Heart Center of the Rockies

Open-heart surgery is done when normal heart function is changed because of coronary artery disease, heart valve disease, or other heart problems. The term open-heart surgery refers to any surgery on the heart.

With open-heart surgery, an incision is made down the middle of your chest and your breastbone (sternum) is divided to allow the surgeon to reach your heart. A smaller incision may be performed for certain types of surgeries. Ask your physician if you are a candidate for a smaller incision.

A heart-lung machine may be used during surgery. This machine pumps blood for the heart and adds oxygen for the lungs while the heart is at rest. Blood goes from the heart into the machine, where wastes are removed, oxygen is added and the blood is pumped back into the body. When the surgery is finished, the heart gradually takes over its job of pumping blood throughout the body and the heart-lung machine is removed.

Coronary artery bypass surgery
Coronary artery surgery is done to bypass one of more blockages in the heart¹s arteries. The bypass increases blood flow to the heart muscle to relieve chest pain (angina) and improve heart function. A leg vein (saphenous vein), an artery from the chest (internal mammary artery), or one from your arm (radial artery) can be used for the bypass graft. The type of graft used depends on the number and location of the blockages.

When a leg vein is used, one end is sewn to the aorta and the other end to the heart artery below the level of the blockage. Using a leg vein may slightly change blood flow from that area of the leg but does not affect the ability to walk. The leg vein is taken through an incision on the inside of the leg, or by small incisions made at the ankle, knee, or thigh.

Bypass surgery is not a cure. You will need to control your risk factors for heart disease to keep new blockages from developing in the future.

Off-pump bypass surgery
This is an alternative method of performing Coronary Artery Bypass Surgery. It is referred to as a minimally invasive operation, and is performed without the heart-lung machine.

In this operation, special instruments are used to keep certain parts of the heart still while the rest of the heart beats normally. This method allows the surgeon to operate on the heart while it continues to beat.

This operation usually takes about three hours. Your surgeon decides whether the heart-lung machine is necessary. The average hospital stay is three to four days because patients can recover more quickly.

Valve repair or replacement
Normal valves are thin, smooth structures that direct blood flow through the heart¹s chambers. The valves can be changed or damaged by birth defects, infection, rheumatic heart disease, or age. Over time, scarring or thickening of the valve can occur. With these changes, the valves become harder to open (stenosis) or can¹t close all the way (regurgitation). The aortic and mitral valves are the ones most commonly affected.

When valves do not open and close as they should, less blood is pumped to the body. This causes the heart to pump harder. If the heart is unable to do this, heart failure occurs. Blood is not emptied out of the heart and it backs up into the lungs and other parts of the body. As a result, shortness of breath, leg swelling, coughing, or fatigue occur. Medicines can improve the heart¹s pumping and relieve the heart failure. Surgery is often needed to improve the heart¹s function.

When possible, your own heart valve is repaired. More often the damaged heart valve must be replaced. Some people feel better right after surgery because their symptoms are relieved. For most people, it takes a few months before they feel the benefits of the heart valve surgery. It takes time for the heart to recover from the extra work it was doing before the surgery.

The replacement valve will be either a mechanical valve or tissue valve. The tissue valve may be porcine (pig tissue), bovine (cow tissue), or human. Your surgeon will recommend the type of valve that¹s best for you. Some factors to consider include age, your disease, the size of your heart, and your ability and willingness to take blood thinner medicines. Your feelings and ideas will be discussed and considered in the planning of the operation.

Other Procedures

Atrial septal defect repair
Sometimes there is a hole between the two upper chambers of the heart. Open heart surgery is needed to repair this hole.

When the hole is small, the defect is repaired with a stitch. If it is large, a patch of material is placed over the hole and stitched into place. This material may be synthetic or the patient¹s own tissue.

Aortic root replacement
Sometimes the aorta becomes weakened and an aneurysm develops as a result of high blood pressure, age or genetic disorders. A portion of the aorta may need to be replaced, using either a Dacron graft or one made from donated tissue.

Repair of aneurysm in heart muscle
Sometimes an aneurysm occurs in the damaged heart muscle. This area of the muscle is weak and bulges. The weakened muscle cannot help the heart pump blood. Open heart surgery may be required to repair this condition.

The Heart Operation

Before surgery
You will have had several tests before your surgery, including:

blood work
chest x-ray
carotid Doppler tests to detect blockages in the arteries of the neck
EKG
pulmonary function test to check overall condition of the lungs
pulse oximetry to check the oxygen level in your blood
ultrasound of leg veins to identify their location

You will be asked questions about your medical history, allergies, and current medications.

You will receive information about the surgery, such as how long it takes, what kinds of tubs and wires you will be attached to, and what happens during your recovery. If you have any questions or concerns about the surgery, they can be answered at this time.

Every question you have is important. Our goal is to ease your fears and assist you through this stressful time in your life.

Day of surgery

The day of surgery you are admitted to the Heart Center Procedure Unit.
You are given medicines to help your relax. You will feel drowsy.
The cardiologist places an IV in the side of the neck. A small catheter may be threaded through this IV to monitor the blood pressure in your heart during and after surgery.
The anesthesiologist places IVs in your arms and a special line in your wrist called an arterial line. The arterial line measures your blood pressure continuously and allows the nurses to draw blood samples without using a needle to stick you.
Any chest, leg, or groin hair is shaved to prevent infection. Someone of the same sex will perform this preparation.
Your family and support people are directed to a waiting area during your surgery. Nurses from the operating room keep them informed of your progress.
The surgery usually takes 4 to 6 hours.

