Your doctor has recommended heart surgery as the best treatment option for your heart condition. In most cases, the surgery will be an open-heart procedure in which the breastbone is cut open so the surgeon can work on the heart. Minimally invasive surgery eliminates the need to open the breastbone and can be used in select cases. A member of your health care team and the surgeon will discuss with you the type of surgery recommended for you.
Coronary Artery Bypass
Your doctor may recommend coronary artery bypass as a treatment for blockages in the coronary arteries. The coronary arteries supply blood to the heart muscle. Blockages in these arteries can cause chest pain, shortness of breath, and heart attacks. Blockages can be treated with medicine, catheter based procedures, or bypass surgery. Bypass surgery reroutes blood around the blockages so that the heart has new blood supply. Bypass surgery relieves the symptoms caused by the blockages and prevents heart attacks from occurring. While more invasive than catheter procedures, bypass surgery is the most durable treatment for coronary artery disease and provides the greatest survival advantage of any treatment option.
Bypass surgery is traditionally done through an “open heart” approach. This technique divides the breastbone to access the heart. This approach is usually required in order to bypass arteries on different areas of the heart. Bypass grafts are constructed using arteries from under the breastbone and veins from the leg. The left internal mammary artery is harvested from under the breastbone and used to bypass blood around a blockage on the heart. Sometimes, both the left and right mammary arteries are utilized. The mammary artery graft usually stays open for the rest of the patient’s life.
Additional bypasses are created using a vein harvested from the leg or arteries from the forearm. The leg has several vein systems and is not permanently affected by removing the vein for bypass. The leg vein or arm artery is connected to the aorta just above the heart, then to the coronary artery beyond the blockage. Vein grafts are less durable than arteries, however, two out of three vein grafts are still working well after ten years. The blockages are left in the coronary arteries and blood flow bypasses the blockage by going through the new grafts. The blockages are not removed from the coronary arteries as this would damage the coronary artery and is less durable than bypassing around the blockage.
Risks of coronary bypass surgery include heart attack, stroke, kidney or respiratory failure, and death. In most cases these risks are all less than 2-4%. You doctor will go over your specific risks and recommended procedures.
Aortic Valve Surgery
The aortic valve is the most commonly operated on valve in the heart. The aortic valve allows flow out of the heart, and prevents blood from coming back into the heart. The valve can either leak, called aortic insufficiency that allows blood back into the heart, or not open well – a condition call stenosis. Most aortic valve operations are done for aortic stenosis associated with aging. Aortic stenosis prevents blood from flowing easily from the heart out to the body and puts and added workload on the heart leading to thickening of the heart muscle. Often even severe aortic stenosis can have no symptoms. When present, symptoms can include shortness of breath, fatigue, and passing out. Once symptoms are present, over half of patients will die within two years without treatment.
Treatment of aortic valve disease, whether stenosis or insufficiency, involves the removal of the native aortic valve and placement of a prosthetic valve. This can be done using a minimally invasive approach if aortic valve replacement is the only procedure required. Minimally invasive approaches can include a partial division of the breastbone, or an approach between the ribs. If coronary bypass or other procedures are required at the time of surgery, then a standard incision through the breastbone is required.
Mitral Valve Surgery
The mitral valve is between the lungs and the main pumping chamber of the heart, the left ventricle. In rheumatic heart disease the valve typically closes slowly over time resulting in restriction of flow into the heart. This is also often associated with leakage from the valve. Mitral valve disease leads to shortness of breath, fatigue, irregular heart rhythms, and high blood pressure in the lungs. In rheumatic mitral valve disease, the valve usually cannot be repaired and requires removal and replacement with a prosthetic valve.
Mitral valve prolapse and degenerative mitral valve disease leads to leakage of the mitral valve. When the mitral valve leaks, blood is pushed backwards into the lungs with each heartbeat resulting in shortness of breath, fatigue, and eventually irregular heart rhythms and high blood pressure in the lungs. Over time, congestive heart failure develops. Fortunately, the mitral valve can typically be repaired in degenerative mitral valve disorders. Mitral valve repair restores the function of the mitral valve and preserves the function of the heart.
