Treatment and monitoring after heart valve surgery

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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 medication and monitor the new valve for problems throughout your recovery.

After valve replacement, you should consider two types of medication: anticoagulants (also known as blood thinners) to prevent blood clots, and antibiotics. Regardless of the type of valve used, you will need to take anticoagulant medication (usually warfarin [for example, Coumadin], although heparin and aspirin are also sometimes used) for the 3 months following surgery. During this time, you are at the greatest risk of a blood clot forming around the new valve. Blood-thinning agents will prevent this. Blood clots that form around valves can break off and travel to the brain, which can cause a stroke.

Heart surgery, such as valve surgery, also can cause an irregular heartbeat (atrial fibrillation). Atrial fibrillation also can cause clots to form, and blood-thinning medication can help prevent these clots. Blood thinners commonly used after valve surgery are summarized below.

**Common blood-thinning medications**
Generic name	Brand name
Warfarin	Coumadin, Jantoven
Heparin	Heparin lock flush solution
Heparin	Heparin sodium injection
Aspirin	Over-the-counter medication sold under many brands, including Bayer, Ecotrin, and many store brands

If your valve has been replaced with a mechanical valve, you will need to take blood thinners indefinitely 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 medication 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 medication is more complicated. Two-thirds of 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, getting an infection in your heart (endocarditis) can be very dangerous for you. To prevent an infection, you may need to take antibiotics before you have certain dental or surgical procedures.

How do I check for problems with my new valve?

It is important to know that you are not cured once 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 indications are similar to those that signaled that the original valve was wearing out: a heart murmur and occasionally symptoms such as shortness of breath and fainting. These signs may be spotted during annual visits to your doctor. Some doctors recommend echocardiograms 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. However, most doctors recommend waiting for signs of change in the valve (by detecting a new heart murmur).

Credits

Author	Merrill Hayden
Editor	Kathleen M. Ariss, MS
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Updated	February 1, 2006

Last updated:	February 01, 2006
Author:	Merrill Hayden
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Terrina Vail

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