Precautions to be taken after Aoric valve replacement surgery?

Question

My FIL had successful Aortic valve replacement surgery of Heart recently. He is recovering slowly. Please mention do's and don'ts under the circumstances.

Answer 1

Aortic valve replacement recovery is a lot like open heart surgery recovery (indeed most AVR has at least one bypass too). Recovery is very individual. It is highly dependent on the shape of the patient PRIOR to the surgery. People who were largely sedentary, have multiple concurrent diseases (diabetes, kidney insufficiency, COPD, etc) tend to take even longer than the average to recover - likewise healthy active people tend to bounce back from the surgery.

Regardless it will take 12 months before your FIL is fully recovered. The first month is the worst and progress is typically slow. The next few months also have a steep curve but it gets increasingly better. He should be about 90% at six months. The next six months with garner gradual improvements for several more months.

One mistake people make is that they continue to observe the directions provided them the week after they are discharged from the hospital, months even a year later. Activity should be "as tolerated." If you CAN do more, you SHOULD do more.

Gentle physicial activity is fine and recommended as tolerated; for instance, with walking, progressively more and more as tolerated, it is very hard to over do it. On the other hand training for a marathon is over the top.

Lifting or carrying very much weight at all (20 pounds or less) is not recommended until at least eight weeks after the surgery. That gives the sternum time to heal. Pain with lifting may still be evident months later while the bone continues to heal - but after 8 weeks it is hard to do damage.

It is common to have plueral effusions - fluid around the lung bases as part of the healing process. This often causes shortness of breath, reduced appetite, and difficulty breathing with laying flat. If effusions are present, they can be found by chest xray. A diuretic (or extra diuretic) can be added to help them resolve.

When appetite comes back, I usually feel like the patient has turned the corner on recovery. Patients tend to do very well from there on out.

Depression is very, very common after this procedure. Your FIL should be evaluated by his PCP for this problem. If evident then it should be treated. It will make a large difference in the speed of his recovery. Note: men sometimes are hostile or angry rather than sad when depressed.

Lastly I would encourage your FIL to participate in a cardiac rehab program - even if its a long drive, etc. It is very important to interact with others who are going through the same thing. Also it is important to have a professional encouraging your FIL to increase his activity, etc.

I hope this helps. Good luck.

Answer 2

This is a routine, well established procedure. The incidence of major complications are less than 4%. There are two kinds of artificial Heart Valves. One is mechanical, and the other is tissue valve. The mechanical valve requires the person to be on life long anti-coagulation therapy. This also requires periodic check on the persons pro thrombin time. Based on this, the anti-coaglation dose will be adjusted. The problem with anti-coagulation is that it may lead to bleeding complications. The tissue valve is made from the tissues of a bovine or porcine heart. The tissue is denatured to ensure that the valve is not rejected as a foreign tissue. (This is not a problem with mechanical valves.) Being made of tissue, these valves do not allow clots to form, which means that anti-coagulation after a short initial period is not required. This is a major advantage, especially for women, who may have some earlier bleeding problems. Then why are mechanical valves used at all? Being made from non-living denatured tissue, tissue valves cannot repair themselves. They also tend to get calcified in younger people with more calcium activity. They also have a shorter life than mechanical valves. Surgeons tend to favour mechanical valves for younger people (whose life expectancy is higher), and the tissue valve for the older, as such people may already have some bleeding problems, the valve's durability is not critical and the patient has lower calcium activity. These are general considerations. Only a surgeon armed with the full test results, and a knowledge of the patient history, who can advise the patient on what is the best option in each case. To reiterate, AVR (Aortic Valve Replacement, not my initials) is a routine procedure and recovery tends to be uneventful. Wish you all the best, and as uneventful a recovery as possible.