Mitral valve surgery can be accomplished without dividing the breastbone by working through the ribs on the right side of the chest. Both valve repair and, if necessary, valve replacement can be done using this approach. If coronary bypass or other procedures are required, however, a minimally invasive approach cannot be utilized.
Aortic Aneurysm Repair
The aorta is the main blood vessel that carries blood from the heart to the body. The aortic root attaches the aorta to the heart and includes the aortic valve and the origins of the coronary arteries. The ascending aorta then goes up towards the neck, turns in the aortic arch, then heads down the body as the descending thoracic aorta. Below the diaphragm it becomes the abdominal aorta. Aneurysms of the aorta are areas of enlargement greater than 50% larger than the normal aorta. Once enlarged, the aorta will never get smaller and typically continues to grow. Causes of aneurysms include smoking, high blood pressure, high cholesterol, family history, and some connective tissue disorders such as Marfan’s Syndrome. Once diagnosed, the entire aorta will require lifelong surveillance – even after repair of the aneurysm.
As aneurysms enlarge, there is an increased risk of the aneurysm rupturing or the inner layer of the aneurysm tearing, called aortic dissection. Both of these conditions can be fatal and will leave the aorta permanently damaged. Aneurysm repair is designed to prevent these complications. Elective aneurysm repair is typically done when the risk of surgery is lower than the risk of an aneurysm related complication. For most aneurysms, a discussion about repair should begin when the aneurysm reaches 4cm in diameter. Elective aneurysm repair is generally low risk, while the complications of rupture and dissection typically carry a high risk of death and permanent complications. The goal of aneurysm surgery is to remove the diseased aorta before complications occur. At the time of surgery, the aneurysmal aorta is completely removed and replaced with a graft made of synthetic material. After repair, the remaining aorta will require periodic follow-up with CT scans to be sure no additional aneurysms develop.
For some aneurysms an endovascular approach may be possible. The technique involves placing a prosthetic graft into the aneurysm, rather than removing the aneurysm. By placing the endovascular graft inside the aneurysm, the blood is channeled through the graft, preventing pressure on the walls of the aneurysm and eliminating the risk of aneurysm rupture. Endovascular grafts are placed into the arteries in the groin through a small incision. Once inside the artery, the endovascular graft is advanced through the arterial system and positioned using X-rays for guidance. Typically, there are no chest incisions with endovascular aneurysm repair. Endovascular repair is usually done for aneurysms of the descending thoracic aorta and abdominal aorta. Aneurysms of the ascending aorta and aortic arch require an open surgical approach due to the branches present in these areas.
Surgery for Atrial Fibrillation
Atrial fibrillation is an irregular heart rhythm that leads to a nine times increase risk of stroke and double risk of death. Often, atrial fibrillation can be managed by medications or catheter based procedures. However, sometimes these treatments are ineffective, or a patient with atrial fibrillation is undergoing heart surgery for a different reason. Surgical treatment for atrial fibrillation is called a MAZE procedure. This is because the procedure involves making scars that block abnormal electrical conduction within the heart and form a “MAZE” which channels the electrical signals in the correct direction.
The MAZE procedure can be done at the time of other heart surgery or can be done as a minimally invasive stand-alone procedure. Either heat energy or cold energy is used to create the scars that channel the electrical signals of the heart. In addition to channeling the electrical signals, the left atial appendage is removed. The left atrial appendage is the source of most strokes from atrial fibrillation. By removing the left atrial appendage, the risk of stroke is significantly decreased.
When done minimally invasively, a video camera is used to work between the ribs and it is not necessary to divide the breastbone. Patients are typically in the hospital for one to three days after the procedure and are discharged without any restrictions. Atrial fibrillation surgery done at the time of other open-heart surgery does not extend the length of the procedure significantly. Patients are typically maintained on anti-arrhythmic medications and anticoagulation for three to six months before an assessment is made about the efficacy of the MAZE procedure.
There is often atrial fibrillation that occurs in the first several months following the MAZE procedure. The occurrence of atrial fibrillation in the post-operative period is not concerning and does not mean that the MAZE procedure did not work. Atrial fibrillation following any surgery in the chest is very common due to the inflammation, irritation, and scarring that occur on and around the heart following surgery. Patients are given a three to six month period following surgery to allow for healing and resolution of inflammation before the efficacy of the MAZE procedure can be assessed. Once an assessment of the success of the MAZE procedure has been made, consideration can be give to stopping anti-arrhythmic medications and anticoagulation.
