Your Procedure

Welcome to our Cardiac Surgery Program. You may have begun your experience with us as an inpatient, referred by your primary care physician or cardiologist, or as an outpatient who saw the cardiothoracic surgeon at the office.

Hospital pharmacist We hope this information answers your questions about what to expect during your surgical experience, and helps to make your stay a positive one. It describes many of the procedures, experiences and routines common to patients undergoing heart surgery, and the typical progress of a patient during recovery. Any special circumstances you may have, which may change the usual course, will be discussed with you.

It is our hope that by having you know and understand your experience here, your fears and apprehensions will be reduced.

Your Care Team

Many people will be involved in a “team” approach to your care. These caregivers may include:

Your surgeon
The anesthesiologist who will administer the anesthetic during your surgery
A physician’s assistant, a specially trained professional able to help the physician in many tasks
Your primary care physician
Consult physicians, if your medical condition so requires
Nurses
Lab and X-ray personnel
A respiratory therapist, trained in assisting the breathing functions
An exercise physiologist who will work with you on rehabilitation after your surgery
A social worker who will help you with planning needs after you go home
A dietitian
A cardiac surgical coordinator who will oversee your care before, during and after your stay
Many others who are here to make sure you receive the best possible care

During Surgery

The first 45-60 minutes in surgery are used to prepare you for the actual operation. An anesthetic will be administered. After you are asleep, a breathing tube will be inserted and you will be connected to a respirator. A stomach tube will be inserted and attached to suction to remove excess stomach juices and acids. A bladder catheter will be inserted to empty your bladder and measure urinary output.

A Central I.V. Line (CVC) will be inserted in your neck to replace the I.V. in your hand. An arterial line will be placed in your wrist to measure blood pressure. You will have chest electrodes placed on your skin to monitor your heart rhythm.

Once you are in a deep sleep, the breastbone (sternum) is cut and separated. If you are having coronary artery bypass grafting, the doctor will decide the location from which to take your grafts. He or she may use your internal thoracic artery in your chest, which can be isolated and brought down for one or more of the bypass grafts. The rest of the grafting material will come from the saphenous vein in your leg. You will have leg incisions where the vein(s) was removed, which will be held closed by stitches.

During your surgery, the heart-lung machine provides circulatory support to the major organs. After the blockages are bypassed, or the valve is replaced or repaired, you will be taken off the heart-lung machine.

Your sternum will be closed and fastened with stainless steel wires which will stay in your chest. Your chest incision will be closed with sutures. Tubes will be placed in your chest to drain the cavity of normal post-operative bleeding.

Shortly after this, you will be brought up to the Critical Care Unit, where you will stay one or two days; then you will move to 2 West where you will stay until discharge. The total stay is usually four to seven days for bypass and possibly a little longer for a valve procedure.

Heart-Lung Machine

After Surgery

At first, while you are in the Critical Care Unit, nursing care will be one-on-one. Your hands will be restrained and you will not be able to talk while you are on the respirator, but your nurse has been trained to recognize your needs by your facial expressions and body language. Once you are more awake, you may write notes to communicate.

Once you are fully awake and expanding your lungs adequately, you will be slowly removed from the respirator. When the breathing tube is removed, your active participation in your recovery will begin.

You will be expected to cough and breathe deeply periodically, and to use the Inspirex every one to two hours.

Visiting Hours

Visiting hours in the Critical Care Unit are strictly enforced. They are limited to 15 minutes on the hour, two persons at a time from the immediate family only, except for the hours from 7:00 - 11:00 a.m. and 3:00 - 5:00 p.m.

Recovery

Your activity will begin in the Critical Care Unit. It will start with sitting on the edge of the bed, moving to a chair, then gradually and steadily increasing your walking distances.

Pain medicine will be given liberally during your stay. You may feel increased soreness related to the surgical procedure. The soreness will decrease as you are able to move around more.

Your monitoring lines and tubes will be removed as soon as possible - some before you leave the Critical Care Unit. After your chest tubes are removed, you will be working toward recovery with the cardiac rehabilitation personnel and the nurses.

You will feel very tired due to minimal sleep and the usual post-operative routines that are part of your recovery. We encourage you to tell well-meaning friends and neighbors to wait until you are discharged to visit; and even at home, they should keep their visits short at first to avoid tiring you.

Your cardiac rehabilitation should continue even after you are discharged from the hospital. The heart center provides programs and education to help you develop lifestyle changes and to continue your physical and emotional rehabilitation.

While still in the hospital, you will continue to participate in cardiac rehabilitation and your activity will increase. Cardiac rehabilitation personnel will instruct you as to which exercises you will be expected to continue as you recover in the hospital and they will arrange and follow-up with a post-surgical exercise program.

If you live out of town, they will arrange your follow-up program with the rehabilitation facility nearest your home. The importance of your participation in cardiac rehabilitation cannot be stressed enough.

You and your family will be visited by a dietitian to give you instructions and material about your recommended diet. The initial diet is to promote good healing and build strength during recovery.

At Home

The first two weeks after your discharge from the hospital can be difficult and you may not feel that you are improving much. This can be discouraging at times. Understand that this is normal. Soon you will begin to feel improvement and you will be on your way to full recovery.

The cardiac surgical coordinator will explain to you all the “do’s and don’ts”, including activity restrictions, medications and follow-up care. A follow-up appointment with your surgeon will be scheduled for you. Your primary care physician will be notified of your discharge and your medications.

After you are discharged, we ask that you call your family physician and schedule a follow-up appointment for approximately one month from the date of your discharge.

If you are going home on Coumadin, your primary care physician will oversee your protime levels and daily Coumadin administration.

Your medications may be different at discharge from what you had been taking before surgery. After discharge, your primary care physician will decide which medications you need.

When you are home, refer to your Discharge Summary Sheet with your home care instructions, your cardiac rehabilitation papers and your dietary guide.

Be good to yourself! You have been through a great deal. Your heart will be functioning well by the time you go home, but it will take about three months for the bone involved in your surgery to completely heal. You can look forward to full recovery by two-and-one-half to three months.

After your recovery, you will probably have no physical restrictions on what you can do, but you might want to consider some lifestyle changes in your activities and diet to lower your risk of future heart disease. Your choice of lifestyle has a lot to do with your quality of life.

If you have been a smoker, you will be advised to quit. Mercy Health Partners offers smoking cessation, exercise and nutrition classes to help you with lifestyle changes. When people try to make changes, they often find it easier with the group support offered through these programs.

Smoking, alcohol abuse, lack of regular exercise and not following a proper diet are all factors that you can control. Diabetes, high blood pressure and weight control are factors that need medical management - as well as your willingness to follow-up.

If you have any questions, concerns or problems after discharge, please do not hesitate to call the cardiac surgical coordinator or your physician. If you feel it’s necessary, come to the emergency room.

On the day of your follow-up appointment, please come to the Outpatient registration desk at the hospital one hour before your appointment. Your lab work, chest X-ray and EKG will take about one hour to complete. Bring your EKG and chest X-ray films with you to the doctor’s office at your appointment time. Also, please bring a list of the medications you are currently taking.

For More Information

Your care is very important to us. We hope that the information you have just read will be helpful to you.

If you have unanswered questions, write them down so you will not forget them. Please feel free to ask any member of your heart surgery team about anything you don’t understand.

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