Adequate rest for 3 months after surgery
In general, the patient can be discharged from the hospital 1 week after the “flap replacement” surgery. After returning home, patients generally need to recuperate for 3-6 months. The 3 months after surgery is an important stage to recover from the surgical trauma and stabilize the function of the systems and organs, so the patient should get enough rest and avoid catching a cold during this period. The patient should have a regular life and should not be overworked or overexcited. Appropriate activities (such as walking, doing a little housework, etc.) are allowed, but if there is discomfort such as panic and shortness of breath during the activities, the patient should rest immediately and reduce the amount of activities appropriately.
Generally speaking, patients can take a shower 2 weeks after surgery. When taking a shower, care should be taken to avoid getting cold and not to rub the wound, and the wound should be cleaned with antiseptic solution after the shower. If abnormal symptoms such as oozing, redness and swelling of the incision are found, the patient should go to the hospital immediately. Since the healing time of the sternum is usually about 3 months, patients should avoid chest expansion exercises, lifting heavy objects or carrying children in the early postoperative period. In addition, patients should not drive for 3 months after surgery.
3~6 months after surgery Gradual return to normal
If the recovery is smooth and no complications occur, the patient can gradually increase the amount of activity (to the extent of “no panic and shortness of breath”) from 3 months after surgery until gradually returning to normal work and life. During the rehabilitation process, patients should always maintain a happy mood and optimistic, positive attitude, do not be impatient, and do not worry too much. At the same time, do not increase the activity or workload violently on the spur of the moment or in a hurry, so as not to cause damage to cardiac function.
Eat a light diet and stop smoking and drinking
After discharge from the hospital, patients can gradually resume a normal diet according to their personal dietary habits and enhance nutrition appropriately to promote wound healing. Of course, “strengthening nutrition” does not mean eating delicious food or tonic every day, but eating more nutritious and easily digestible food, such as lean meat, fish, eggs, fruits and seasonal vegetables.
Patients with “valve replacement” generally have no special contraindications, but because some foods (such as spinach, tomatoes, pork liver, etc.) are rich in vitamin K, which may interfere with anticoagulation therapy, they should be avoided in large quantities. In addition, to avoid increasing the burden on the heart, patients should not eat foods that are too salty and should never abuse alcohol or smoke. Patients with poor heart function should also limit the amount of water they drink and not eat large amounts of thin rice and soups.
Take the medication as prescribed by the doctor and do not stop taking it without permission
Since most “valve replacement” patients have some degree of cardiac function impairment, surgery is undoubtedly a heavy “blow” to their fragile hearts. To protect and improve cardiac function, patients should not stop taking their medications suddenly after surgery, but should take them strictly according to medical advice.
At the same time, patients should also pay close attention to the changes in their urine volume, observe whether they have edema or a feeling of heaviness in their limbs, and monitor their pulse. Generally speaking, patients need to take the medication for 3 months after surgery, after which the dosage can be gradually reduced under the guidance of the doctor according to the review. Before stopping the medication, the patient must go to the hospital for a review, and must not stop the medication without permission.
Adherence to anticoagulation therapy
There are two main types of prosthetic valves, one is a biological valve and the other is a mechanical valve. Because the prosthetic valve is a “foreign body” to the heart, blood can easily clot on the prosthetic valve, which can lead to thromboembolism (e.g., cerebral infarction) or prosthetic valve dysfunction. Therefore, all “valve replacement” patients require anticoagulation therapy. In general, patients with bioprosthetic valves require oral aspirin and clopidogrel for 6 months, after which they can be tapered off. Patients with mechanical valves and patients with atrial fibrillation require lifelong anticoagulant medication (warfarin).
Anticoagulation after “valve replacement” is a long-term and delicate task. Improper anticoagulation can lead to thromboembolism (under-anticoagulation) or bleeding (over-anticoagulation), which can be life-threatening. Patients taking warfarin should visit the hospital regularly to check their coagulation parameters. Usually, anticoagulation therapy should be started the day after surgery. The doctor will give the patient a dose of warfarin based on the prothrombin time measured each day.
At the time of discharge, the doctor will clearly inform the patient how large a dose of warfarin to take each day. After discharge, the prothrombin time will continue to change as the amount and structure of the patient’s diet changes. Therefore, patients should have their prothrombin time rechecked regularly after discharge. During the first two months, the patient should be rechecked every 1 to 2 weeks. If the prothrombin time is stable, it can be extended to once a month.
If the prothrombin time is stable for one year, the interval between reviews can be extended, but not longer than 2 months. Patients should also pay attention to whether they have gum bleeding, nose bleeding, skin bruising, increased menstruation, etc. during the medication period, and if so, they should also seek medical attention.
It is important to note that some medications can affect the efficacy of anticoagulant drugs and should be avoided at the same time. If it is necessary, the dose of anticoagulant drugs should be adjusted promptly. For example, indomethacin (anti-inflammatory pain), aspirin, metronidazole, sulfonamides will enhance the anticoagulant effect, vitamin K, phenobarbital, meprobamate (Meprobamate), birth control pills and hormonal drugs will reduce the anticoagulant effect. In addition, if the patient is combined with hepatobiliary disorders and heart failure, the production and secretion of vitamin K in the body will reduce the effect of anticoagulants, and the dose of anticoagulants should be reduced as appropriate.
Regular follow-up visits to the hospital
After “flap replacement”, patients should go to the hospital regularly for follow-up examinations so that doctors can understand the recovery situation and adjust the treatment plan in time. It is important to remind patients to keep the discharge summary after discharge. At the time of review, the patient should bring the discharge summary and various examination reports, such as X-ray chest film, electrocardiogram, laboratory tests, etc., and give the doctor a detailed description of his or her recovery, ;
For example, what is the current activity level (e.g. how many floors can you go up, how many kilometers can you walk, etc.), what kind of work and physical activities can you do, what are the usual symptoms of discomfort, what is the diet, how much urine you pass every day, whether you have been to the hospital for checkups recently, what medications you are currently taking, how much you take and how to take them, etc., so that the doctor can comprehensively assess the current condition and guide the next step of treatment. Generally speaking, patients need to have a repeat echocardiogram six months, one year, and annually thereafter after surgery in order to understand the degree of recovery of cardiac function and the functional status of the prosthetic valve.