Prosthetic Heart Valve Choices
There are two basic types of heart valves that can be implanted – mechanical valves and tissue valves. There is not one option that is right for all patients. You should have an open discussion with your surgeon about the advantages and disadvantages of each option for your particular situation. Mechanical heart valves are made from carbon and have the advantage of being very durable and not wearing out over time. However, they have the disadvantage of requiring blood thinner medication for life to prevent the formation of blood clots on the valve. Tissue valves are made from the tissue from the sac around the heart from a cow (bovine pericardium), or the actual heart valve from a pig (porcine valve). The living cells are removed during processing so there is no rejection of tissue valves. Since they are made from natural tissue, tissue valves have the advantage of not requiring blood thinners, except aspirin. Unfortunately, tissue valves have a limited lifespan, lasting approximately 15- 25 years depending on a variety of factors, including the age of the patient at the time of implantation.
In general, mechanical heart valves are favored for younger patients while older patients choose tissue valves. Patients receiving mechanical heart valves require life-long blood thinners (anticoagulation). Blood tests are required one to two times a week to check anticoagulation levels initially, and approximately two to three times a month once a regimen as been established. Anticoagulation can be managed quite well by most patients and has a low annual risk of significant bleeding. For patients choosing tissue valves, aspirin is recommended but no further anticoagulation is necessary. Since tissue valves can wear out over time, your cardiologist will monitor the function of your valve with echocardiograms. If a tissue valve does wear out and need to be replaced, this can be done with another operation, or can be done with a catheter delivered valve in some cases.
Robotic and Minimally Invasive Surgery
A limited incision, whether on a portion of the breastbone or between the ribs, speeds the recovery following surgery. In addition, less invasive approaches are associated with lower need for blood transfusion, lower rates of infection, shorter lengths of stay, and for some patients lower mortality. Your surgeon will discuss with you if your condition could potentially be treated with a minimally invasive approach. Even if a minimally invasive procedure is planned, in rare cases, the procedure may need to be converted to a standard procedure for your safety.
The Journey of Heart Surgery
Heart Surgery – Preparation
You will meet with your surgeon and other members of the surgical team either in the office or the hospital about your condition and why surgery is being considered as a treatment option. You should understand the nature of your problem and why surgery is felt to be a good treatment for you. You should also understand the basic nature of the procedure recommended and the risks involved with the operation. If having valve surgery, you should discuss the different types of prosthetic heart valves available and selected which type you would prefer.
For outpatients, a pre-operative appointment will be made where you will receive pre-operative teaching about what to expect with surgery and the recovery process. This will be done by the nursing staff and by our nurse practitioner if you are admitted to the hospital. You will have standard blood work, a chest x-ray, and other tests done before surgery. For almost all patients, a coronary angiogram (“heart cath”) will be done prior to surgery. The coronary angiogram is performed in the hospital by your cardiologist. This typically takes half of a day at the hospital and is scheduled by your cardiologist two or more days before your surgery. You may also need some additional test for your particular condition. We encourage you to ask questions throughout the process. It is best to have a family member/friend accompany you to take notes and write down questions.
Your surgeon or a surgical team member will go over your medications and discuss with you any medications that may need to be stopped or changed prior to surgery. The day before surgery, you should take your medications as directed unless instructed otherwise by your surgeon. Medications that typically need to be stopped prior to surgery include Warfarin/Coumadin, Plavix, Predaxa, Effient, and other blood thinners, diabetic medications such as Metformin, and blood pressure medications of the class call ACE inhibitors (lisinopril, Zestril, and others). Aspirin should not be stopped prior to surgery unless specifically directed to do so. You should not take any medications on the morning of surgery unless specifically told to do so. You will be given special soap to shower with the night before surgery, you will also be given antibiotic ointment to place in your nostrils the night before surgery. You should not eat or drink after midnight the night before surgery. It is okay to brush your teeth with a small sip of water the morning of surgery.
