What Does Heart Surgery Involve?
Before your Heart Surgery
Blood tests:
This will provide a baseline value regarding your hemoglobin level and blood counts. In addition it provides us with an estimate of the function of the kidneys and liver prior to surgery. Your blood group and type will also be performed – this is in case a transfusion is needed during or after surgery.
Chest X-ray (CXR):
This is performed assess how the disease process has afffected the heart and lungs and gain a baseline reference prior to surgery.
Electrocardiogram (ECG):
To evaluate your baseline heart rhythm.
Echo:
This is performed in all cardiac cases to obtain a baseline about the cardiac function prior to surgery and evaluate all chambers of the heart, the valves and their function.
Coronary Angiogram:
Other than those patients undergoing a CABG, a CAG is performed on patients above 40 years of age undergoing surgery for valvular and other heart diseases to rule out blocks in the vessels supplying the heart.
Carotid Ultrasound:
Typically performed in patients over 40 years of age undergoing heart surgery and those with a previous history of stroke to detect a blockage in the neck vessels.
Dental examination:
In those patients undergoing surgery for valvular heart disease a a dental exam is necessary to rule out infection that can potentially seed the newly implanted valve with life threatening consequences.
Pulmonary Function Tests (PFT):
As one ages there is a decrease in lung function. A PFT enables the operating team to anticipate problems in weaning patients from the ventilator and take appropriate measures to prevent respiratory insufficiency in the post-operative period.
CT scan:
Performed in those patients who are being considered for surgery on the aorta, treatment of aortic aneurysms, transcatheter valve replacement procedure and possibly those who are candidates for a minimally invasive procedure.
Transesophageal echocardiogram (TEE):
This is an echo that is performed by passing a probe down the throat. It is performed in cases where additional information is needed that is not provided by a conventional transthoracic echo (TTE).
Please mention to the surgical team all medications that you are on currently in addition to blood pressure medications do not forget to mention if you are on:
- Antiplatelet medications
- Blood thinners (Anti coagulants)
- NSAIDS
- Herbal medications
- Supplements
- Steroids or other immunosuppresants/ immunomodulators
The Day of Surgery
Cardiac surgery is performed under general anesthesia.
The cardiac anesthesiologist would have gone over the minute of the same with you prior to the procedure. In essence a breathing tube will be inserted during general anesthesia. Intravenous (IV) and monitoring lines will then be secured to assess hemodynamic parameters during and after surgery. A catheter will also be placed for emptying urine from the bladder.
Be sure to share with your anesthesia team details regarding prior surgical procedures, anesthesia used during the same, complications from prior procedures and allergies to any medications.
Surgery is a team effort.
It involves your surgeon, the surgical assistant, the nurses in the operating room, the perfusionist who runs the heart-lung machine and of course the anesthesia team.
Is is essential that the surgical team has gone over the various options available for surgery, the pros and cons of various approaches and the possible complications that are associated with any routine cardiac surgical procedure.
The surgery will be conducted through a sternotomy (splitting the breast bone) or via an incision through the muscles of the chest based on whether a conventional or minimally invasive access approach has been deemed suitable.
Coronary bypass surgery in India is commonly performed beating heart (off pump), certain surgeons may chose to arrest (stop) the heart and do a bypass procedure using the heart lung machine.
Valve surgery and major aortic surgeries are almost always performed using the heart lung machine.
Following surgery you will be shifted to the cardiac ICU. In addition to the breathing tube there will be drainage tubes coming out of the chest.
Following a period of observation in the ICU where the intensive care team monitors various hemodynamic parameters and other variables – and once stable you will be taken off the ventilator.
After Heart Surgery
Following surgery you will be transferred to the cardiac ICU where you will still be having a breathing tube down your throat.
The intensive care team will be assessing parameters like your heart rate and rhythm, blood pressure, chest tube drainage.
In addition a few blood tests will be performed to gain information about the function of various organ systems like the lungs, kidneys and the liver.
The anesthesia medications will then be gradually weaned to wake you up and when awake and able to breathe on your own you will be taken off the ventilator (extubated).
Following extubation you will be encouraged to breathe deeply and cough – a spirometer will be provided – this gives a visual estimate of the intensity of respiratory effort. A good respiratory effort is essential to prevent the complications of lung collapse, pneumonia and fluid build up around the lungs (effusion).
You will be gradually mobilized onto a chair and then asked to ambulate. This is paramount to avoid blood clots in the legs and make a early recovery.
When satisfied most of the monitoring lines and the urinary catheter will be removed and you will be transferred out to your room from the ICU.
The surgical team will titrate your various medications for blood pressure, heart rate and rhythm, pain. There may be various other medications for diabetes, cholesterol and antiplatelet therapy as well as anticoagulants depending on the disease.
Your vitals and oxygen level on room air will be monitored as well as the ability to carry out regular activities to evaluate functional status.
Chest tubes, pacing wires will be removed; a chest X-ray and echo will be performed prior to discharge.
Your surgeon will arrange for follow up visits at regular intervals to evaluate the recovery process and monitor your surgical incision sites.
If you have undergone a sternotomy
- Avoid driving for 1 month and lifting and pulling heavy weights for atleast 2 months.
- All patients who have undergone surgery are encouraged
- To be active at home and engage in moderate physical activity like walking
- Have a shower with soap and water. Keep the incision dry after the same.
- Keep blood sugars under control and monitor your incision.
- Report back to the surgeon if there is swelling, discharge, redness or pain in the wound associated with fever at any point of time. Wound infection if left untreated can lead to sternal osteomyelitis which can be difficult to treat.