As you know, a 3D ring (annuloplasty ring) is usually used at the end of the valve surgery. This artificial material is paid for by the patient.
No pain after surgery is our priority. Painkillers are prescribed depending on the patient's sensitivity, mental status, kidney function, age and surgical incision. Both the anesthesiologist and surgeon will give you some postoperative movement recommendations. There is less pain and more freedom of movement after minimally invasive surgery without sternum dissection.
Generally, there may be pain in your chest, back, shoulder blades and shoulders after heart surgery. You should use prescription painkillers correctly. Gentle massage can help reduce pain and relax the muscles in your back and shoulders. Taking a warm shower can also have a good effect on your pain.
The patient's individual characteristics and condition before surgery play a big role here. However, this time is more dependent on the location of the incision:
The patient is discharged 6-7 days after sternum surgery. The full recovery period takes 3 months. Some people (if they feel in good shape to work and do not work hard) can go to work in 6 weeks.
Patients who do not have a thoracic incision (i.e., a minimally invasive intercostal incision) are discharged 2-3 days after surgery. The recovery period takes 2-3 weeks. They can go to work in 3-4 weeks (even if it is heavy physical work).
First of all, let's clarify in which cases it is necessary to abstain from sexual activity altogether:
- Unstable angina (chest pain): that is, more frequent, pre-existing chest pain that worsens or occurs at rest
- Chest pain occurring recently
- Uncontrolled arterial hypertension (high blood pressure).
-Serious heart failure: presence of severe dyspnea at rest and during minimal movements
- Myocardial infarction that occurred within the last week.
- Certain rhythm disorders, especially if they originate in the ventricular area of the heart (ventricular arrhythmias)
- Valvular heart disease accompanied by severe complaints
Although all of these conditions increase a patient's risk of cardiac arrest, they do not mean "the end of the sex life." After appropriate surgery or treatment, the patient returns to sexual activity.
It is difficult to say exactly when sexual activity begins after heart surgery. Some authors note that a patient who can comfortably walk up 2 floors can begin to have sex.
However, a large number of studies have acknowledged that sexual activity can begin 6 to 8 weeks after heart surgery performed by sternal dissection. In the early stages, positions that do not involve the sternum are recommended. If the surgery is performed with a mini-incision, i.e., between the ribs, sexual activity can begin in 1-2 weeks.
It should be noted that although some postoperative medications affect sexual function, the main cause of postoperative sexual function weakness is psychological factors such as fear and depression. These factors are easily treated by experienced doctors.
You should tell your doctor if you have any of the following symptoms during intercourse:
Heart palpitations and shortness of breath lasting more than 5 minutes after intercourse
Chest pain during or after intercourse
Feeling very tired 1 day after sex
If you had surgery involving a sternal incision, you are not allowed to turn right or left in bed for 6 weeks, to make any sudden movements for 8 weeks, or to lift weights (more than 5 kg in one hand or more than 10 kg in two hands) for 12 weeks.
If you have had minimally invasive heart valve surgery or other heart surgery, you may lie in any position after 1 day, move with any intensity after 2 weeks, and lift any heavy weight after 3-4 weeks.
Note: The above times may be affected by the individual patient and the musculoskeletal condition prior to surgery.
You need to be patient during the recovery period. A slight feeling of weakness and fatigue is normal after heart surgery. Often this period will progress and the patient will feel better day by day. Sometimes you may need to take pain medication for several weeks, especially at night.
Try not to walk in very hot or very cold weather. Try to walk in normal weather conditions every day. Try to walk on a level surface, not uphill. You should have a chaperone when you walk during the first month.
Keep your walking speed at a level where you can comfortably talk to the person next to you. For the first week, walk 15-20 minutes each day. Each following week, add 5 minutes. After 2 months, you should be able to walk at least 45-60 minutes a day.
It depends on which incision you had surgery with:
After surgery with a sternal incision, 6 to 8 weeks.
If the surgery is done without a sternal incision (intercostal incision) - you can drive even after you are discharged from the hospital.
If you are not driving, sit in the back. Do not go on long trips. If you must, stretch your legs after an hour on trips. Be sure to wear elastic stockings before starting your trip.
It is encouraging that minimally invasive heart surgeries, which are widely used all over the world, are already performed in our country. In the Republican Diagnostic Center minimally invasive heart surgeries, which are considered to be a modern method of cardiovascular surgery, are successfully performed.
The development of cardiovascular surgery in general is determined by two factors: artificial circulation and full dissection of the sternum in the middle. However, both methods have disadvantages. For this reason, in recent years, cardiovascular surgeons have tried to avoid one or both of these factors. Unfortunately, this is not always possible.
While coronary artery surgery (aorta-coronary bypass) (working heart surgery) can avoid artificial circulation, in valve surgery, minimal invasiveness can only be achieved by reducing the incision. This is possible for the mitral valve from the right intercostal space, and for the aortic valve from both the partial (upper 1/3) sternum and the right intercostal space.
