Treatment and monitoring after heart valve surgery

Valve replacement surgery is a type of open-heart surgery, and recovering from major surgery can be a long process. You may need to take medicine and monitor the new valve for problems throughout your recovery.

Anticoagulants. After valve surgery, you will take anticoagulants (also called blood thinners). This medicine is needed because you have a higher risk for blood clots. After heart valve replacement surgery, both warfarin (such as Coumadin) and one of several types of anticoagulant medicines—a low-molecular-weight heparin, an unfractionated heparin, or another antithrombotic medicine—are started. Warfarin is given in pill form while the other medicines are given as a shot. The injected medicines (low-molecular-weight heparin, unfractionated heparin, and an antithrombotic medicine called a selective Factor Xa inhibitor) act immediately. Warfarin takes several days to become effective. When warfarin begins to work, the other medicines are stopped.

Anticoagulants, especially warfarin, may be used if you have an irregular heartbeat called atrial fibrillation. Atrial fibrillation can cause blood clots in the heart that can cause a stroke.

If your valve has been replaced with a mechanical valve, you will need to take warfarin for the rest of your life because the risk of clots never goes away. Some doctors also recommend taking low doses of aspirin in addition to warfarin if you have had the aortic valve replaced. This is for two reasons: Aspirin can reduce the risk of other cardiovascular diseases, and the risk of a blood clot obstructing your aorta or pulmonary arteries is higher with aortic valve replacement. Aspirin can help further reduce the risks of postsurgery problems, which is why some doctors will add it to your warfarin therapy. Other doctors do not believe that aspirin lowers risk factors enough to justify adding another medicine to your regimen. Also, it can further increase your risk of excessive bleeding because of its anticlotting effect, which is already a problem with warfarin therapy.

If your valve has been replaced with a biological or tissue valve, the use of anticoagulant medicine is more complicated. Most people who have biological valves are able to stop taking warfarin or aspirin. But if you have a history of atrial fibrillation or presurgery problems with clots forming, you will likely need to take anticoagulants indefinitely because your risk of developing clots that could cause a stroke is still high.

If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis.

How do I check for problems with my new valve?

It is important to know that you are not cured after you have had a valve replacement. You still have a serious heart condition that must be monitored. Unfortunately, although scientific progress continues to improve valve technology, all artificial heart valves eventually deteriorate and will need to be replaced.

You and your doctor will need to monitor the new valve periodically for signs that it is wearing out. These signs are similar to those that signaled that the original valve was wearing out: a heart murmur and sometimes symptoms such as shortness of breath and fainting. These signs may be spotted during annual visits to your doctor. Some doctors recommend echocardiograms (echos) at these visits, while others believe that echos should be performed only if there are symptoms or signs of deterioration.

Biological valves last about 10 to 15 years when replacing the aortic valve. Again, there is disagreement, but some doctors recommend echos annually after these milestones, depending on which valve(s) you have had replaced and if you have a biological valve. But most doctors recommend waiting for signs of change in the valve (by detecting a new heart murmur).

Last Updated: January 7, 2010

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