Heart valve surgery - discharge

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.

Most people spend 3 to 7 days in the hospital. You may have been in the intensive care unit some of the time, in the hospital, you may have begun learning exercises to help you recover more quickly.

It will take 4 to 6 weeks or more to heal completely 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. This may last 6 months or more.
• Be constipated from pain medicines.
• Have mild trouble with short-term memory or feel confused.
• Feel tired or have little 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.

The following are general recommendations. You may get specific directions from your surgical team. Be sure to follow the advice your health care provider gives you.

Have a person who can help you stay in your home for at least the first 1 to 2 weeks.

Stay active during your recovery. 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 at least a little bit.
• Walking is a good exercise for the lungs and heart. Take it slowly at first.
• Climb stairs carefully because balance may be a problem. Hold onto the railing. Rest part way up the stairs if you need to. Begin with someone walking with you.
• It is OK to do light household chores, such as setting the table or folding clothes.
• Stop your activity 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, twisting, 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 provider when you may return to work.

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

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

• Most of the time, it is OK to start sexual activity after 4 weeks, or when you can easily climb 2 flights of stairs or walk a half-mile (800 meters).
• Keep in mind that anxiety, and some medicines, may change sexual response for both men and women.
• Men should not use medicines for impotence (Viagra, Cialis, or Levitra) until the provider says it is OK.

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 (such as helping you move around or get out of bed).
• Lift anything heavier than 5 to 7 pounds (2 to 3 kilograms) for about 3 months.
• Do other activities that keep your arms above your shoulders.

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 incision or breastbone. Stop right away if you hear or feel any popping, moving, or shifting of your breastbone and call your surgeon's office.

Use mild soap and water to clean the area around your incision.

• Wash your hands with soap and water.
• 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 only for 10 minutes at a time. Make sure the water is lukewarm. Do not use any creams, oils, or perfumed body washes. Apply dressings (bandages) the way your provider 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 provider 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 provider first.

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

You may need to take blood-thinning medicines to help keep your blood from forming clots. Your provider might recommend one of these medicines:

• Aspirin or clopidogrel (Plavix) or another blood thinner, such as ticagrelor (Brilinta), prasugrel (Effient), apixaban (Eliquis), dabigatran (Xeralto), and rivaroxaban (Pradaxa), edoxaban (Savaysa).
• 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.

Contact your provider if:

• You have chest pain or shortness of breath that does not go away when you rest.
• You have pain in and around your incision that does not continue to get better at home.
• Your pulse feels irregular, 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 very bad 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 (1 kilogram) in a day for 2 days in a row.
• Your wound changes. It is red or swollen, it has opened, or it has drainage coming from it.
• You have chills or a fever over 101°F (38.3°C).

If you are taking blood thinners, call your provider 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

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 66.

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77:e25-e197. PMID 33342586 pubmed.ncbi.nlm.nih.gov/33342586/.

Rosengart TK, Aberle CM, Ryan C. Acquired heart disease: valvular. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 61.

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.