Here are answers to some of the most frequently asked questions regarding heart valve surgery. Be sure to discuss these and other questions with your physician before surgery and during follow-up visits. The questions are categorized for your convenience.

About Valve Surgery
After Surgery
About Artificial Valves

About Valve Surgery

How many other people have this surgery annually?
If you need to have valve replacement surgery, remember that you are not alone. There are approximately 225,000 heart valve procedures performed worldwide each year.

How long will I need to be hospitalized?
Conventional heart valve surgery typically requires a hospital stay of up to a week or more, followed by about six to eight weeks of recovery at home. Each patient recovers at a different rate. Your physician will work with you to determine the right amount of recovery time needed.

However, if your heart valve has been repaired or replaced by the less invasive method, your hospitalization stay and recovery period will be shortened.

Are there things I need to watch out for?
After surgery, some people experience fluid retention. This fluid buildup may overload the heart and make it work harder and less efficiently. To prevent fluid retention, your physician may recommend medications and/or dietary changes, such as a low-sodium diet.

You can help monitor fluid retention at home by weighing yourself every morning. Report any sudden weight gain of three pounds or more in one day, or five pounds in one week. Also, contact your physician if you experience unusual shortness of breath or observe swollen hands, ankles, or stomach.

In addition to watching for fluid retention, you should also call your physician if you experience any of the following signs or symptoms:

• chills, sweating, or fever of more than 100°F for a day or more
• cold or infection
• abnormal heart rhythm (heart beating fast or slow, or skipping a beat)
• pain in your shoulder or chest that becomes worse with deep breathing or coughing
• incision that swells, oozes, or becomes red and tender.

Will I need to take antibiotics before surgery or dental work?
Bacteria may enter the bloodstream during dental and some medical procedures. This bacteria may then cause an infection, known as bacterial endocarditis, in the tissue surrounding an artificial heart valve. Although this does not happen frequently, it can have serious consequences. The easiest and best defense is simply taking antibiotics before and after dental work and other medical procedures. Check with your physician before having any dental or medical procedures performed. Inform your dentist and any other physicians that you have an artificial heart valve.

Will I need to take medications after the surgery?
During your hospital stay, you will most likely be given several medications. One medication you will receive is an anticoagulant, warfarin (often called by its brand name Coumadin^®). Anticoagulants are given to help keep your new heart valve free from blood clots, which could adhere to the valve if the blood is not anticoagulated (thinned) enough. Whereas tissue valves may require several months of anticoagulant treatment following surgery, mechanical valves require lifelong treatment with anticoagulants.

Your physician will determine the level of anticoagulant that is right for you based on the guidelines and your medical situation.

According to the American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Prosthetic Heart Valves¹, the following International Normalized Ratios (INR) are recommended for bileaflet valves:

*Risk factors: Atrial fibrillation, Left Ventricular dysfunction, previous thromboembolism, and hypercoagulable condition.

For complete INR Guidelines, please see the American Heart Association website.

To maintain proper levels of anticoagulation, take your medication as prescribed and follow-up with blood tests as scheduled. The blood tests drawn to indicate the anticoagulation level of the blood are the PT, or prothrombin time, and the INR, international normalized ratio. Always wear or carry patient identification with you that indicates the medications you are taking, their dosages, your PT and INR levels, and the fact that you have received a new heart valve.

Check with your physician if you are on anticoagulants and experience any of the following: excessive bleeding; excessive bruising; blood in your urine; bloody or black, tarry stools; unusual nosebleeds; bleeding gums; possible pregnancy; and fever or other illnesses that include vomiting, diarrhea, or infection.

Remember, take only those medications that are prescribed by your physician. Anticoagulants may be affected by many other medicines, so always check with your physician or pharmacist before taking any other medication, including over-the-counter products such as aspirin.

Certain foods and alcohol may also affect how your anticoagulant works, so it is important to discuss your diet with your physician. Some slight modifications may be necessary.

¹ACC/AHA Practice Guidelines, Guidelines for the Management of Patients With Valvular Heart Disease. Circulation;98:1949-1984.

