WESTBOROUGH, MA March 28, 2016 Whenever surgery is recommended there are inherent risks that should be understood. The fast answer is “yes, there are risks when you replace someone’s aortic valve.” But not so fast.
Cardiac surgery has become almost commonplace in the current medical society. Here in the Boston area there are several heart centers providing surgical treatments and risks have been greatly reduced in the past 25 years. Procedures are now minimally invasive and require much less recovery time than the former procedures. Many centers are also using robotic assistance in valve replacement. There are at least 3 major centers in Boston with excellent surgical teams. Your physician will discuss these with you but the patient must understand the risk versus reward conundrum. You can read the list below for a bullet point visual. This is the case whenever one embarks on treatment – “what are the risks of taking one drug over another?” or “is there a risk when I undergo surgery to replace a stenotic heart valve?
One’s heart valves are meant to last a lifetime. The heart valves are paper thin and amazingly flexible and strong. The majority of people are born with the valves they will have at the end of life – 5-6 billion beats later. Arguably the greater risk associated with valve replacement surgery may be linked to the pre-surgical health of the recipient of the valve. It is common that patients have multiple comorbid medical conditions such a diabetes, poor cardiac health, hypertension, and obesity. The outcomes become only slightly murky with the host of illnesses I just cite.
My role in the cardiac rehabilitation is to assess cognitive functions when necessary. This includes concentration, attention, S-T memory, problem solving, and higher order thinking skill. It is not uncommon for patients to have altered mental status following surgery. Sometimes this is simply the result of pain cocktail and anesthesia but other conditions can contribute to changes in one’s cognition as well. Sometimes I am asked to provide support and counseling for those few patients who exhibit affective changes or frank signs of depression. On occasion behavior therapy is needed to redirect idiosyncratic motor restlessness or agitation. In general the goal of cardiac rehabilitation is to enhance functional capacity in the areas of endurance, physical fitness and activities of daily living to regain their independence. Full recovery requires a change in habits and lifestyle. This takes time.
The rehabilitation process is a continuum of care provided to those recovering from surgery who may be ready for the changes that will take them forward. This includes physical exercise and the nutritional support needed to enhance patient outcome.
The vast majority of patients who undergo valve replacement surgery sail right through it and never come to hospital acute rehabilitation. Most are referred to outpatient rehabilitation where they stay at home and attend rehabilitation during the day. For those who are sent for inpatient rehabilitation they wrestle with fatigue as much as anything. Many were in poor physical shape prior to surgery because of the insidious impact of declining cardiac health in the months or years prior to the procedure. Post surgical depression is common in as many at 25-40 % of cases. Psychotherapy and coaching can assist in the management of feelings that are sometimes present during recovery. I have heard “why am I doing this…” just as much as: “I can do this and have a second chance for health…”.
Risks of valve replacement
- Blood clots
- Cardiac arrhythmia – atrial fibrillation
- Excess bleeding
- Transient ischemia or stroke
- Kidney failure
- Death – 1-2 %
NHS – UK website – taken 3-10-2016
The Cleveland Clinic has a wonderful video that is attached.