What to Expect Before Surgery
- Pre-operative visit – This will often be the first meeting with your surgeon. He will review your medical records, including your catheterization films, x-rays, and CT scans. He will have already discussed your case with the physician who referred you and make specific recommendations for your surgery. This is the perfect time for your questions and we are happy to review all aspects of your operation. To expedite this process, please fill out our online patient form before your office visit.
- Scheduling – We have a specialist in our office who will coordinate with you and make appropriate arrangements to schedule your surgery. We will also initiate the contact with your insurance company and obtain pre-authorization if required.
- Pre-op Testing – After a specific date for your procedure is selected, pre-op testing will be scheduled. This takes place at the main hospital onthe first floor of the hospital. They will instruct you to bring a list of all prescription medications, herbal preparations, and dietary supplements you take, including vitamins. You will be asked to complete a health history for the hospital and a nurse will take your vital signs and evaluate your current condition. Any special testing we need for surgery will be done, such as x-rays, EKGs, blood work, and pulmonary function screening. This is done Monday- Friday, between 8:00 am-5:00 pm and generally takes about an hour and a half. They will give you a small bottle of antibacterial soap with instructions to shower with it the night before surgery. You will also be asked to not eat or drink anything after midnight the night before surgery.
What Are the Complications and Risks for Surgery?
As with any surgery, there are certain risks that the patient should be aware of. The amount of risk will vary based on your general health status prior to the procedure. These risks can include, but are not limited to, bleeding, up to and including transfusion: infection; damage to major organs including the kidneys, which may require temporary or permanent dialysis; difficultly with breathing, requiring long-term ventilation; the risk for neurologic injury or stroke; the risk for heart attack, irregular heart rhythms, heart failure, or death. However, advances in how the surgery is performed and how patients are managed afterwards have led to a steady decline in complication rates.
What to Expect After Surgery
After the procedure you will generally spend three to seven days in the hospital. The first 24 hours will be in the intensive care unit. You will have a breathing tube in temporarily and one to two chest tubes which will be removed in the first several days. After the intensive care unit you will be moved to step down. Cardiac nurses and personnel who have special training in the next portion of your recovery staff this ward. You will retain at least one IV line and will be on a heart monitor for the duration of your hospital stay. Adjustments to your medications and treatments will be made. The focus on your stay here will be on strengthening. You will need to get up and out of bed, sitting in a chair during the day. Your lungs work better in an upright position, so it makes it easier and more comfortable for your breathing. Therapists and their assistants will take you for walks in the halls to help build up your strength. You will be given a breathing exerciser,called an incentive spirometer, to help build up your pulmonary reserve and prevent postop pulmonary complications. It is very important that you work with this on an hourly basis.
Once you and your surgeon feel you are strong enough to go home, your nurse will provide a written list of the medications you are to take. Do not resume your home medications unless you have been specifically instructed to. Most patients will be discharged with a home care nurse to visit the following day. They will review your medications, check your wounds, listen to your lungs and check your vital signs. They are a good source of information and provide regular reports to our office. You will have an office visit with us in 10 to 14 days. Some patients (depending on their convalescence and family support system) are not discharged directly home. For patients who need it; additional physical therapy, rehabilitation or a transitional care unit is an option. This will be evaluated near the time of discharge and coordinated with the case manger at the hospital.
Your Post-Op Activity Instructions
- Activity – Stop any activity immediately if you feel short of breath NOT relived by rest, notice irregular heartbeats, feel faint or dizzy, or have chest pain. Rest until the symptoms subside. If they do not subside within 20 minutes, notify your doctor.
- Incision Care – Avoid soaking in baths until your incisions are healed. Avoid extremely hot water. Shower in the morning and clean incisions 2 times a day with soap and water, peroxide or wound cleanser. Avoid lotions, creams, and ointments on incisions.
- Dress – Wear comfortable, loose fitting clothes that do not put undue pressure on your incisions.
- Diet – Regular home diet. No added salt. Switch to low fat, low cholesterol diet when appetite returns. Constipation is a common complaint after surgery due to inacitivy or pain medication. Any over the counter laxative is acceptable such as: milk of magnesium, stool softeners, fiber supplements, enema or suppository if needed.
- Rest – You need a balance of rest and exercise for your recovery. Plan to rest between activities and to take short naps as necessary. Resting also includes sitting quietly for 20-30 minutes. Rest 30 minutes after meals before exercising.
- Walking – This is one of the best forms of exercise because it increases circulation throughout the body and to the heart muscle. It is important to increase your activity gradually. Walk at your own pace. Stop and rest if you get tired. Each person progresses at a different rate after heart surgery. In cold weather, wear a scarf or mask around your mouth and nose.
- Stairs – Unless your doctor tells you differently, you can climb stairs. Take them at a slow pace. Stop and rest if you tire. When using the handrail, do not pull yourself up with your arms. Use your legs.
- Sexual – You can resume sexual relations when you feel comfortable. For many people this is about 2 to 4 weeks after discharge, unless instructed differently by your doctor. Please ask your nurse for more detailed information, if needed.
- Driving – You can ride as a passenger in a car at any time. Avoid driving, outdoor bicycling, or motorcycle riding for 6 weeks after surgery. This time period is recommended to allow your breastbone (sternum) to heal. Also, your movements might be limited and slow before the 6 weeks are up. When traveling, be sure to get out of the car every 2 hours and walk around for a few minutes.
- Lifting – You should not put too much strain on your sternum while it is healing. Avoid lifting, pushing, or pulling anything heavier than 10 pounds for 6 weeks after surgery. This includes carrying children, groceries, suitcases, mowing the grass, vacuuming, and moving furniture. Don’t hold your breath during any activity, especially when lifting anything or when using the rest room.
- Work – Check with your surgeon before returning to work, but most patients will begin to feel like returning to light work 6 to 12 weeks after surgery.