to help prevent blood clots during the procedure.


Some hospitals will offer you and your close relatives the chance to visit the Intensive Care Unit on the day before surgery (this is where you will wake up and spend the first couple of nights post op). If you have never visited an Intensive Care unit, it can look a little daunting at first.


The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.


An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.


You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.


WHAT CAN I EXPECT DURING SURGERY?

Once in the anaesthetic room, if you do not already have one inserted, a small plastic needle called a cannula will be placed into a vein in your hand or arm. This will then be used to give you an intravenous sedative to put you to sleep (the first stage of your anaesthetic). You won’t remember anything more until you wake up in Intensive Care.


Once fully asleep, you will be taken to the operating theatre. Here you will be connected to a number of machines such as a ventilator to breathe for you and a heart lung machine which replaces the functions of the heart and lungs by adding oxygen to the blood and maintaining circulation. You will also have several catheters inserted to measure different pressures in your heart and to replace voiding manually.


An incision about 25 cms long will be made down the middle of your sternum and the rib cage will be opened to allow access to your heart to locate the valve that is faulty and loosen it from the tendons before removing it. The replacement valve is inserted and stitched in place. The heart is restarted with the help of controlled electric shocks and the heart lung machine is disconnected.


The sternum is then joined together again using wires and the skin is sutured closed with stitches that gradually dissolve on their own. Plastic tubes are left in place to allow the drainage of any remaining blood from the space around the heart.

3. Aftercare

WHAT HAPPENS AFTER SURGERY?

After the operation is finished you will be taken to the Intensive Care Unit where you will be stabilised and your vital signs such as heart rate, blood pressure, and oxygen levels are closely monitored.


You may receive medication through a drip to help control your blood pressure. Your chest drain tubes are connected to a device with very gentle suction to make sure any blood is removed from the chest. You will also be connected to a ventilator.


If required, your surgeon will have put in ‘pacing wires’ which are small wires that allow temporary connection of an external pacemaker to help control your heart rate.


It will take between 6-12 hours after the surgery until you are fully awake and until this time, the breathing tube will need to be kept in your throat. Some people find the breathing tube and ventilator to be an uncomfortable experience but it is a crucial part of the process. The tube will be removed as soon as it is safe to do so but you will be required to wear an oxygen mask or nasal prongs for at least a day or so and in some cases, for a good deal of your hospital stay.


Your chest tubes will usually be removed the day after the operation and once this is done, you will be able to get out of bed and begin taking small walks with some assistance. You will be encouraged to be as active as possible and will be shown breathing exercises to help re-expand your lungs (they were collapsed whilst on the heart-lung bypass machine). Early mobilisation and active breathing exercises are extremely important to your recovery.


In order to control any pain, you will usually be given tablets regularly as well as a strong analgesia such as morphine. This is delivered either by a pump that you are able to control yourself (a PCA, patient controlled analgesia) or given by a nurse via injection into a vein or muscle.


You will be able to start drinking and perhaps eating very light meals the day following your operation and gradually build back up to your normal diet. Your intravenous drip is likely to remain in place for several days, longer if you need any medication such as antibiotics. Your urinary catheter is usually removed after a couple of days.


The normal Intensive Care stay is 2 nights, after which you will be transferred to the cardiac ward. The sternal (chest) wound is normally stitched with internal, dissolvable sutures and the scar is usually dry and able to be left without a dressing within a couple of days. You will become more and more independent until your discharge home.


Before you are discharged you will be given instructions regarding:


• Care of your wound

• Diet

• Exercise

• Continuing pain relief


In some instances you may be offered a cardiac rehabilitation program to guide you through your recovery and assist you to be as healthy as possible in the future.

1. Preparation

WHAT IS A HEART VALVE REPLACEMENT?

A heart valve replacement is a surgical procedure that is performed to replace a valve that is not functioning correctly.


Your heart has four valves that direct blood flow through the heart in one direction. Pressure changes on either side of each valve cause flaps to open and close with each heartbeat to regulate blood flow.


The four heart valves are:


  • Aortic
  • Mitral
  • Tricuspid
  • Pulmonary

Diastole – Blood is pumped from the atria into the ventricles.


Systole – Blood is pumped out of the ventricles to the lungs and the body.


