Cardiac Surgery: Guide to Your Hospital Stay and Recovery

The heart is about the size of a clenched fist and weighs just 11 ounces. The heart beats more than 100,000 times each day. The heart has much more to it than muscle and arteries.

Chambers

The heart has four chambers. The first chamber (right atrium) receives the bluish, oxygen-poor blood as it returns from its course through the body. The next chamber (right ventricle) sends this blood to the lungs to pick up oxygen. The third chamber (left atrium) receives the red, oxygen-rich blood back from the lungs. The fourth chamber (left ventricle) sends the oxygen-rich blood for another course through the body. This all takes about one minute.

Electrical System

The heart’s electrical system provides the “spark” that begins and maintains the pumping of the heart’s chambers and controls the rate at which the heart beats. The top of the heart (the sinoatrial node) fires a signal to the atria (upper chambers of the heart), causing the atria to contract and pump blood into the ventricles (lower chambers). The signal then triggers the ventricles to contract and pump blood out of the heart. The right ventricle pumps oxygen-poor blood to the lungs, where it picks up oxygen and the left ventricle pumps oxygen-rich blood to the rest of the body. Sometimes disease or aging can disrupt this signal.

Valves

Each chamber of the heart has its own valve which acts like a door, opening and closing. Normal heart sounds, sometimes called lub-dub, are sounds when the valves open and close. Abnormal valve sounds are called heart murmurs. Not all murmurs are serious, but some do need to be checked by your doctor.

Veins and Arteries

Veins carry blood to the heart; arteries carry blood away from the heart. The heart muscle has its own supply of arteries that branch off from the aorta, the main artery of the body. With aging, poor diet, and/or heredity, the coronary arteries can harden and become clogged with plaque, a build-up of fat, cholesterol, and calcium. As a result, the coronary arteries can become so narrow that blood flow to the heart muscle is slowed or even blocked. This can cause a heart attack and lasting damage to the heart muscle. A weakened heart muscle has trouble pumping blood through the chambers and on to the rest of the body.

Coronary Artery Disease

The special blood vessels that feed the heart are called coronary arteries. Coronary artery disease causes the vessels to narrow over time. Build-up of fat and plaque in arteries can worsen without any symptoms. Angina (chest pain) is a common warning sign of coronary artery disease.

“Open heart” surgery means that the chest is opened up to operate on the heart. The options for open-heart surgery include:

Coronary Artery Bypass Grafting (CABG or Bypass Surgery)

The surgeon uses a blood vessel from the patient’s own body to bypass blockage in an artery that supplies blood to the heart. This is the most common open-heart surgery.

Off Pump Coronary Artery Bypass (OPCAB) Surgery

With OPCAB there is no need to be connected to a heart-lung machine. This is not an option for everyone. OPCAB is used in select patients when only one or two arteries need to be bypassed. Your doctor will decide if this procedure is right for you.

Heart Valve Surgery

There are four valves in the heart. Each valve lets blood flow in one direction. A congenital defect, rheumatic fever, infection or aging can cause these valves to not open or close as they should. Damaged heart valves can lead to more serious heart disease. Heart disease affects the ability to lead a normal, active life.

Repair and Replacement of Heart Valves

When there is a problem with a heart valve it is better, if possible, to repair a valve than to replace it. A repaired valve lasts longer than a mechanical or biological replacement valve. Your surgeon will decide which option is best for you.

Minimally Invasive Surgery

Minimally invasive surgery is when your heart surgeon makes a small incision in the right side of your chest.  The surgery is done between the ribs. There is no need to split the breastbone (a sternotomy). The result is a quicker recovery for most people. Minimally invasive surgery is not for everyone. Your surgeon will decide if this is an option for you. 

Within the United States, most hospitals that perform heart surgery report outcomes to the Society of Thoracic Surgeons National Cardiac Surgery Database. Heart surgeries performed at Doylestown Hospital have better outcomes than national averages.

One-Stop Post-Op

Heart and Vascular patients are cared for in the CVICU (cardiovascular intensive care unit) from the time of admission until the time of discharge from the hospital. Care is provided by specialists in a personalized, healing environment.

Before your heart surgery you may need to have the following tests to check your health status:

• Blood tests

• Carotid doppler

• Chest x-ray

• ECG (electrocardiogram)

• Pulmonary function testing

• Urine sample

Members of your surgery team will meet with you before surgery to answer any questions. They will explain important information about your surgery and recovery. The team includes your cardiothoracic surgeon, a nurse, a physician assistant, an anesthesiologist (the doctor who puts you to sleep for surgery) and a cardiovascular patient care coordinator.