Recently, our team in our center has been performing minimally invasive multivessel coronary artery surgeries. In this case the incision is made through the left intercostal space.
The patient is the only one who benefits from this surgery, because the surgeon has more attention, stress, and responsibility. Pain is also reduced during heart surgery with a small incision because there is less tissue trauma. Thus, the patient becomes more active earlier, performs breathing movements more comfortable, and most importantly, is able to turn to the right and to the left from the first day of sleep.
Of course, the smaller the incision, the less blood loss and less chance of blood transfusion. The use of antibiotics is reduced because the risk of wound infection is reduced. It is also better from an aesthetic point of view. I would also like to emphasize psychological comfort and patient satisfaction with this surgery.
The success of each operation is determined before the incision - this is called proper instruction. For this, you need to know the contraindications. If a patient has severe coronary heart disease or aortic stenosis, a very low heart rate, excessive body weight, or severe chest pain (with intercostal access for mitral valve malformation), these operations should not be performed on the patient because they can be risky.
All four valves of the heart can be operated on. The most common defects are found in the mitral and aortic valves.
Surgery on the aortic valve can be performed with a right mini-thoracotomy (intercostal incision) as well as a mini-sternotomy (partial sternal incision).
Mitral valve surgery is usually performed with right mini-thoracotomy (intercostal incision).
In combined lesions of both valves, the use of mini-thoracotomy is considered risky.
You can follow our surgeries and postoperative satisfactory patient outcomes on Instagram and Facebook, as well as on my YouTube channel and in the "Gallery-Videos" section of this website.
Facebook: Minimal Imagive Ürək Cərrahı
Youtube: Natiq Mirzeyev. Heart Surgery
In fact, 1/3 of the heart is on the right side of the midline of the human body. However, this is not the reason for making the incision on the right. The anatomy of the heart is such that the thick muscular portion is on the left. The important veins are also located on the left side. Thus, there is a thinner and safer area for intervention on the right. Therefore, in valve surgery, the entrance to the chest is from the right intercostal region, while in mini bypass coronary artery surgery, the entrance is from the left side.
Mitral valve grafting: it is the right choice for all patients with valve insufficiency, as well as for most people with valve stenosis. Protecting the patient's own valve is always better than replacing it with a mechanical or biological valve. Advantages of surgery over valve replacement:
- Short- and long-term results are better
- Better protection of cardiac function
- Lower risk of stroke and endocarditis
- No need for lifelong use of anticoagulants
If there is discharge, redness, foul odor, or severe pain in the wound area;
A single fever over 38.3 degrees or a temperature of 37.8 degrees for more than 24 hours;
If you feel chills, tremors, muscle aches, or severe fatigue with a fever;
If your weight is rapidly increasing (more than 1 kg per day) or decreasing (measure your weights every day in the morning, with the same device and in the same clothes);
If you have difficulty urinating, or you may notice a dark color of urine or urination may become painful;
If swelling in the hands and feet does not go away over time;
If your heart starts beating (tachycardia) during normal physical activity;
During sudden onset of shortness of breath and severe weakness;
If your complaint occurs at night and bothers you so much that you can't wait until morning, you can call the surgeon directly. Numbers are listed on the website.
What is important to pay attention to after heart surgery (by dissecting the sternum):
Do not touch objects that are above shoulder height;
Do not rotate your torso about its axis, do not lean on the bed, and do not open heavy doors;
When bending, bend at the knees, not in the lower back;
Engage your leg muscles instead of your arms when you get up from your seat;
For 6 weeks, sleep on your back only. When you get out of bed, a family member should support you across your back and neck and help you sit up. The goal is to keep the patient from engaging the arm muscles.
If there is no family members in the house (not recommended!) or if the person in the house cannot help you, slide to the side where you want to sit up to get out of bed. Bend your knees slightly and carefully lean into the seat. Carefully lift your body up through this elbow and support your body with your other hand. Then gently swing both feet toward the floor. Try to sit for three to five minutes. This will keep you from turning your head, and you will be able to get out of bed on your own without straining your sternum.
For the first two weeks, you can go up one floor once a day, and then several floors in the following weeks. If you get tired between floors, you can put a small seat and rest.
Do not lift weights heavier than 5 kg during the first month (5 kg with both hands).
- Playing board games
- Walking with friends
- Going to the movies
- These symptoms indicate that you are very tired while working:
- Dizziness, blurred vision
- Nausea and vomiting
- Sweating in a cold sweat
- Shortness of breath that makes it difficult to speak
- Feeling very weak and exhausted
- Rapid heartbeat (tachycardia)
- Pain or tightness in the chest, back, neck, chin, hands, and teeth
- Wiping dust from surfaces
- Simple home repairs
- Preparing the dining table
- Washing dishes
- Cooking simple meals
- Changing linens
- Lift trash cans or furniture
- Working in the garden
Postoperative insomnia and the inability to fall asleep at night after waking up are completely normal. Try to avoid short naps during the day. Before going to bed, do something soothing, like reading a book or listening to music. Do not take any other pain medication during the day.