You should avoid people who are ill prior to surgery. Avoidance of large crowds and air travel during the week prior to surgery is also recommended. Vaccines such and flu and pneumonia are not recommended less than two weeks before surgery. You should continue to be as active as your condition allows unless directed otherwise. Regular walking is good preparation for your surgical recovery. If you would like to tour the Intensive Care Unit or the Cardiovascular Unit where your post-operative recovery will occur this can be arranged through our office.
If you smoke, it is recommended that you stop smoking for at least a week prior to surgery. Stopping smoking causes your body to produce a great deal of mucus in the lungs several days after stopping smoking. If you wait until the day before surgery to stop smoking, you will experience heavy phlegm in the first several days after the operation. Coughing during this time is already difficult due to pain from the incision. Excessive phlegm plus poor coughing after surgery can rapidly lead to pneumonia, a potentially fatal complication.
Heart Surgery – Day of Surgery
You will arrive in the pre-operative (pre-op) preparation area approximately two hours before the scheduled time of your operation. For patients coming from home, you will be given an arrival time when your surgery is scheduled in the office. For patients already in the hospital, you will be taken to the preop area by the hospital staff. Two family members can accompany you in the pre-op area. The pre-op area has limited space and cannot accommodate larger groups. In the pre-op area, a nurse will review with you the operation planned, your medications, and when you last ate or drank. An IV will be started in a vein in your arm and your chest, abdomen, groins, and legs will be shaved. You will have the opportunity to meet with the anesthiologist and ask any questions you may have about the anesthetic plan. Almost always, the anesthesia will be general anesthesia that involves going to sleep completely with a breathing tube placed into the windpipe for control of the airway during the operation. If you or family members have had previous problems with anesthesia be sure to tell the anethesiologist about these issues.
Please be patient while waiting in the pre-op area. We realize that this is a time of great anxiety for you and your family. Please also recognize that only the first operation of the day starts exactly on time; all other “scheduled” times are estimates of when the next operation will begin. Scheduled surgery times are affected by many things such as the emergency operations, unexpected difficulties during surgery, and surgical, anesthesia, and patient delays. Any of these factors can cause your “scheduled” time to be moved up sooner, delayed, or cancelled completely. If this happens, we apologize for the stress caused to you and your family. If changes occur to the scheduled time please understand that the change is necessary because we believe that it is in your best interest, or for another patient with an urgent need for surgery.
Heart Surgery – In Hospital Recovery
Following heart surgery, you are taken directly to the Critical Care Unit (ICU) on the second floor, you will not go to the “Recovery Room”. Various monitoring lines will be attached to you after you go to sleep with the anesthesia. When you first awake from anesthesia, there is usually a breathing tube in your throat. This will be removed as soon as you are awake from anesthesia and strong enough to breath on your own. While the breathing tube is in place, you will not be able to talk. Your nurse will give you sedation and pain medication to keep you comfortable until the tube can be safely removed. There will also be monitoring lines attached to your wrist and through a big IV line in your neck or upper chest. There will also be tubes coming from the bottom of your chest to drain fluid. You will also have a tube in your bladder to drain urine. Typically the monitoring lines, urine catheter, and drainage tubes are removed in the first few days after surgery. Patients usually spend one to three days in intensive care before moving to the Cardiovascular Unit (CVU).
After leaving intensive care, you will spend three to five days on CVU progressing on a standard pathway. During this time, any remaining drainage tubes or monitoring lines will be removed. You will usually also have temporary pacing wires placed during surgery in case a pacemaker is needed after surgery. If a pacemaker is not necessary, these wires will also be removed on CVU. Removal of the drainage tubes is associated with brief pain, while removal of pacing wires and monitoring lines is generally not painful. On the first full day on CVU you will take a shower and begin to walk in the hall. You will eat all of your meals sitting in the chair. Walking will be initially done with a specialized walker to aid you in your balance. You should not try to walk alone at first but allow the nurses to assist you.
Patients who have traditional open-heart surgery through the breastbone have lifting restrictions for six weeks following surgery. These restrictions are in place to allow the breastbone to heal properly. To facilitate healing, we ask that you not lift anything greater than five to eight pounds during this time. It is also important not to push yourself up from a chair or do other movements that place stress on the breastbone. The nurses and therapists will teach you about these precautions and restrictions while you are in the hospital.