Your family is welcome to join you during these meetings.

The Night Before Surgery

• Shower from shoulders to toes with the special soap that you were given.

• DO NOT put any lotions, powders, or oils on your skin following use of the special soap.

• DO NOT eat or drink anything after midnight.

• DO NOT take any medicines unless told to do so.

The Morning of Surgery

• Shower again from shoulders to toes with the special soap that you were given. Do not put any lotions, powders or oils on your skin following use of the special soap.

• DO NOT take any medicines unless told to do so.

• DO NOT wear contact lenses. Glasses may be worn.

• Report to the Cardiovascular and Critical Care Pavilion and enter through the Gorsky Atrium.

• Before surgery the nurse will cleanse your skin and remove body hair with special clippers.

• All valuables and clothing need to be removed and given to your family.

• You will need to empty your bladder just before you are taken to the operating room.

• When you are ready to go to the operating room, your family will be shown to the surgical waiting area. A volunteer will be available to answer any questions. As waiting time varies, your family should be aware it will be several hours before they can see you after surgery.

After Your Surgery

You will be taken to the CVICU where the staff will work together for a smooth recovery.

Your surgeon will meet with your family to talk about your operation while the nurses in CVICU get you settled in your room. The nurses will need time to get you settled in the CVICU after surgery. Your family may then visit.

Your family needs to know that you may look different to them right after surgery. You may look swollen and pale. This is normal. The staff will explain all of this to your family. You will begin to look better and be more awake as each hour/day passes.

A chaplain is available 24 hours a day for any needs that you or your family may have during your stay. Simply ask the staff to contact Pastoral Care Services.

Cardiovascular Intensive Care Unit (CVICU)

The nurses in the CVICU will check your vital signs and your condition often. This level of constant care is routine for all postoperative patients.

There will be many tubes and pieces of equipment used to monitor you. You may be given medicine to help you relax. You may not remember much about this part of your recovery. 

Your family should expect to see you attached to a lot of equipment, such as:

• A breathing tube in your mouth until you wake up from anesthesia

• Chest tubes to drain fluid from the surgical area

• A catheter in your bladder to measure urine

• A heart monitor to watch your rhythm and rate

• IV (Intravenous) lines for giving medicines

• Pacemaker wires to control your heart rate

Communication

While the breathing tube is in your mouth you will not be able to talk. The staff and your family should ask you “yes” and “no” questions so it is easier for you to answer. The breathing tube will be in your mouth for some time after surgery. When removed, you will have oxygen either through a mask placed over your nose and mouth or through small tubes (a nasal cannula) placed at the end of your nostrils.

Coughing and Deep Breathing Exercises

It is important for you to cough and do deep breathing exercises. You will be taught how to do these exercises with an incentive spirometer. It is very important to expand your lungs and prevent lung infections after surgery.

Pain Control

You will be given pain medicine either through your IV line or by mouth. Ask for pain medicine if you need it. We want you to be comfortable. You may feel sleepy from the medicine for the first 24 hours after surgery. 

Activity

Movement helps prevent blood clots, helps keep your muscles strong and helps with deep breathing. Your activity will be increased each day. You will follow a cardiac exercise program guided by CVICU nurses and cardiac rehabilitation. Do not get out of bed by yourself. 

Some of the tubes and catheters will be removed the morning after surgery. You will be placed on a portable heart monitor so that you can start walking in your room and the hallway. 

The bandage on your chest incision will be kept on until the day of discharge.

Visiting Hours

Visiting hours in the CVICU are flexible. All visitors should check in at the nurse’s station in the CVICU. We may need to limit your visitors so that you can rest.

Going Home

The cardiovascular patient care coordinator will work with you and your family to decide what you will need. Your discharge plan will be based on your own needs.

Follow-Up Appointments

Follow-up appointments will be made for you before you leave the hospital:

• Surgeon about 4 weeks after surgery

• Cardiologist in two to four weeks

• You may also have a follow up home visit with a nurse.

Your surgeon will want you to have a follow-up ECG (electrocardiogram), chest x-ray, and blood work before your appointment. Call your primary care doctor if you need a referral for these tests.

Your cardiologist and/or your primary care doctor will see you for your long term follow-up care. 

Medicines

You will get your prescriptions at the time of discharge. Medicines prescribed at discharge are a very important part of your recovery.  

They should not be changed (unless by your primary healthcare provider). 

Chest Incision Care

You may be worried about harming your chest at home. Your breastbone has been secured with wire. It is unlikely that you could injure it. Sternal precautions will be reviewed with you.

