After Cardiac Surgery
After the Operation
You will be taken from the operating theatre to the ITU where you will be closely monitored for around 24-48 hours.
● You may have a tube in your mouth, which passes down your windpipe, and is connected to a ventilator (a machine to help you breathe). This will be removed once you are awake, alert and breathing by yourself.
● When you wake up from the anaesthesia, you will be connected to machines that record the activity of your heart, lungs and other body systems.
● A clip on your finger will measure the level of oxygen in your blood.
● A thin, flexible tube (catheter) is usually placed in the bladder before surgery begins. The catheter is needed to collect and measure urine. Once you are able to get up and go to the bathroom, the catheter is removed.
● Fluids, medications, and sometimes blood transfusions are given before, during, and after the surgery through an intravenous (IV) line. When you are able to eat and drink and no longer require IV medications, the line is removed.
● Tubes are placed inside the chest to drain fluids that accumulate around the heart after surgery. These are usually removed within one to three days after surgery.
● The incision in the chest is usually sore, with the most discomfort in the first 48 to 72 hours after surgery. Pain medications are usually given to relieve this discomfort.
When continuous monitoring is no longer required, usually after 12 to 24 hours, most patients are moved to a step-down or transitional care unit. Most people can sit in a chair the day after their surgery. The person is encouraged to start walking within one to two days after surgery. Many people have a poor appetite for several weeks after surgery. This is normal and expected. Talk to a doctor or nurse if there are concerns about appetite. Constipation is also common during this time, probably due to decreased activity and food intake and use of pain medications. Medications to relieve constipation may be recommended. People who have a graft taken from their leg sometimes notice swelling in this leg after surgery. Elevating the leg and wearing compression stockings can help to reduce the swelling. It is common to have difficulty sleeping after bypass surgery, especially while in the hospital. This usually improves following discharge from hospital. Approximately 20 to 40 percent of people become depressed after CABG. Signs of depression include sadness for most of the day, diminished pleasure or interest in almost all activities, insomnia or excessive sleep, or feelings of worthlessness or guilt. Depression can interfere with recovery and increase the risk of heart problems in the future. Anyone who notices signs of depression that last for more than two weeks should speak to their healthcare provider about treatment options. Most people recover in the hospital for four to five days after surgery. However, hospitalization may be longer, depending upon an individual’s rate of recovery and any complications that develop. People who do not have complications or a prolonged hospital stay are usually able to return to desk work within six weeks to three months. People who have a physically demanding job often need more time to recover. Complete recovery from surgery often takes three months.
Before you go home, a nurse and a doctor will advise you on diet and caring for the healing wound, hygiene and bathing. You will be given a contact telephone number for the hospital and follow up arrangements will be made.
After you return home
If you need them, continue taking your medications and painkillers as advised by the hospital.
If you have a mechanical valve, you will need to take anticoagulants daily, possibly for life.
The wires holding your chest together are permanent. Your breastbone will take about 12 weeks (3 months) to fully heal. Stitches or staples are usually removed before you leave the hospital, by your doctor or at your follow up consultation.
It is not advisable to drive for at least six weeks after cardiac surgery. Car insurance companies may not insure you for a number of weeks following cardiac surgery.
You should not lift, pull or push anything for 6 weeks and restrict lifting, pulling and pushing heavy objects for at least 3-6 months following cardiac surgery.
You should exercise as much as possible using aerobic exercises and regular daily walks. Specialist cardiac rehabilitation programs will help you with this.
You can potentially fly 10 days after cardiac surgery but it is not advisable to do so for the first 6 weeks.
Your recovery continues for at least 12–18 weeks and most people return to work around 10–12 weeks after their surgery. Returning to work however, will depend on the surgery you had, how well you’ve healed, and the type of job you do. Getting back to work sooner rather than later can help your recovery.
There are some common symptoms that you may have when you get home. These can feel difficult and unpleasant to go through.
- night sweats
- deep sighing
- being short tempered , feeling emotional and crying easily
- stiffness between your shoulder blades and the base of your neck
- initial numbness around the wound on your chest followed by hyper-sensitivity from the touch of a shirt or blouse.
These symptoms are usually temporary, and will get gradually get better with time. If they persist, discuss them with your surgeon.
After discharge from the hospital, the patient is usually given instructions about how to care for their chest and/or leg wounds. It is important to follow these instructions closely and to notify a healthcare provider immediately if there are questions or concerns. When you take a shower please remember not to rub your wounds and to use two different towels, one for the upper body and one for the lower body. Different colour towels will help to avoid mixing them.
When to seek help
If the patient develops any of the following signs or symptoms of wound infection, a healthcare provider should be contacted immediately. Most wound infections develop within 14 days of the surgery. ●Fever greater than 100.4º F (38º C) ●New or worsened pain in the chest or around the incision ●A rapid heart rate ●Reddened skin, bleeding or pus-like drainage from the incision
Most people who have undergone cardiac surgery benefit from participating in a structured, comprehensive cardiac rehabilitation program. People who participate in cardiac rehabilitation usually have appointments several times per week in a hospital or clinic, allowing the person to live and sleep at home. There are several components to cardiac rehabilitation, including exercise, reducing risk factors, and dealing with stress, anxiety, and depression. The benefits of cardiac rehabilitation are seen only when all these components are addressed. Exercise has consistently been shown to improve cardiovascular health. Importantly, the first step in starting to exercise is to determine the potential risk of complications to heart and/or blood vessel from exercise. This is usually done by undergoing a monitored exercise test on a treadmill. Although nearly everyone can exercise safely after discharge, the intensity and duration of exercise should be tailored to the severity of a person’s heart disease.
Follow up appointment
You’ll be reviewed in the cardiac surgical clinic at approximately six weeks after your operation.
How to look after your new heart valve
Heart valves (native or prosthetic) can sometimes get infected. This can happen during certain types of dental work and operations. You may need extra antibiotics to help protect your new heart valve from infections (endocarditis).
Before having any medical or dental testing or procedures, you need to tell your doctor, dentist, dental therapist or dental hygienist that you have had heart valve surgery.
Endocarditis is a rare but serious condition where any heart valve (native or prosthetic) becomes infected after bacteria enter your bloodstream. It can also affect the tissue surrounding a new heart valve. New, prosthetic heart valves, although sitting within your blood stream, they do not have feeding blood supply of their own and as such, they can not fight infections to the same way your native valve does. When a prosthetic heart valve becomes infected (prosthetic valve endocarditis), antibiotics can not treat the infection and there is usually a need for a re-operation.
If not treated quickly, endocarditis can be life-threatening condition.
- Look after your teeth. Make sure you have regular six-monthly dental checks and brush your teeth with toothpaste twice a day.
- Avoid body piercing and tattooing.
- Don’t inject any drugs that have not been prescribed.
- If you have any signs of infection, report it to your doctor straight away so you can get treatment quickly.
If you experience flu-like symptoms with a high temperature, you should see your GP as soon as possible and tell them you have had a heart valve procedure.