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Patient Instructions

You had surgery to repair or replace one of your heart valves. Your surgery may have been done through a large incision (cut) in the middle of your chest, through a smaller cut between 2 of your ribs, or through 2 to 4 small cuts.

After your operation, you will probably spend 3 to 7 days in the hospital. You may begin learning exercises to help you recover more quickly.

It will take 4 to 6 weeks to completely heal and start feeling better after surgery. During this time, it is normal to:

• Have some pain in your chest around your incision
• Have a poor appetite for 2 to 4 weeks
• Have mood swings and feel depressed
• Feel itchy, numb, or tingly around your incisions for 6 months or more
• Be constipated from pain medicines
• Have difficulty with short-term memory or feel confused or “fuzzy-headed”
• Be tired or not have much energy
• Have trouble sleeping. You should be sleeping normally within a few months.
• Have some shortness of breath
• Have weakness in your arms for the first month

Someone who can help you should stay with you in your home for at least the first 1 to 2 weeks.

Stay active during your recovery, but be sure to start slowly and increase your activity little by little.

• Do not stand or sit in the same spot for too long. Move around a little bit.
• Walking is a good exercise for the lungs and heart after surgery. Take it slowly.
• Climbing stairs is okay, but be careful. Balance may be a problem, so hold onto the railing. Rest part way up the stairs if you need to.
• You can do light household chores, such as setting the table or folding clothes.
• Stop if you feel short of breath, dizzy, or have any pain in your chest.
• Do not do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or lifting weights.

Do not drive for at least 4 to 6 weeks after your surgery. The twisting movements needed to turn the steering wheel may pull on your incision.

Expect to take 6 to 8 weeks off work. Ask your doctor when you may return to work.

Do not travel for at least 2 to 4 weeks. Ask your doctor when you can travel again.

Return to sexual activity gradually. Talk openly with your partner about it.

• Usually it is okay to start after 4 weeks, or when you can easily climb 2 flights of stairs or walk a half-mile.
• Keep in mind that anxiety, and some medicines, may alter arousal and performance for both men and women.
• Men should not use medicines for impotence (Viagra, Cialis, or Levitra) until their doctor says it is okay.

For the first 6 weeks after your surgery, you must be careful how you use your arms and upper body when you move.

Do NOT:

• Reach backwards
• Let anyone pull on your arms for any reason -- for instance, if they are helping you move around or get out of bed
• Lift anything heavier than 5 to 7 pounds for about 3 months
• Do other activities that keep your arms above your shoulders for any period of time

Do these things carefully:

• Brushing your teeth
• Getting out of bed or a chair. Keep your arms close to your sides when you use them to do this.
• Bending forward to tie your shoes.

Stop any activity if you feel pulling on your breastbone.

Use mild soap and water to clean your incision area. Wash your hands with soap and water first, then gently rub up and down on the skin with your hands or a very soft cloth. Use a washcloth only when the scabs are gone and the skin has healed.

You may take showers, but limit them to 10 minutes. Make sure the water is warm, not too hot or cold. Do not use any creams, oils, or perfumed body washes. Apply dressings (bandages) the way your doctor or nurse showed you.

Do NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Keep the incision dry.

Learn how to check your pulse, and check it every day. Do the breathing exercises you learned in the hospital for 4 to 6 weeks.

Follow a heart-healthy diet.

If you feel depressed, talk with your family and friends. Ask your doctor about getting help from a counselor.

Continue to take all your medicines for your heart, diabetes, high blood pressure, or any other conditions you have. Do not stop taking any medicine without talking with your doctor or nurse first.

You may need to take an antibiotic before any medical procedure or when you go to the dentist. Tell all of your health care providers (dentist, doctors, nurses, or nurse practitioners) about your heart problem. You may want to wear a medical alert bracelet or necklace.

Your doctor may ask you to take blood-thinning medicines to help keep your blood from forming clots. Your doctor might recommend one of these medicines:

• Aspirin or clopidogrel (Plavix)
• Warfarin (Coumadin). If you are taking warfarin, you will need to have regular blood tests. You may be able to use a device to check your blood at home.

Call your doctor or nurse if:

• You have chest pain or shortness of breath that does not go away when you rest.
• Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
• You have dizziness or fainting, or you are very tired.
• You have a severe headache that does not go away.
• You have a cough that does not go away.
• You have redness, swelling, or pain in your calf.
• You are coughing up blood or yellow or green mucus.
• You have problems taking any of your heart medicines.
• Your weight goes up by more than 2 pounds in a day for 2 days in a row.
• Your wound changes. It is red or swelling, it has opened, or there is more drainage coming from it.
• You have chills or a fever over 101 °F.

If you are taking blood thinners, call your doctor if you have:

• A serious fall, or you hit your head
• Pain, discomfort, or swelling at an injection or injury site
• A lot of bruising on your skin
• A lot of bleeding, such as nosebleeds or bleeding gums
• Bloody or dark brown urine or stool
• Headache, dizziness, or weakness
• An infection or fever, or an illness that is causing vomiting or diarrhea
• You become pregnant or are planning to become pregnant

Aortic valve replacement - discharge; Aortic valvuloplasty - discharge; Aortic valve repair - discharge; Replacement - aortic valve - discharge; Repair - aortic valve - discharge; Ring annuloplasty - discharge; Percutaneous aortic valve replacement or repair - discharge; Balloon valvuloplasty - discharge; Mini-thoracotomy aortic valve - discharge; Mini-aortic replacement or repair - discharge; Cardiac valvular surgery - discharge; Mini-sternotomy - discharge; Robotically-assisted endoscopic aortic valve repair - discharge; Mitral valve replacement - open - discharge; Mitral valve repair - open - discharge; Mitral valve repair - right mini-thoracotomy - discharge; Mitral valve repair - partial upper sternotomy - discharge; Robotically-assisted endoscopic mitral valve repair - discharge; Percutaneous mitral valvuloplasty - discharge

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.