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Aortic valve replacement - Recovering from surgery

NHS Choices Medical Reference

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After an aortic valve replacement, you will be taken to an

intensive care unit

(ICU). Here, the activity of your heart, lungs and other systems will be closely monitored for the first 24 to 48 hours.

You may be kept asleep for a few hours after your operation, or until the following morning, and you will remain on a ventilator during this time.

Ventilator

A ventilator is an artificial breathing machine that moves oxygen-rich air in and out of your lungs. This is done through a tube, called an endotracheal tube (ETT), which is placed in your mouth and sometimes also in your nose. The tube will usually be held in place behind your neck.

When you wake up, the tube will still be in place and may be uncomfortable. You will not be able to talk or drink anything. Once the intensive care team are satisfied that you can breathe without aid, you will be taken off the ventilator and the tube will be removed. A mask will be placed over your mouth and nose to supply oxygen for you to breathe.

Pain

As with any major operation, you can expect to have some discomfort after an aortic valve replacement.

While you are in hospital, you will be given painkillers to help ease the pain after your anaesthetic wears off.

If the painkillers do not control your pain, tell a nurse or the doctor in charge of your care. You may need a stronger painkiller.

You will also be given advice about painkillers to take at home. You can expect to have some discomfort around the site of the operation, but this will start to feel better as the wound heals.

Moving to a ward

You will be moved from the ICU to a surgical ward once the doctors treating you are satisfied that you're ready. This will probably be a high dependency unit (HDU) for people who need to be kept under observation after an operation.

You may have several tubes and monitors attached to you. These could include:

  • chest drains - small tubes from your chest to drain away any build-up of blood or fluid (these will usually be removed the day after your operation)
  • pacing wires - if necessary, these will be inserted near the chest drains to control your heart rate (they will usually be removed after four or five days)
  • wires on sensor pads - these may be placed in various areas and can be used to measure your heart rate, blood pressure and blood flow, and the air flow to your lungs
  • a catheter - a tube that is inserted into your bladder so that you can pass urine

On the ward, your care team will focus on increasing your appetite and getting you back on your feet.

Depending on how well you progress, you should be able to leave the hospital 7 to 10 days after your operation.

Someone from the cardiac rehabilitation team or physiotherapy department should visit you before you go home to discuss your rehabilitation with you.

They can give you advice on how to get back to normal, and where there is a cardiac rehabilitation programme or support group in your area. The aim is to help you recover as quickly as possible and get back to living as full and active a life as you can, while preventing further heart problems.

Recovery time

The recovery time after aortic valve replacement surgery varies from person to person and will depend on:

  • your age 
  • your overall health and fitness 
  • how well you were before the operation

Your breastbone usually takes about six to eight weeks to heal, but it may be two to three months before you feel completely back to normal.

Going home

You are likely to be pleased and relieved to get home, but you may also feel anxious about your recovery and how you will manage without full-time nursing care. Take things slowly and at your own pace. It is common to experience some or all of the following mild and short-lived symptoms.

  • Loss of appetite - it may take a while for your appetite to return and you may temporarily lose your sense of taste. 
  • Swelling and redness - the site of your incision may be swollen and red, but this will gradually fade over time. Seek medical help if it becomes more, rather than less, painful. 
  • Insomnia - some people have problems either falling asleep or sleeping through the night. This should improve with time. Taking a painkiller before bed may help. 
  • Constipation - you may find it difficult to empty your bowels. Drinking plenty of fluid (1.2 litres or six to eight glasses a day) and eating plenty of fruit and vegetables will help. Your doctor may also suggest taking a laxative (a medication to help you pass stools more easily). 
  • Anxiety and depression - these are completely normal after heart surgery. Talking to your friends and family can help. If a cardiac or district nurse visits you, you may want to discuss it with them. You will start to feel emotionally stronger as you regain your health and strength. 

Caring for your wound

You will have a scar where the surgeon cut down your breastbone. The scar will be red at first, but will gradually fade over time.

Wash your wound using mild soap and water when you have a bath or a shower. In hospital, you should be able to have a shower after your pacing wires have been removed (after four or five days). Avoid very hot water and soaking in a bath until your incision wound has healed.

Protect the wound from exposure to sunlight during the first year after surgery because the scar will be darker if it is exposed to the sun.

Call your doctor if you notice:

  • increased tenderness around the incision site 
  • increased redness or swelling 
  • pus or oozing 
  • a high temperature of 38C (100.4F) or above

If dissolvable stitches have been used to close the wound, they should disappear within around three weeks. Other types of stitches may need to be removed by a healthcare professional. You will be given advice about this, and a follow-up appointment to have your stitches removed if necessary.

Sex after heart surgery

Before your operation, symptoms of fatigue or shortness of breath may affect your sex life. After your operation, you may feel like having a more active sex life. You can do so as soon as you feel able to, although avoid strenuous positions and be careful not to put any pressure on your wound until it has fully healed.

Some people find that having a serious illness can cause them to lose interest in sex. In men, the emotional stress can also cause impotence, where it is difficult to get and maintain an erection. If you are worried about your sex life, talk to you partner, a support group or your GP.

Driving after surgery

After your operation, you can be a passenger in a car straight away. However, you may not be able to drive again until around six weeks after you're discharged from hospital. Wait until you can comfortably do an emergency stop. If you are unsure, ask your surgeon for advice. If you drive a lorry or a passenger-carrying vehicle, you will need to tell the DVLA about your surgery.

Returning to work

When you can return to work will depend on the type of work you do, so ask your surgeon for advice. You may be able to return to work six to eight weeks after you have been discharged from hospital. However, if you do heavy manual work, it may up to three months before you can return to work. You may want to change your role to involve lighter duties, or speak to your occupational health department if your workplace has one.

Aortic valve

The aortic valve is the valve that controls the flow of blood out of the left ventricle of the heart, to the aorta (the body's main artery).
Medical Review: January 25, 2012
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