• Clean and look at your incisions every day.

• You may shower, but do not soak in any type of water.

• Gently wash your incisions with soap and water.

• To dry your incisions, gently pat the area with a clean towel.

• Do not apply any lotions, creams, or ointments to your incisions.

• Do not rub or pick at your incisions.

• Do not let family or friends touch your wound.

• Normal drainage is pink or clear. Check for redness, swelling, pain, or cloudy/thick drainage.

Leg Incision Care

With a leg incision you may have some swelling. Elevate your legs when able. Avoid crossing your legs.

Bathing and Showering

There are no limits for your self-care. You may wash your hair, hook your bra strap and attend to your own personal hygiene needs without fear of hurting your incision. Shower daily. Keep a stool or chair in the bathroom if needed. No tub baths, swimming pools, hot tubs, or any other soaking until completely healed.

Physical Activity

For the first four weeks after surgery:

• Do not lift more than 15 pounds.

• Do not drive. You may ride in the car in the front passenger seat.

• Always wear your seatbelt.

• No air travel.

• Increase your activity slowly.

• Rest in between activities so you do not get over tired.

• Rest when you feel tired.

• Get the amount of sleep that is normal for you.

• Nap during the day, if needed.

• Climb stairs as tolerated, but limit your trips up and down the stairs to prevent fatigue.

• Talk with your surgeon before you travel.

In Review:

1. No lifting more than 15 pounds.

2. No driving.

3. No air travel.

When to Go Back to Work

Talk with your surgeon first about the following:

• What type of work you do

• How far you travel to and from work

• How many hours you work each day/week

• If you are able, take rest periods if needed during the day

Your Diet

Your doctor may want you to follow a special diet. Your appetite may be less than normal. Food may not taste the same. This is temporary. Try to eat healthy foods that you enjoy. The right amount of calories allow your wound to heal and help you gain back physical strength. Small frequent meals may help restore your appetite.
If you need help managing your nutrition intake, contact Doylestown Health Nutrition Services at 215.918.5701 or 215.918.5702.

Sexual Activity

Many people have concerns about sexual activity after heart surgery. You can expect to feel tired at home and a little sore.  You should be able to resume sexual activity at your own pace once you are feeling better both physically and emotionally.

While you recover, avoid sexual activity when:

• You are tired

• You are upset

• After heavy meals

• After drinking alcohol

• In extremely hot or cold weather

Choose positions that avoid strain on your incision. Talk with your doctor about any concerns.

Emotions

Both your mind and body have been through a lot and will need time to regain their strength.

You may have “good” days and “bad” days. These ups and downs may make you feel that you are not getting better. Changes in your energy level are a normal part of the healing process.

You may feel depressed, irritable, easily upset, and frustrated with simple things. Activity or rest may help you through these times.

Share your feelings with family, friends, and your health care providers. Remember that these feelings are normal.

Important Information for After a Valve Procedure

An infection can enter the body in many ways. Bacteria in the mouth may enter the blood if the gum is cut by dental procedures or rough tooth brushing. If you have had a valve procedure, you may be at risk for infections in the heart.  You should take antibiotics for the following:

• Any procedure that causes trauma to soft tissue, such as bladder exam

• Any type of surgery

• Childbirth

• Any dental procedure: cleaning, filling, removal of teeth, root canal, or gum work

• Mouth ulcers from poorly-fitted dentures

To prevent infection:

• Be gentle when brushing your teeth and gums.

• Avoid anyone with an infection or illness for at least eight to 10 weeks after your heart surgery.

Any infection should be treated right away. Tell your doctor if you have symptoms such as fever, chills, or sore throat.

• A card with important information about your heart valve will be sent to your home within one month. If you do not get a card, please call the surgeon’s office.

• You may be placed on blood-thinning medicines. You may need blood tests often. The first test will be scheduled before you leave the hospital. Your cardiologist or primary care doctor will change the dose according to these results. Please contact your insurance company or primary doctor with any referral questions.

When to Call the Doctor 

• Chest pain lasting longer than 15-20 minutes and getting worse and not relieved by taking three nitroglycerin tablets five minutes apart

• Chest pain when deep breathing

• Palpitations (your heart feels like it is racing or skipping beats)

• Your surgery site is red, feels hot, is draining yellow fluid or is foul-smelling

• Fever above 101 degrees Fahrenheit

• No bowel movement during the first week after discharge

If you have any questions about your incision, call the surgeon’s office at 215.345.2100. An answering service will take all calls when the office is closed. Calls will be returned as needed.