Your medications will be different following surgery than they were before surgery. Prior to discharge, a team member will go over all of the medications that your surgeon wants you to be on at home. At discharge, you will be given a written list of these medications, dosages, when to take the medicine, and how long you are expected to be on each medicine. You will receive a prescription for any new medications. You should follow the written discharge medication instructions even if they are different from what you were taking before. You should not resume any of the medications that you were on previously unless you are told to do so.
Each patient’s home situation is unique. Our team will work with you, case management, and social work to assess your unique situation and what needs you may have when you get home. Everyone will require some assistance following heart surgery and there are numerous resources available to tailor a plan that meets your needs. Almost all patients will also go home on oxygen for several weeks. This is normal given that we are one of the highest altitude heart surgery programs in the world. At your post-operative appointment your oxygen level will be re-assessed and many patients are taken off oxygen at that time. Prior to going home, you will have a home care plan put together which will include medication instructions, home health care, home oxygen, and outpatient cardiac rehab. We will discuss this plan with you and your family to be sure there are no questions and that you understand the plan and your responsibilities.
Heart Surgery – Recovery at Home
Once at home, your recovery will continue. We will provide you will an activity log to chart your progress. We expect that you will continue to work just as hard at home as you did in the hospital. Regular walking and graduated activity are essential to your recovery and the discharge plan should be followed and your progress charted in your log. It is also important to follow your weight, blood pressure, pulse, and temperature at home daily and track these in your patient log. Patients with diabetes should also chart their blood sugar levels. Your patient log will be reviewed at your post-operative visit.
We recommend that you begin taking short outings after the first week at home. Make trips away from home short and to places you enjoy – go sightsee or get a treat. Gradually make longer trips and errands. If you have a traditional open-heart operation through the breastbone you may drive three weeks after surgery if you are not taking prescription pain medication. You should keep driving trips short at first and slowly work up to longer outings. Air travel is safe approximately three weeks after surgery but should be discussed with your surgeon.
Outpatient cardiac rehab is typically begun two weeks after leaving the hospital. Cardiac rehab is an outpatient program that you attend three times a weeks for approximately one hour. The program can continue up to 12 weeks depending on your needs. We highly recommend cardiac rehab for patients who had heart attacks, who had heart failure, or are over age 60. Cardiac Rehab is available at Penrose Hospital and St. Francis Medical Center in Colorado Springs, St. Mary Corwin Hospital in Pueblo, and St. Thomas Moore Hospital on Canon City. For patients who live too far to come to the hospital for rehab we will craft a home exercise program for you at the time of discharge.
Following surgery you may have a poor appetite and not enjoy foods that were once favorites. It is important that you continue to drink fluids and eat what you can. While you do need enough calories to heal and recover, you do not have to clean your plate when you get home. If you have a poor appetite, try favorite foods or whatever sounds good – even if they are not “healthy” choices. While proper diet is very important, you are already under a great deal of stress and you cannot make too many changes at once. Trying a radically different diet when you first come home from surgery is not likely to succeed. Instead, we recommend that you get through the first several weeks after surgery before making dramatic lifestyle changes. Once things have settled down, then make small changes in an incremental fashion. This will increase the odds that the changes will become a permanent lifestyle change for you. Healthy diet and lifestyle are important to you over the long term, not in the days and weeks immediately after surgery.
Returning to work after heart surgery is stressful. You will need to be honest about your progress and readiness to begin working again. Some people are ready to return to work sooner than others, and some jobs are easier to return to than others. If your work involves physical labor then you will need to be six weeks out from surgery in order for your lifting restrictions to be lifted before considering returning to work. If you can do some work by email or phone, you may begin to start doing these things sooner on a limited basis. When you are ready, we recommend that you return to work on a part time basis at first. Ideally, this would be half days, three days a week initially. From this you can slowly increase the number of days and then the length of your days. It is important to recognize stressors that may cause you to want to return to work sooner such as financial pressure, supervisor pressure, or guilt over the burden placed on co-workers by your absence. It is important to identify these factors and consider how they may be affecting your decision to return to work. If you have paperwork necessary to be absent from work, or to return to work, please bring that paperwork to our office to be completed.
