This film will show you
what to expect if you are having
valve replacement surgery. It includes images of the surgery
and shows a live beating heart. My name’s Nick. I’m 41.
I’m from Macclesfield in Cheshire. And I’m here
to have a heart valve replacement. – Nicholas, how are you?
– Hi! I’m Mr Rajamiyer Venkateswaran,
consultant cardiac surgeon. I work in Wythenshawe Hospital
in Manchester. The major problem
is the valve narrowing. As explained, cut out the valve… Nick has a condition
called aortic stenosis, which is a severe narrowing
of the outflow valve. This condition, if not treated,
may lead to severe heart failure. On a daily basis,
my symptoms mainly are shortness of breath,
I get tired quite easily, and a tightening of the chest. Your heart valves make sure
blood flows in the right direction through your heart. If the valves are
damaged, stiff or narrowed, then your blood
doesn’t flow properly, which can cause strain on your heart. Heart valve surgery is used to treat leaking or narrowed valves
by replacing them if the damaged valve
cannot be repaired. Your damaged valve will be removed
and a new one put in its place. It will either be mechanical,
made from metal and plastic, or tissue from a human or animal. The new valve will improve
the blood flow through your heart. I’m a bit nervous about
the operation. It is quite serious. We’ll just carry on now
and get it done. Today we are going
to replace his aortic valve by doing open-heart surgery and replace it
with a mechanical heart valve. Prior to admission he will have all
the blood tests, X-rays and an ECG and he will have seen
an anaesthetist the night before. Then in the evening his chest
will have been fully shaved. Just take a nice few deep breaths. You’re going to drift off to sleep. Normally it would take around
45 minutes for the anaesthesia time. This usually involves getting
some monitoring lines in his neck, and also in his arm,
to monitor pressures. Also, an echocardiogram probe to look at the valve
and also the function of the heart. Then we start the operation. Usually it would take
around three-and-a-half hours. The first step is
to get access to the heart. Then once we expose the sternum,
we cut through the bone and then we get access to the heart. Now we should be able
to see the heart. We have to establish bypass because we have to make sure
the heart work is done by a machine. Once it is done
I have to stop the heart, so that I can actually cut open
the aorta to access the valve. The heart has stopped. You can
see here. The valve is exposed, so I’m going
to have to cut it out Then I have to size the correct size
of the valve to stitch in. Once that is done I have to close
the chamber before restarting it. There, you can see on the ECG, It’s almost at a regular rhythm now. Then I have to come off the
bypass machine and close the chest. Once the operation is finished we close his chest
using stainless-steel wires. They don’t need to be taken out. Usually he will spend one full day
in intensive care after a valve replacement and the following day
in a high-dependency unit. The risks are very small considering
the magnitude of the operation. The benefits far outweigh the risks
involved with the operation. – How are you doing?
– Fine, thank you. Yourself? Once he’s well, after two days, most of the lines in the neck
and the catheter all come out and he goes to the ward. After five days, I would expect him
to be up and about and he should be ready to go home. – Is there any pain anywhere?
– Yeah, just a bit tender. Everyone gets cardiac rehab
when they get discharged. We advise for the first six weeks
not to do any strenuous exercise to avoid disrupting the wound. By the end of three months,
if the wound is well-healed, they should be free
to do anything they want. He’s doing well. He’ll have some pain
because it’s only the second day, but that’ll get better
in the next few days and by tomorrow when the tubes
are removed, he’ll feel even better. I had the operation
on Tuesday morning and it’s now Friday morning. A bit of a daze when I came round,
but I don’t feel too bad today. There is pain in the chest, but hopefully
it should make a vast difference. Going on walks
without feeling out of breath, being able to do simple things
like run up and down stairs should have a dramatic influence
on my day-to-day life. Coronary heart disease is still
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