For concerns not related to your incision, call your primary care doctor.
In a major “life-threatening” emergency, go directly to the nearest emergency room or call 911.

Risk Factors You Cannot Change 

• Age

• Gender

• Family history or heredity

• Race

• Ethnicity

Risk Factors You Can Control or Change 

• High cholesterol

• Diabetes

• Lack of exercise

• High blood pressure

• Obesity

• Smoking

• Stress

Cholesterol Levels

Cholesterol is a type of fat in your blood. A high total blood cholesterol level has  been closely linked to coronary artery disease.

Less use of saturated fat and cholesterol in your diet may help lower these levels in your blood. Medicines that lower cholesterol may also help. 

Diabetes

High blood sugar has been linked to coronary artery disease and other risks such as obesity, high blood cholesterol, and high blood pressure. Blood sugar control needs meal planning and sometimes medicine. Regular checkups, lifestyle changes, and weight control are important.
For help managing your diabetes, call Doylestown Health’s Diabetes Center at 215.345.2168.

Exercise

The heart is a muscle. It benefits from regular exercise. Aerobic exercise raises your heart rate and breathing. This helps the heart work better and get stronger. It lowers the oxygen needs of the heart, improves the tone of other muscles and helps blood flow.

Your doctor may refer you to a cardiac rehabilitation program if you have had a heart attack, heart failure, angioplasty, or heart surgery. Cardiac rehabilitation can improve your fitness and lower your risk for future cardiac events. 

Learn more about Doylestown Health’s Cardiac Rehabilitation Program 

High Blood Pressure (Hypertension)

High blood pressure can be caused by age, a high salt or high cholesterol diet, family history of high blood pressure, gender, obesity, or race. The cause may not be known. When blood pressure is high, your heart has to work harder to pump. Over time this makes your heart bigger. It may cause congestive heart failure (CHF), hardening of the arteries, kidney damage, and coronary artery disease. Your risk of stroke is higher. This is due to damage to the blood vessels that lead to the brain.

High blood pressure can be controlled with lifestyle changes such as diet and exercise, medicine, or a blend of all.

Obesity

If you weigh more than 30% above your ideal weight, your risk for heart disease may double. High blood pressure, high cholesterol and adult onset of diabetes are also linked to obesity.  A few tips: (1) meet with a dietitian for a meal plan; (2) know how many calories you need a day; (3) exercise each day; (4) follow your meal plan, and (5) set realistic goals.

To learn more about weight loss and healthy meal planning, ask to see a dietitian during your hospital stay. 

Call Doylestown Health’s Nutrition Counseling Services at one of the following numbers: Health and Wellness Center in Warrington at 215.918.5701 or 215.918.5702, or Doylestown Hospital at 215.345.2356.

Smoking

Smoking is a major cause of heart disease. The American Heart Association lists cigarette smoking as the most dangerous of the risks that can be changed. Ten years after quitting, your risk of death from heart disease is almost the same as if you had never smoked.

Don’t wait until you have heart disease to quit. STOP SMOKING NOW! The telephone number for the PA Smoking Quitline is 1.800.784.8669.

Stress

Stress can be bad for your health, but it cannot always be avoided. Here are a few things that may help:

• Try to sleep six to eight hours a night

• Plan rest times during the day

• Relax by doing something that you enjoy (reading, prayer, yoga, meditation, exercising or listening to music)

• Take slow deep breaths

• Talk with your healthcare provider if you need help managing stress

Exercise Helps Strengthen The Heart. 

Doylestown Health’s three-phase Cardiac Rehab program helps patients achieve their recovery goals. You will get personal attention, help with goal setting, and guidance from an expert team of certified exercise physiologists, registered dietitians, and registered nurses who specialize in heart care.

Three Phases to a Healthier Heart

PHASE 1

Cardiac rehabilitation for inpatients who are recovering from surgery will include:

• Education about the causes, risk factors, and prevention of heart disease

• Education from an exercise physiologist about how to resume physical activity, such as getting out of bed and walking

PHASE 2

Cardiac rehabilitation for outpatients either at Doylestown Hospital or your local cardiac rehabilitation program will include:

• Heart and blood pressure monitoring during exercise sessions

• Education about nutrition

• Tips to stop smoking

• Suggestions for managing stress

PHASE 3

Outpatient cardiac rehabilitation at Cornerstone Health & Fitness Club at the Health & Wellness Center or your local cardiac rehabilitation program will include:

• Expert guidance, giving you the tools and skills you will need to maintain heart health

For more information, call Doylestown Health’s Cardiac Rehabilitation program at 215.345.2390.