Many patients experience varying degrees of depression following heart surgery. This is especially true for patients who had heart attacks and/or needed urgent surgery. These feelings are common and should be discussed with your family and doctors. The stress of major surgery, the long recovery, and the shock of a new diagnosis of heart disease all play a role in feeling depressed. These feelings are often the strongest approximately two weeks after going home from the hospital.
After being home for a week or more, progress is not as fast as the first week in the hospital and this frustrates many patients. One month after surgery, most patients are still experiencing some fatigue and have less endurance. These feelings should be discussed with your family, your doctors, and with the cardiac rehab staff. Other patients at cardiac rehab are also a good resource to help you realize that you are not alone in your feelings. The combination of time and open discussion is usually sufficient to work through the depression and frustration.
Many patients have questions about resuming intimacy and sexual activities. While it is important to emotionally reconnect with loved ones after a significant life event such as heart surgery, it is also important to remember that sexual activity is exercise. When you are walking regularly for more than 10 minutes without stopping you can consider resuming sex. It is also important to remember that lifting restrictions on your healing breastbone may preclude some positions. Avoid positions in which you have to hold yourself up with your arms as this places excessive stress on the healing breastbone until your lifting restrictions are over.
Cardiac Surgery Patient Pathway
The following charts will give you a quick reference on what to expect before surgery, on the day of surgery and during your hospital stay.
|Before Your Surgery|
|Activities at Home
|Day of Surgery|
|Days 1-5 After Surgery|
|Discharge Planning –
Case manager can help:
Managing Your Care at Home
You will continue your walks when you get home, increasing a little bit every day. (See section on “Exercising for a Healthier Heart.”)
Walking is important as you build your strength. It should become a habit that will protect your heart’s health for the future.
- You will still be tired when you go home. You will need to rest between activities. Plan your day to allow rest breaks, for example, after your shower, before and after your walks, etc.
- Share your work with others if it is too hard, if it makes you tired or if you get short of breath.
- Sit whenever possible: when you are getting dressed, preparing food in the kitchen, etc.
- Listen to your body and rest when you are tired.
If you have diabetes, continue to check your blood sugar at home. Call your primary care doctor if your medicines are not controlling your blood sugar.
Activities of daily living
- Turn down the water temperature in the shower and limit your shower to five to seven minutes to avoid fatigue.
- Make sure all your supplies are within reach and not above your head.
- Limit reaching over your head for objects —it makes your heart work harder.
- Sit down to put on socks and pants. Bending over and reaching down can place too much strain on your chest.
For six weeks, do not lift, push or pull objects that weigh more than 5 pounds. Examples: car doors, purses (8 to 12 pounds), gallon of milk (8 pounds), children, pets. Slide objects or use a rolling cart if needed.
Getting out of bed
First roll to your side, slide your feet off the bed and then use your forearm/elbow to gently push yourself up to a sitting position. Do not pull on someone’s arm to get up. Sleeping with your chest up on several pillows may be more comfortable at first and makes it easier to get up.
When getting up from a seated position, follow these guidelines:
- Avoid low or soft chairs.
- Use a pillow.
- Consider a raised toilet seat.
- Scoot to the edge of the seat.
Hold your pillow or put your hands between your knees or across your chest; do not push up from arm rests or pull on something to get up (lifting restriction). Use your legs to push up; use a rocking motion if that helps give you momentum to get up.
If someone helps you get up, have the person hold onto the waist of your pants. Do not let the person pull using your arms.
When getting into a car, sit down first. Then swing your legs in. When getting out, swing your legs out first. Then stand up. You may need a pillow to sit on.
- Limit stairs to one or two trips a day at first; increase as your body allows.
- If you have a leg incision, go up with your “good leg” first and go down stairs using the leg with the incision first.
- Gently hold on to a handrail. Do not pull yourself up with it.
- Put a basket near the steps to collect things that need to go with you; have someone else carry it for you (lifting restriction).
Checking your heart rate (pulse)
Check your pulse every day; write it on your activity diary. Use your finger tips to press gently at your wrist below your thumb or on your neck between your voice box and the big muscle on the side of your neck.