In most cases the valves that require replacement are the aortic and mitral valves located on the left side of the heart. These two valves work harder than the tricuspid or pulmonary as they are responsible for controlling oxygen rich blood flow from the lungs to the rest of the body.


When having heart valve replacement surgery, your damaged valve or valves are removed and replaced with artificial valves. The three main classifications of artificial valves are:


  • Bioprosthetic – These valves come from animals and in order to avoid rejection, they are specially treated with chemicals.

  • Mechanical – These are valves made of materials such as metal, carbon or synthetics. To prevent blood clots when these types of valves are used, anticoagulation is required.

  • Biologic – These are valves taken from the human heart of deceased donors. Once the valves are removed from the donor, they are frozen for use at a later date.

There is a procedure performed where the patient’s own pulmonary valve is used to replace the diseased aortic valve and the pulmonary valve is then replaced by the donor valve.



heart-valve-replacement.gif

WHY IS IT DONE?

A heart valve replacement is required when the valve or valves are beyond repair due to the extent of damage caused by the following:


  • Damaged valves due to:

- rheumatic fever

- bacterial infection

- calcific degeneration


  • Degeneration from the normal ageing process
  • Abnormally formed valves due to birth defect

Stenosis and regurgitation are the two most common types of valve disease.


Stenosis – This is when the valve does not open completely, forcing the blood to flow through a narrowed opening.


Regurgitation – This is caused when the valve does not completely close and the blood flows backwards through the valve.


Because your heart pumps harder to compensate for the disease, insufficient circulation of the blood to the rest of the body occurs. Your heart can grow weaker and enlarge due to the additional work it needs to do, causing the following symptoms:


  • Increase in shortness of breath
  • Chest pain
  • Leg and ankle swelling
  • Increased fatigue
  • Dizziness
  • Fainting

HOW DO I CHOOSE A SPECIALIST?


Your GP or cardiologist will be able to recommend and refer you to a cardiothoracic surgeon who can perform the surgery.


You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the RoyalAustralasianCollege of Surgeons via their website www.surgeons.org. This is a very informative website.


The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of Cardio-thoracic Surgeons who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.


WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.


WHERE IS IT DONE?


A heart valve replacement is done in a hospital and the average length of stay is approximately 12 days.


HOW LONG IS THE PROCEDURE?

Depending on the number of valves being replaced, a heart valve replacement surgery can take two to four hours or more.


WHO IS INVOLVED?

The people involved in the procedure are:


  • The Cardio-thoracic Surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Perfusionist: a specially trained anaesthetist who operates the heart lung bypass machine
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Pathologist for blood tests and/or specimen samples
  • Radiologist for x-rays
  • You may see a physiotherapist after the procedure

HOW DO I PREPARE FOR THE SURGERY?

You will usually be required to attend a pre-admission clinic where you will undergo basic tests to assess your general fitness for surgery. These tests include an ECG (recording of your hearts’ rhythm), chest x-ray and blood tests.


If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.


The evening prior to your surgery, you will be asked to shower with an antiseptic soap and the operative area will be shaved or clipped. You may also be given a sedative that evening, and will usually have a pre-med before going to theatre the next day.


It is also important that you do not eat or drink anything from midnight prior to your morning surgery; if your operation is scheduled for the afternoon you shall be required to fast for at least 6 hours prior to surgery.


Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.


WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear warm comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans
  • You may also wish to bring something to read whilst you wait

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Heart Valve Replacement admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $31,790 $0 $31,637
1 Medical Services Component
Anaesthetic Services $4,660 $2,000 $2,537 $1,765 7.0% $0 93.0%
Assistant in Operations $671 $351 $293 $642 4.2% $0 95.8%
Cardio-Thoracic Surgical Services $4,116 $1,851 $1,697 $3,122 18.2% $0 81.8%
Diagnostic Procedures $254 $150 $104 $21 2.5% $0 97.5%
Miscellaneous Medical Services $2,554 $1,556 $887 $1,581 7.0% $0 93.0%
Pathology Services $1,522 $827 $632 $384 16.4% $0 83.6%
Specialist Consultation $926 $543 $371 $155 7.4% $0 92.6%
Radiology Services $1,240 $658 $473 $279 38.3% $0 61.7%
2 Total Average Medical Services $15,276 $7,587 $6,717 $1,973 49.1% $0 50.9%
Hospital and Medical Services Average for Heart Valve Replacement Admissions $47,066 $7,587 $38,354 $1,973 49.1% $0 5 50.9%

Heart Valve Replacement FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 116 overnight admissions with an average length of stay of 12.5 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) - covered under Medicare item 38488.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 These medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($15,276) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors' charges vary so always ask your doctor whether he/she will participate in HCF's No Gap arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all heart valve replacement admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

In most cases you will be admitted to hospital the day before your surgery. When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.


