What is an open aortic valve replacement?

An open, 有创主动脉瓣置换术是一种用人工瓣膜替换工作不佳的主动脉瓣的手术. The aortic valve is one of the heart’s 4 valves. 这些瓣膜帮助血液通过心脏流向身体. Under certain circumstances, your valve can stop working well. 你的外科医生会用一个人工瓣膜来代替你工作不佳的瓣膜. 这将确保你的血液可以正常流出心脏，流向身体. 这种手术被称为“开放式”手术，因为它使用传统的切口来暴露你的心脏. 这个切口比微创主动脉瓣置换术的切口要大.

Why might I need an open aortic valve replacement?

当你的主动脉瓣工作不佳时，比如主动脉瓣狭窄或主动脉瓣反流, you may need this procedure.

• 在主动脉瓣狭窄的情况下，瓣膜不能完全打开，流出心脏的血液就会减少.
• In aortic regurgitation, your valve is leaky. 一些血液通过瓣膜向后渗漏，而不是流向身体的其他部位.

在这两种情况下，你可能需要更换主动脉瓣. A poorly working aortic valve may lead to symptoms, such as:

• Shortness of breath
• Fatigue
• Swelling in your legs
• Dizziness
• Chest pain
• Passing out
• An unpleasant awareness of your heartbeat

If these symptoms get worse, surgery may be needed. 即使你没有明显的症状，医生也可能会建议你做手术, since surgery is most effective if symptoms are not too advanced.

主动脉狭窄和主动脉反流都是由瓣膜老化引起的. Other causes of aortic valve disease include:

• Heart birth defects (like a bicuspid aortic valve)
• Bacterial infection of the heart valve
• A tear in the aorta
• Aortic aneurysm (weakened, stretched aorta wall)
• Certain genetic conditions (like Marfan syndrome)
  
  

What are the risks of an open aortic valve replacement?

There are certain risks with any type of surgery. 您的具体风险将根据您的具体医疗状况而有所不同, your age, and other factors. Be sure to talk with your doctor about any concerns that you have.

大多数接受主动脉瓣置换术的人都能获得成功. However, there are some possible risks. These include:

• Infection
• Bleeding
• Irregular heart rhythms
• Blood clots leading to stroke or heart attack
• Complications from anesthesia

Certain factors increase the risk of complications. Some of these are as follows:

• Chronic illness
• Other heart conditions
• Lung problems
• Increased age
• Being overweight
• Being a smoker
• Infections

How do I get ready for an open aortic valve replacement?

As you plan for the surgery, 你和你的医疗保健提供者将决定哪种瓣膜最适合你. 你的外科医生会用生物瓣膜或机械瓣膜替换你的瓣膜.

• 生物瓣膜主要由猪、牛或人的心脏组织制成. 生物瓣膜的使用寿命不如机械瓣膜长，但产生血栓的风险更小.
• Mechanical valves are man-made. 由于存在血栓的风险，机械瓣膜患者需要终生服用血液稀释药物. Mechanical valves also have an increased risk for infection.

和你的医疗保健提供者谈谈如何为即将到来的手术做准备. Remember the following:

• 手术前避免在午夜之后吃或喝任何东西.
• Try to stop smoking before your operation. Ask your doctor for ways to help.
• 在手术前，你可能需要停止服用某些药物. 如果你经常服用血液稀释药物，如华法林或阿司匹林，请遵循医生的指示.

你可以在手术的前一天下午到医院. 这是一个很好的时机来问你关于手术的任何问题. 在手术前，你可能需要做一些常规检查来评估你的健康状况. These may include:

• Chest X-ray
• Electrocardiogram (ECG)
• Blood tests
• Echocardiogram (to assess your current valve)
• Coronary angiogram (to assess blood flow in your heart arteries)

手术前一小时左右，医生会给你一些药，帮助你放松. In most cases your surgery will proceed as planned, but sometimes another emergency might delay your operation.

What happens during an open aortic valve replacement?

Check with your doctor about the details of your procedure. In general, during your open aortic valve replacement:

• You will be given anesthesia before the surgery starts. 这将使你在手术过程中睡得更深，无痛. Afterwards you won’t remember it.
• The operation will take several hours. 家人和朋友应该待在候诊室，这样外科医生就可以告诉他们最新情况.
• Your doctor will make an incision down the middle of your chest. To access your heart, your doctor will separate your breastbone.
• The surgery team will connect you to a heart-lung machine. 在手术过程中，这台机器将充当你的心脏和肺.
• 你的外科医生会移除你现在的心脏瓣膜，并换上一个新的瓣膜.
• The surgery team will remove the heart-lung machine.
• The team will wire your breastbone back together.
• 然后医生会把你皮肤上的切口缝合起来.   

What happens after an open aortic valve replacement?

After your open aortic valve replacement:

• 你将在重症监护室或康复室开始康复.
• When you wake up, you might feel confused at first. 你可能会在手术后几个小时醒来，或者稍晚一点.
• 大多数接受主动脉瓣置换术的人在手术后症状立即缓解.
• The team will monitor your vital signs, such as your heart rate. 他们可能会把你连接到几台机器上，这样护士就可以更容易地检查这些.
• You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. Someone will usually remove the tube within 24 hours.
• You may have a chest tube to drain excess fluid from your chest.
• 你的胸部可能有临时的起搏器导线
• Bandages will cover your incision. These can usually come off within a couple of days.
• You will feel some soreness, but you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
• 再过一两天，你就能坐在椅子上，在别人的帮助下走路了.
• 你可以做呼吸疗法来帮助清除手术中积聚在肺部的液体.
• You will probably be able to drink liquids the day after surgery. You can have regular foods as soon as you can tolerate them.
• 你可以穿上弹性长袜，帮助血液在腿部静脉中循环.
• You will probably need to stay in the hospital around 5 days.

After you leave the hospital:

• Make sure you have someone to drive you home from the hospital. You will also need some help at home for a while.
• 你可能会在7到10天的后续预约中拆除缝线或订书钉. Be sure to keep all follow-up appointments.
• 手术后你可能很容易疲劳，但你会逐渐开始恢复体力. It may be several weeks before you fully recover.
• 回家后，每天量一下体温和体重. Tell your doctor if your temperature is over 100.4°F (38°C), or if your weight changes.
• Ask your healthcare provider when it is safe for you to drive.
• Avoid lifting anything heavy for several weeks. Ask your healthcare provider about what is safe for you to lift.
• 遵循您的医疗保健提供者给您的所有药物说明, exercise, diet, and wound care.
• 确保你所有的牙医和其他医疗服务提供者都知道你的病史. 在进行某些医疗和牙科手术之前，你可能需要服用抗生素，以防止瓣膜感染.
  
  

Next steps

在您同意测试或程序之前，请确保您知道:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• 谁来做测试或程序，那个人的资格是什么
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• 在测试或程序后，如果您有疑问或问题，可以打电话给谁
• How much will you have to pay for the test or procedure