Use a watch or clock with a second hand and count the number of beats you feel in 10 seconds. Multiply this number by six to figure the number of beats in one minute. For more detailed instructions on taking your pulse, see “Exercising for a Healthier Heart.”
- No driving for three weeks after you leave the hospital.
- Put your pillow under your seat belt for comfort. When not driving.
- Limit local rides/drives to 45 minutes. Stop to stretch when you are tired.
- When beginning to drive again, avoid long periods of driving, rush hour traffic and bad weather.
- Limit the number of visitors and how long they stay. You will be tired.
- Do not allow anyone to visit if they are sick (cough, fever, sore throat, a cold). You are more likely to pick up an infection.
Common Concerns After Going Home
Constipation and poor appetite
Being less active and taking pain medication can make you constipated after surgery. Eat plenty of high-fiber foods like fruits and vegetables (see green section on “Eating with Your Heart’s Consent”) and drink liquids. An over-the-counter stool softener, laxative or enema may be used.
A lack of activity also can affect your appetite. Try eating five to six small meals each day instead of three larger meals. See the green nutrition section for ideas to make foods taste better.
It takes extra calories and protein to heal wounds. Try to eat a high-protein food with each meal. Good protein sources include:
- Poultry, fish or lean meat – try to eat a total of 6 ounces daily
- Milk (skim or 1%) – try to have 2 cups daily
- Reduced-fat cheeses
- Egg substitutes and eggs
Iron can help rebuild your blood. Vitamin C helps you absorb iron and also is good to help wounds heal and fight infection. Foods high in iron include:
- Fortified cereals
- Lean beef, pork, veal, lamb
- Spinach, chard
- Lentils, dried beans and peas
- Lima beans, soybeans and tofu
Good sources of Vitamin C:
- Citrus fruits and juices (oranges)
- Dark green vegetables (broccoli, green peppers, leafy greens)
Heart rhythm — skipped beats, irregular rhythm
You may notice an occasional skipped beat or you may be more aware of your heartbeat after surgery. This is normal. If you feel more than five skipped beats each minute, call your doctor.
If you notice a fast, irregular heartbeat that does not go away or causes you to feel dizzy or short of breath, call your surgeon. Atrial fibrillation, a rapid, irregular rhythm, is sometimes caused by irritation and swelling in the heart after surgery. It usually lasts for a few weeks, and often needs to be controlled with medicine during that time.
Depression and forgetfulness
It is normal to feel a wide range of emotions after surgery. Pain, boredom, limits on your activities and being out of your normal routine can affect the way you feel.
It is common to feel “down” or discouraged after surgery, when you don’t think you are improving as fast as you should. Talk about what is bothering you. Find some activities that you enjoy and are able to do. If the “down” feeling lasts too long, tell your doctor.
It also is common to be forgetful for a while after surgery. A lack of normal sleep and the use of pain medicines can add to your forgetfulness. This should get better in the weeks after surgery.
- It’s common to have sleep problems in the weeks after heart surgery. You may be more comfortable sleeping in a recliner chair at first.
- It helps to set a bedtime routine. Go to bed at a regular time and get up at the same time each day. Rest during the day, but limit naps to one-half hour.
- Avoid foods high in sugar at bedtime. Do not eat late, heavy meals. Try herbal tea at bedtime. Chamomile is a good choice. Avoid caffeine (coffee, tea, cola) in the evening.
- Take your pain medicine one-half hour before bedtime to make you more comfortable.
- Try a 15-minute hot foot bath or a warm shower an hour before bed time. Ask your loved ones for a 10-minute backrub.
- Use earplugs. Darken the room as much as possible. Turn the alarm clock away so you can’t see the numbers glaring during the night.
- If you are awake and can’t get back to sleep, get out of bed and do a task to make your eyes tired (read a dull book, play solitaire, pick up your knitting or needlework). Don’t turn on the television (it is too stimulating).
Ask your surgeon at your first follow-up visit about resuming sex. Sexual activity is considered a moderate exercise. When you can climb two flights of stairs without problems, it is usually okay to have sex.
