Benefits and risks with heart valve procedures

The prognosis after heart valve surgery is good, and most patients can expect to resume normal activities within a few months. A successful surgery will restore proper valve functions in the heart. Signs such as heart murmurs or enlarged heart chambers should be resolved, as well as any symptoms that the patient may have been experiencing (e.g., fatigue).

However, the resumption of normal activities and energy levels can take six months to a year in some patients, particularly if they have lung-related conditions such as pulmonary hypertension. As long as their echocardiogram after surgery is normal, patients are generally encouraged to keep pushing themselves throughout the recovery process, striving to be as active as usual.

Although a successful surgery will restore proper valve functions in the heart and eventually resolve both signs (e.g., heart murmurs) and symptoms (e.g., fatigue) of valvular heart disease, there are a number of potential complications that could arise during or after the operation. They include:

• Excessive bleeding
• Infection at the incision site
• Circulation disorders, including fluid retention and swelling (edema)
• Kidney damage or failure
• Heart attack or heart failure
• Numbness in the face, arms or legs
• Breathing difficulties
• Cardiac arrest (in which the heart abruptly stops pumping)
• Deep vein thrombosis (the formation of an obstructing blood clot in a deep vein, usually in the leg)
• Stroke
• Embolism

As with any invasive procedures, surgical risk increases with:

• Decreased function of the left ventricle prior to surgery
• Advanced age
• Obesity (body mass index of 30 or greater)
• Excessive use of alcohol or drugs (e.g., sedatives, sleep inducers, narcotics)
• Smoking (either before or after the procedure)
• Use of certain medications, such as antihypertensives and muscle relaxants

Though the risk of death following valve replacement is small, risk may increase when more than one valve is being replaced during the same procedure. In addition, research has suggested that shorter patients (under 5 feet, 1 inch tall) are at higher risk following an aortic valve replacement procedure.

If a biological valve is used, the patient may be prescribed anticoagulants for a few months to reduce the risk of blood clots. The condition of a biological valve should be reassessed annually because it has a tendency to deteriorate over time. After about 10 years, a second replacement procedure may be necessary. If a mechanical valve is used, patients will continue taking anticoagulants for the rest of their lives because they are at greater risk of blood clots.

In some rare circumstances, abnormal heartbeats (arrhythmia) may develop after the surgery. These can usually be controlled with the temporary use of medication, but occasionally permanent medication use or the implantation of a pacemaker is necessary.