It’s amazing: While patients lie peacefully during open-heart surgery, all around them a well-orchestrated drama is unfolding. In a matter of hours, their hearts are repaired, renourished or even replaced. In the past few years alone, technical advances have dramatically reduced operating and recovery times to a minimum.
Even so, open-heart surgery is serious business—especially if you happen to be the one facing surgery. No doubt, you’re a bit wary about having your heart exposed to the world, and you’re bursting with questions. To help put your mind at ease, here’s some information about the procedure:
You’ll meet with the cardiothoracic surgeon, who will already have reviewed your diagnostic tests such as X-rays and angiography film. The surgeon will explain the test results, what will be done to your heart and the benefits (and risks) of surgery.
This is your chance to voice concerns. What’s routine to your surgeon is all quite new to you, so don’t shy away from asking basic questions like how long the bandages will remain in place. Find out if having the stitches removed will hurt. How big will the scar be? How long will you be in the hospital? Once you get home, will you have to stay in bed? Can you drive a car? What about making love?
It’s a good idea to have a friend accompany you to this initial visit; he or she may recall details you’ll forget because of anxiety.
About two weeks before surgery, you’ll be told to stop all medications that might prevent your blood from clotting, including aspirin, dipyridamole and warfarin. (Make sure your doctor is aware of every medication you’re taking.)
If you’re admitted the night before
You will be asked to shower to reduce the presence of bacteria on your skin’s surface. No food is allowed from around dinnertime on because anesthesia may be dangerous on a full stomach. You can also expect a visit from the anesthesiologist. It’s important to discuss any drugs you’re taking and tell the anesthesiologist if you’re allergic to any medications. Even if you’ve shared this information with your other doctors, don’t assume it’s been relayed to the anesthesiologist.
The morning of surgery
A mild tranquilizer will reduce your anxiety before you’re taken to the operating room. Monitoring electrodes will be attached to your chest and legs, and a local anesthetic will be given before intravenous (IV) lines are inserted.
Each of these IV lines has a specific purpose: One directs anesthesia into the bloodstream, another maintains the proper balance of electrolytes, another measures pressure and oxygen levels in the arteries and still another administers medication directly to the heart.
You’ll feel very drowsy, even detached, while all this is taking place. The first administration of the anesthetic will then render you unconscious.
Once you’re completely anesthetized, an endotracheal tube is inserted into your windpipe to keep airways open. The tube connects to a ventilator that performs the job of breathing. Another throat tube collects stomach fluids that might interfere with breathing or make you nauseous. Catheters that collect urine and monitor blood pressure are also inserted at this time.
To reach the heart, the surgical team must cut open the chest from top to bottom of the breastbone. The breastbone is then separated and clamped open to reveal the lungs and heart.
Since most open-heart surgery procedures cannot be performed on a beating heart, you may be hooked up to a heart-lung machine that will take over the job of circulating your blood, allowing the team to inject a solution directly into the heart to stop it.
Once the procedure is completed, the above steps are reversed; the breastbone is realigned and held together with tiny wires, and the incision is sewed up.
You’ll be taken to the intensive care unit, where specialized nursing care is available round the clock and sophisticated instruments monitor the heart’s activity.
The endotracheal tube will be in place until you begin to wake up, making it impossible for you to talk. When you can breathe on your own again, the tube will be removed and you’ll be helped into a chair.
Usually, within 48 hours, you’ll be moved to a private room or a special unit called open-heart recovery, where you’ll remain until you go home.
Cardiac rehabilitation is an integral part of a healthy recovery. It is important to have your surgery at a facility that has a strong cardiac rehab program.
As some cardiothoracic surgeons have said, “Getting open-heart surgery is like going on a business trip. You leave town on Monday and return on Friday.” True enough, thanks to medical advances, many patients are home in about five days, their hearts—and spirits—on the mend.