Wait one to three hours after a full meal before sexual activity. Don’t drink alcohol for three hours before sex. Make sure you are rested.
Don’t use positions that cause you to support your weight with your arms until six weeks after surgery.
If you have chest pain, shortness of breath or skipped heart beats, stop and rest. Some medicines can affect sexual activity. If you think this is causing a problem for you, talk to your doctor. Do not stop taking a medicine without talking to your doctor first.
Returning to work
It will be weeks before you are ready to return to work. It will depend on the type of work you do, your physical condition before the surgery, the type of surgery that you had and how well you are healing. Cardiac rehab can help provide you with the stamina and endurance you need for your work day. Your surgeon will tell you when you can go back to work.
Ask your doctor if you have any work restrictions (e.g., lifting or driving). You may need to provide documentation to your supervisor indicating any work restrictions.
When you are back at work, remember:
- Start slowly. Pace yourself. Returning to work after a major cardiac event is usually very tiring. Try to start back gradually -talk to your manager about working half days for the first week.
- Make exercise part of your daily routine. Talk to your doctor about cardiac rehab. For more information, see “Lifestyle Changes for a Healthier Heart.”
- Remember nutrition. Look for heart-healthy eating options at work. If your company has a cafeteria, ask the staff what healthy nutrition choices they offer. If you eat out for lunch, ask die restaurants for a breakdown of the nutrition content of their menu items. Packing your own lunch is the easiest way to ensure you get the nutrients you need without the fat and sodium you want to avoid.
- Combine diet and exercise by walking past the vending machines. Bring an extra piece of fruit from home instead of purchasing a less-healthy snack from the vending machine at work.
Impact of heart surgery on your family
Having a heart or lung operation is definitely a family event. The reality is that major surgery is a big deal—not just for the patient, but for a lot of other people, too. Ordinary life goes on hold as families adjust schedules, change plans, talk, wait, and worry. Each of us has a family, even if our family is a friend, a neighbor or even a special pet.
Experience and research shows that when patients and families have access to the people and information they need, and are invited to actively participate in care and decision making, every kind of outcome improves. Patients recover better and faster, with less stress all around. Life stays closer to normal for everyone.
Certainly hospitals are fast-paced, intimidating places. But ethically and legally, the patient and only the patient is the person truly in charge. If a patient is competent to make decisions, nothing will happen unless he or she agrees that it should. Remember this, and use it.
With this perspective as a starting point— that control ultimately rests with the patient and family and not the healthcare team— then mutually respectful relationships of trust and shared accountability can be reached. Honesty, openness, trust, and mutual respect are the building blocks. When these are achieved, anxiety and fear are greatly reduced. Good care and rewarding friendships usually follow.
If you are interested in learning more about how patients and family can participate in care and decision making, helpful information is available from the Institute for Family Centered Care.
One more thought, based on watching many patients and families go through serious illness and recovery. Surprisingly, at the far end of the difficult experience of being ill and having surgery, patients and their families often find an unexpected new wholeness and happiness in their lives.
What may seem at first to be the worst thing that could ever happen turns out to be, in a surprising and unexpected way, a time of deep personal and family healing and learning that reorients every priority and makes life truly worth living. Major life events like heart surgery or lung surgery help us see and appreciate the things that really matter.
Attributed to Dr. Paul N. Uhling.
Guidelines for family members
Heart disease and heart surgery affect the whole family. Things may change at home. Chores may have to be done by someone who usually does not do them and roles may be switched.
It is normal to be tired, anxious, scared, confused, angry, sad, helpless or even depressed after having a family member go through heart surgery and then dealing with changes at home. These feelings are not “bad” or “wrong.” Talk about how you feel. Naming your feelings gives you some control over them.
It is important to take care of yourself while you are helping a loved one heal:
- Eat a healthy, balanced diet.
- Get some rest; nap when your “patient” naps.
- Take a walk.
- Practice deep breathing or other relaxing exercises.
- Accept help from family and friends. Don’t be afraid to ask for help.
- Talk with a trusted friend or someone who also has been through this.
- Take the phone off the hook or let the answering machine take over for a while.
Daily Activity Log for Open-Heart Surgery Patients
Click on image below to download Activity Log [PDF]