Constipation is also completely normal after heart surgery. They occur in 20-30% of patients. At this time, increase your intake of fruits and vegetables, as they are rich in dietary fiber. Eat dried cherries and plums. Increase the amount of physical activity. If you are not taking enough fluids, bring them up to normal. If you have previously taken medication for constipation, use it. If this does not help, see your doctor.
Lack of appetite during the first 2 weeks is perfectly normal. This is due to increased levels of inflammatory mediators in the blood after surgery.
You can eat appetizing, sour, spicy food (it is important to consider stomach and duodenal diseases). During the first month, eat often and in small portions. If you do not have diabetes or high blood pressure, you can eat everything, but do not overeat.
You can bathe the same day you get home. It is best if you shower every day with fragrance-free soap. When bathing, use lukewarm water, avoid hot water and boiling water. Do not stay in the bath too long and do not steam too much. Do not take a bath until your wounds are completely healed and crusted (this takes 2-4 weeks). Do not wipe wounds with any cloth while bathing. In the first month, it is best to be accompanied by someone to help you shower. You can use a seat so you do not get too tired while bathing.
A special feature of heart surgery is that the resulting immunosuppression (decreased immunity) can affect wound healing (especially in diabetic patients and those who are overweight). A superficial wound infection usually shows symptoms within 48-72 hours. It is not difficult to notice, since the patient is in the hospital during this period. However, if sterility (cleanliness rules) was not observed during or after surgery (contamination occurred), the patient's relatives did not take care of the wound properly at home, the patient's diet was not of sufficient quality (zinc and protein intake is very important) or improper control of diabetes (in diabetic patients) problems with wound healing can occur (especially problems with deep wounds). These conditions can occur in 1 week and 10 days after surgery. During this time, the patient and his family should monitor the condition of the wound, since the patient is already at home: if there is any discharge, redness, unpleasant odor or severe pain in the wound area, the surgeon should be notified.
Important points to be aware of:
The patient may experience pain in the surgical area, but these complaints will diminish over time. Your stitches will be removed in 1 week to 10 days after the doctor's examination. You should not apply lotion, oil, powder, ointment, etc. to the wound area during this process.
You can wash the wound area thoroughly at home with unscented soap and water. Do not wipe the wound area with any cloth while bathing. Once a day (+ after bathing) you should apply a solution of iodine to the wound area (in our hospital we use Betadine).
You should keep the injured leg elevated to prevent swelling and edema, and do not cross your legs for a while. You can safely do breathing exercises while supporting the wound on your chest with a small pillow.
Note. The risk of wound infection in minimally invasive surgeries is lower than in traditional incisions.
Medications to be taken at home after heart surgery are very important. This is to prevent risky changes that may occur during the recovery period and to control the patient's comorbidities. You may see any of the following medications, on prescription:
Anticoagulants: Aspirin, Warfarin (Coumadin), Clopidogrel, etc. They are taken to prevent blood clots. These drugs are injected into the inner layer of heart valves and vessels (endocardium, endothelium), until a new layer of tissue develops in the sutures, or for life (aspirin in coronary bypass surgery, warfarin in mechanical valve prosthetics).
Antiarrhythmic drugs: to regulate the rhythm of the heart.
Antihypertensive drugs: to maintain blood pressure levels. This is especially important for the elderly and patients taking anticoagulants.
Gastroprotector drugs: prescribed to prevent increased acidity of gastric juice.
Anti constipation drugs: to normalize the act of defecation.
Antibiotics: To support wound healing or prevent respiratory and urinary tract infections.
Diuretics: provide more fluid excretion to prevent the accumulation of excess fluid in the body and the development of edema.
You must take the medication regularly and in the right amounts at the right hours.
Diseases that disrupt blood flow in one direction by impairing the function of heart valves can be grouped as follows:
Degenerative valve diseases - in this case, the mitral valve is mainly affected. In this case, the disease, which began with prolapse, develops over the years, leading to thinning or thickening of the valve cusps. This is the leading cause of mitral valve malformation in developed countries.
Rheumatic heart disease is caused by untreated or incompletely cured acute rheumatic fever (the body's immune response to a throat infection caused by Streptococcus pyogenes). The main target of this disease is the mitral valve, then the aortic valve. It is the leading cause of valve disease, mainly in developing countries.
Calcification valve disease is mostly an age-related lesion of the valve. Consequently, this disease is more common in older people. It mainly affects the aortic valve and then the mitral valve.
Ischemic valve disease - this usually damages the mitral valve. Not directly, however, it impairs valve closure by disrupting blood flow to the muscles that support the valve. Mostly this disease is seen in elderly people and patients with ischemic heart disease.
Congenital valve defects - the mitral valve may be defective, but aortic valve malformation is more common. Defects of the aortic valve usually require operative intervention in the mid to late stage of development, while defects of the mitral valve require early intervention.
Endocarditis is an infection that affects the heart valve via the hematogenous route. It can damage all the valves of the heart. Endocarditis of the mitral and aortic valves comes with a high risk because of the possibility of systemic embolization.