After Surgery

Can I continue my active lifestyle?
Valve replacement does not mean a sedentary lifestyle. A progressive increase in activity over time will improve your strength and endurance. The goal is a well-conditioned heart muscle that pumps more effectively. Walking is one of the simplest and most effective forms of exercise to improve heart function. More aerobic exercise, such as a brisk walk, swimming, or bicycle riding, will provide cardiovascular conditioning. Talk with your physician and follow his/her advice about what is the best exercise program for you. Many people who receive new heart valves are able to lead more active lives than they did before surgery.

But for the first six to eight weeks after surgery, take things slowly. You will gain more energy with each day. Rest when you get tired. Ask your physician what you can and can't do as you recover. He or she will also let you know when you will be able to return to work.

To read some patient testimonies about their active lifestyles after heart valve replacement, click here.

How can I get an identification bracelet?
It is important to have some type of identification that indicates you have had a heart valve replaced. Additionally, if you are on anticoagulant medication, this information should be included on the identification. A bracelet, necklace, or wallet card are all good ways of identifying this important information.

You may purchase a medical identification bracelet or necklace from a jeweler or pharmacy. Or call "Medic Alert" at 1-800-432-5378.

What should I be eating?
A heart-healthy diet is recommended for everyone, but especially for people who have any type of heart disease, including heart valve disease, or for those who have had valve surgery. Surgery for heart valve replacement or repair does not eliminate the possibility of developing further heart disease.

Use fats and oils sparingly, avoiding saturated fats (e.g., butter, cream, cheese, fatty meats, and bakery products). Try to prepare your food by grilling, microwaving, and baking. Choose low-fat foods, such as lean meats, poultry, fish, fresh fruits, and vegetables, as well as whole-grain breads and cereals. Ask your physician to help you develop a heart-healthy diet.

Is it okay for me to undergo diagnostic tests (e.g., MRI, CT scans)?
Mechanical heart valves are made of materials that are compatible with magnetic resonance imaging (MRI), computed tomography (CT) scans, and X-rays. But it is important to check with your physician before any diagnostic testing is done, even if the test is for a health problem that is not heart-related.

About Artificial Valves

How often will my valve need to be checked?
Long-term management of your health requires active participation. Your physician will tell you how often to return for regularly scheduled follow-up visits.

During these visits, blood tests may be done to monitor your medication levels, especially your anticoagulation levels. To check healing, your physician may also order chest X-rays, echocardiograms (to check valve function), or electrocardiograms (to show any abnormal heart rhythms).

Your physician will also discuss other factors affecting your health during these visits. Follow your physician's advice/guidelines regarding diet, exercise, and medications. Always keep your scheduled appointments.

What is the sound I hear coming from my chest? What does it mean?
Some patients have indicated that they hear a clicking sound during quiet or restful times. If you hear this sound, rest assured; it just means that everything is working fine. This sound is actually the sound of the mechanical valve leaflets closing.

This sound is heard by some patients and not others. Each patient's anatomy and physiology affects the quality of the sound. Mechanical valves sound differently in each patient. The St. Jude Medical^® mechanical heart valve has been shown in studies to be one of the quietest mechanical heart valves available.

If your valve is new and you are noticing this different sound, understand that many patients grow accustomed to the sound with time. It becomes like "white noise" in the background that grows unnoticeable. There is some comfort in knowing that if you hear the sound, you can be assured that the valve is working properly and keeping you alive.

How long will the valve last?
The St. Jude Medical^® mechanical heart valve is made of graphite and coated with pyrolytic carbon. Studies have shown that the valve will not wear out during the patient's lifetime. However, if there are problems with blood clot formation, the valve may need to be replaced.

But a tissue valve, which is composed of living tissue, may have a shorter life span than a mechanical valve. The symptoms of valve failure may be the same symptoms you experienced before surgery (e.g., shortness of breath, dizziness, chest pain, fatigue, fluid retention). If one or more of these symptoms occur, notify your physician.

Where can I see a picture of my valve?
The patient information section that discusses heart valve disease and therapy shows pictures of different St. Jude Medical^® heart valves. To get there now, click here.