After surgery

You are transferred to the ICCU (Intensive Coronary Care Unit) for about 24 to 36 hour where specially trained nurses guide you through your recovery.
As you wake up, you hear many noises and find various tubes and wires attached to your body. Your arms may also be tied at this time. This is for your safety to keep tubes from accidentally being disconnected. You will likely be connected to the following:

breathing tube: to help you breathe until you are fully awake and stable. You are not able to talk with this tube in place. A nurse communicates with you by asking questions. The first goal is to take you off the breathing machine.

stomach tube: to empty out natural stomach secretions.

bladder catheter: to empty the bladder and measure urine output.

intravenous (IV) lines: to provide medicine, fluids and nutrition.

arterial line: to measure blood pressure and draw blood samples.

chest tube: to drain the chest cavity of normal post-operative bleeding.
A temporary pacemaker is sometimes used.
An EKG monitors your heart rhythm throughout your recovery.
Most tubes are removed the day after surgery and you are able to sit at the edge of the bed or up in a chair.
You are transferred to the Cardiac Unit with IVs in your arms and neck

Transfer to Cardiac Unit

During this transition, you are encouraged to take an active role in your recovery.
As you continue your recovery on the Cardiac Unit, you become more independent while remaining in a safe environment. It is normal to feel anxious. Nurses are available to answer your questions and address your needs and concerns. You¹ll stay on this unit for 3-7 days before going home.
You wear a small monitor that transmits information to the nurse¹s station about your heart.
As you continue to recover, nurses check your blood pressure, pulse, and temperature and do assessments less often. This allows you to get more rest and have visitors.
You¹ll gradually start eating more.
Over the next few days, you¹ll be able to increase your walking and other activities to help your body functions return to normal. You learn to take your pulse and limit your upper arm movement to allow safe breastbone healing.
Breathing exercises are important during the first few days after surgery. You are asked to cough and breathe deeply to prevent fluid from collecting in your lungs.
You are given a special pillow. Hold the pillow tight against your chest when coughing. It helps decrease the pain and stress on the breastbone.
Your oxygen levels are monitored and you gradually are weaned from needing extra oxygen.
Knee-high elastic stockings (TED) provide support and help prevent blood clots from forming in the legs.
Take pain medicines regularly. Feeling comfortable will improve your breathing, walking and sleeping.

Recovery at home

The following describes the period of healing immediately following discharge from the hospital. As patients are well enough, they begin a more regimented course of exercise and education, which is described in the Rehabilitation section.

Care of incisions

Keep the incision clean and dry.
Wash the incision before the rest of the body. Dry it first, too.
If the incision is draining, was gently with anti-bacterial soap and water. Pat dry with a clean towel. Cover with a clean, dry gauze.
Do not use ointments, lotions or creams on the incisions unless your physician instructs you to.
Avoid lifting or pulling with your arms for 6 weeks.
Do not lift, push or pull anything over 10 pounds for 6 weeks.
Do not drive for 6 weeks.
It is normal for chest and leg incisions to be slightly tender. The incisions may drain clear, yellowish, or straw-colored fluid.
Tell your doctor about any increased tenderness, redness, or cloudy, foul-smelling drainage from the incision, or if your oral temperature exceeds 101 degrees.

Elastic stockings

If you did not use these in the hospital, you may be fitted with knee-high (or thigh-high) support stockings. These help prevent blood clots from forming in your legs and help reduce swelling.
Wear your stockings for several weeks to improve circulation. You may stop wearing them when your feet no longer swell in the evening, or as your doctor instructs.
Elevate your legs whenever you are sitting.
You may remove your stockings at night, but put them on again in the morning. Have someone help you put them on and take them off.
Wear slippers or non-skid socks on feet with TEDS to avoid slipping or falling.

Bathing

Shower in the morning. Evening showers may be overly tiring.
Avoid tub baths until chest and leg incisions heal completely.
Avoid long, hot showers for the first week to reduce dizziness.
Use a shower stool while bathing if dizzy or tired.
Wash incisions before the rest of the body using a clean cloth or bath sponge.
Dry incision first. Pat dry with a clean towel.

Deep breathing exercises

Continue deep breathing and coughing exercises 3-4 times a day for 1-2 weeks after going home.
Firmly support your chest incision with a pillow when you cough.
A nurse will teach you how to use an incentive spirometer while you are in the hospital, and will give you instructions for home use after you are discharged.
You may receive oxygen at home for a few weeks.

Weight

Weigh yourself every morning before breakfast.
Use the same scale and record your weight each time.
Notify your doctor immediately if: You gain 3 pounds overnight or 5 pounds or more in 3 days; you have swelling in feet, legs, hands, or face; or you have shortness of breath.

Chest discomfort

Chest, shoulder, back and leg pain gradually disappear after several weeks.
Use your pain medicine as directed.
Do not take tranquilizers or alcohol with your pain medicine.
Notify your doctor immediately if: Chest soreness persists or changes, or if you have any movement, clicking, or grinding in your sternum.

Changes in sleep and appetite

You may notice changes in your normal sleep and eating patterns. This may be due to anxiety, pain or discomfort.
Eat foods you enjoy that are high in protein and low in fat and sodium.
Sleep in any comfortable position as long as you don't use your arms to push or pull.
You may take pain medicines before going to bed.
Sleep with pillows between your knees to prevent incisions from rubbing.
Ideas to help you sleep include relaxation tapes, back rubs, and fewer naps during the day.
Sleep and appetite usually improve within 6 weeks.

Fatigue

It is normal to tire easily after major surgery. This usually lasts a few weeks.
Take short rest periods during the day.
Limit visitors as needed.

Dental work

Plan to wait at least 6 weeks before you have any dental work. If any dentistry is necessary, discuss this with your surgeon.
Notify your dentist before your appointment if you have had valve surgery. Antibiotics will be needed before your procedure.

Flu shots

Discuss with your surgeon the timing of any flu shot you may need. Plan to wait at least 2 weeks after your operation.