Definition and Overview

A heart valve surgery follow-up is an appointment with the cardiovascular surgeon and a cardiologist after the surgery has already been completed.

A heart valve surgery is the only treatment option for patients diagnosed with serious heart valve disease or a congenital valve defect that can no longer be treated with medications and other non-surgical treatments.

The heart has four main valves called the aortic, tricuspid, mitral, and pulmonary valves. Any of these valves can be affected or damaged, although the most commonly treated ones are the aortic valve, which is in between the left atrium and the aorta, and the mitral valve, which is near the left ventricle. In cases that involve the mitral valve, the surgery is focused on repairing it while damage to the aortic valve typically requires valve replacement.

A heart valve surgery can be either invasive or minimally invasive. The latter is often performed when the valve has weakened and it needs to be reinforced. One of the techniques used is catheterization where catheters are used to introduce a collapsible balloon to expand the stenotic valve to clear the path. A stent is then used to keep the pathway open after the balloon has been removed.

In a more invasive surgery, a valve is replaced with a synthetic or a biological valve, which may come from a tissue of a human or an animal such as a bovine.

Who Should Undergo and Expected Results

A heart valve surgery follow-up is scheduled:

  • Following the heart valve surgery – A heart valve surgery, even if it’s minimally invasive, has risks and complications. The surgeon makes a follow-up to ensure that these are managed or prevented so they do not affect the patient’s healing process.

  • When the patient develops symptoms – Some patients who have undergone a heart valve surgery may experience symptoms such as lightheadedness or dizziness. The follow-up is meant to monitor these symptoms and ascertain they are related to the surgery or the condition of the heart’s valves.

  • If the patient is referred by the cardiologist – Although the cardiologist is an expert in heart conditions, he doesn’t have surgical expertise. Thus, any question or concern that may be related to the surgery warrants a referral to the surgeon who performed the procedure.

  • Continued counselling for the patient – Following the surgery, it’s extremely important that preventive and management approaches are in place to ensure the valve is not diseased again or harmed further. A follow-up is a good way to continue to educate the patient on these proactive interventions.

How Does the Procedure Work?

Normally, it takes around four to six weeks after surgery before the patient is fully recovered. It may take longer if complications develop. However, the patient spends only a few days in the hospital, and the rest of the recovery period occurs while on discharge. Therefore, most of the follow-up sessions are performed on an outpatient basis.

The first follow-up normally occurs within two to four weeks after the surgery. The surgeon is expected to monitor the patient’s progress, check for any complication, and address symptoms if there are any. The surgeon also takes this opportunity to provide pointers on follow-up care, which may include wound dressing and management, exercise, diet and activities such as work. The surgeon then informs the patient about the best time to return to his job and the kinds of exercises he can perform while recovering.

In the succeeding follow-up sessions, the surgeon determines how the patient is faring after returning to his normal routine. Based on the patient’s needs, he may be referred to other healthcare professionals such as a physical therapist or a cardiothoracic specialist.

Usually, once the patient has fully recovered, the follow-up care with the surgeon ends. However, the patient continues to meet with the cardiologist for monitoring.

Possible Risks and Complications

Because of the risks and complications associated with a heart valve surgery, it’s essential that close monitoring is achieved through follow-up sessions. However, it’s possible that the patient may skip, ignore, or forget these especially when he feels better. To prevent this from happening, the surgeon should be able to emphasize the significance of cooperating as early as during the initial consultation.

References:

  • Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.

  • Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 66.

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