Before the heart valve procedure

Before surgery, the patient will undergo a number of tests, which may include:

• Urine and blood tests. These are done to ensure that the patient is in good overall health for undergoing surgery. Blood tests to assess blood clotting (coagulation tests) include an INR or prothrombin time (PT), partial thromboplastin time (PTT), bleeding and clotting times, and a platelet count.
  
  
• Electrocardiogram (EKG). A recording of the heart’s electrical activity as a graph on a moving strip of paper or video monitor.
  
  
• Echocardiogram. This test uses sound waves to visualize the structures and functions of the heart. A moving image of the patient’s beating heart is played on a video screen, where a physician can study and measure the heart’s thickness, size and function. The image also shows the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation) or narrowing (stenosis).
  
  
• Chest x-ray. A radiation–based imaging test that offers the physician a picture of the general size, shape, and structure of the heart and lungs.
  
  
• Cardiac catheterization and angiogram.

Depending on the procedure, a patient may also be advised to visit a dentist prior to the surgery to check for any infections.

Patients undergoing open-heart surgery to either repair or replace a defective valve should prepare in advance for a hospital stay of four to six days.

Eight hours before surgery, all patients are placed on NPO (non per os; nothing by mouth) status. That means they are not permitted to eat, drink or take anything by mouth until after their surgery. Smokers will have been advised to completely avoid smoking for at least two weeks before their surgery to prevent problems in breathing, reduce secretions and facilitate necessary coughing. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their cardiologist before surgery.

Immediately before surgery, the patient will be given specific pre-operative medications and then “prepped” for surgery. First, the chest area is shaved. Next, the surgical team provides a sterile environment by swabbing the patient’s chest with an antiseptic solution and covering the patient in sterile surgical drapes. An intravenous (I.V.) line will also be started, usually in the forearm or back of the hand.

The patient is then given a sleep-inducing medication through the intravenous (I.V.) line. The patient will continue to breathe a mixture of oxygen and anesthetic gas (general anesthesia) to make sure that he or she remains asleep throughout the entire surgery.