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 an effective 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 diverse 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 important pre-operative teaching about what to expect throughout the surgical process as well as recovery. This will be done by the nursing staff and by our nurse practitioner/physician assistant 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, Pradaxa, Effient, and other blood thinners, diabetic medications such as Metformin, and specific classes of blood pressure medications known as angiotensin-converting enzyme (ACE Inhibitors) and angiotensin II receptor blockers (ARBS). ACE inhibitors are commonly known as lisinopril, benazepril, captopril, enalapril, and ramipril. ARBS are commonly known as losartan, olmesartan, telmisartan. 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. Vaccine such as 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.

Smoking cessation is always recommended as soon as possible. Stopping smoking causes your body to produce a great deal of mucus in the lungs several days after cessation. 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 surgical incision. Excessive phlegm coupled with poor coughing ability after surgery can rapidly lead to pneumonia, a potentially fatal complication.