Immediate postoperative management.

The management of the patient after valvular surgery is influenced by the preoperative left ventricular function and by the specific type of valvular lesion that has been corrected. The hemodynamics of the patient immediately after surgery must be evaluated carefully, and the patient can be supported with a variety of pharmacologic and mechanical measures as ventricular function recovers. Perioperative ischemia, arrhythmias, and bleeding may occur and should be specifically treated. Initiation of anticoagulation and adjustment of warfarin doses is an important aspect of postoperative care. Finally, the patient needs to be counseled that the presence of a prosthetic valve carries a risk for infective endocarditis and instructed on appropriate regimens for antibiotic prophylaxis.