On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. Once this admission procedure is completed, you will be taken to the ward, where a nurse will perform a series of basic tests and assessments. You may be started on a blood thinning medication such as heparin to help prevent blood clots during the procedure.

Some hospitals will offer you and your close relatives the chance to visit the Intensive Care Unit on the day before surgery (this is where you will wake up and spend the first couple of nights post op). If you have never visited an Intensive Care unit, it can look a little daunting at first.

The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.

An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.

You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.

WHAT CAN I EXPECT DURING SURGERY?

Once in the anaesthetic room, if you do not already have one inserted, a small plastic needle called a cannula will be placed into a vein in your hand or arm. This will then be used to give you an intravenous sedative to put you to sleep (the first stage of your anaesthetic). You won’t remember anything more until you wake up in Intensive Care.


Once fully asleep, you will be taken to the operating theatre. Here you will be connected to a number of machines such as a ventilator to breathe for you and a heart lung machine which replaces the functions of the heart and lungs by adding oxygen to the blood and maintaining circulation. You will also have several catheters inserted to measure different pressures in your heart and to replace voiding manually.

An incision about 25 cms long will be made down the middle of your sternum and the rib cage will be opened to allow access to your heart to locate the valve that is faulty and loosen it from the tendons before removing it. The replacement valve is inserted and stitched in place. The heart is restarted with the help of controlled electric shocks and the heart lung machine is disconnected.

The sternum is then joined together again using wires and the skin is sutured closed with stitches that gradually dissolve on their own. Plastic tubes are left in place to allow the drainage of any remaining blood from the space around the heart.


3. Aftercare

WHAT HAPPENS AFTER SURGERY?

After the operation is finished you will be taken to the Intensive Care Unit where you will be stabilised and your vital signs such as heart rate, blood pressure, and oxygen levels are closely monitored.


You may receive medication through a drip to help control your blood pressure. Your chest drain tubes are connected to a device with very gentle suction to make sure any blood is removed from the chest. You will also be connected to a ventilator.


If required, your surgeon will have put in ‘pacing wires’ which are small wires that allow temporary connection of an external pacemaker to help control your heart rate.


It will take between 6-12 hours after the surgery until you are fully awake and until this time, the breathing tube will need to be kept in your throat. Some people find the breathing tube and ventilator to be an uncomfortable experience but it is a crucial part of the process. The tube will be removed as soon as it is safe to do so but you will be required to wear an oxygen mask or nasal prongs for at least a day or so and in some cases, for a good deal of your hospital stay.


Your chest tubes will usually be removed the day after the operation and once this is done, you will be able to get out of bed and begin taking small walks with some assistance. You will be encouraged to be as active as possible and will be shown breathing exercises to help re-expand your lungs (they were collapsed whilst on the heart-lung bypass machine). Early mobilisation and active breathing exercises are extremely important to your recovery.


In order to control any pain, you will usually be given tablets regularly as well as a strong analgesia such as morphine. This is delivered either by a pump that you are able to control yourself (a PCA, patient controlled analgesia) or given by a nurse via injection into a vein or muscle.


You will be able to start drinking and perhaps eating very light meals the day following your operation and gradually build back up to your normal diet. Your intravenous drip is likely to remain in place for several days, longer if you need any medication such as antibiotics. Your urinary catheter is usually removed after a couple of days.


The normal Intensive Care stay is 2 nights, after which you will be transferred to the cardiac ward. The sternal (chest) wound is normally stitched with internal, dissolvable sutures and the scar is usually dry and able to be left without a dressing within a couple of days. You will become more and more independent until your discharge home.


Before you are discharged you will be given instructions regarding:


  • Care of your wound
  • Diet
  • Exercise
  • Continuing pain relief

In some instances you may be offered a cardiac rehabilitation program to guide you through your recovery and assist you to be as healthy as possible in the future.

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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.