Heart Surgery
TMC offers a comprehensive heart surgery program that provides advanced surgical procedures to treat a variety of heart conditions. Our team of skilled surgeons use advanced technology and minimally invasive techniques whenever possible to deliver the best possible outcomes for our patients.
Call 911 if you are seriously injured or feel you need emergency care. Emergency responders will help you decide the best course of action.
Heart surgery
TMC's heart surgery program is committed to providing high-quality care to patients with a variety of heart conditions. Our surgeons are experts in a wide range of procedures, including coronary artery bypass surgery, valve surgery, and aortic aneurysm repair.We use the latest technology and minimally invasive techniques to provide our patients with the best possible outcomes. Our experienced team will work with you to create a personalized care plan that meets your individual needs.
What to expect before, during and after heart surgery
This information is supplemental to the education provided to you by your physician and nurse.
If your heart surgeon has told you that you need open heart surgery, the next step is to go to Pre-Anesthesia Testing. Anesthesia (sleep) is a necessary part of your surgery and is performed by a physician who is not your surgeon. This doctor is called an anesthesiologist. Your anesthesiologist needs additional information to be able to assist in your surgery. Staff at PAT will provide you with more information about what to expect. A nurse will be with you at your appointment to ensure everything is done with your safety in mind. This nurse will also make sure that each of your physicians has done what is needed before your surgery.Please make sure you attend your scheduled PAT visit or your surgery may be delayed. Please bring your binder to all appointments.
- You will be asked for your photo ID and insurance cards.
- A name band will be placed on your wrist.
- You will be given three consent forms to sign including Patient Rights and Responsibilities and Conditions of Treatment. These consents are different from the surgery or anesthesia consent forms. They give TMC permission to treat you by drawing your blood, running an EKG and taking your blood pressure. The third form, Informed Consent: Transfusion of Blood Products, is about blood products. Your doctor will explain to you the benefits and risks of receiving blood products. You will also be given the opportunity to sign the consent at TMC before your surgery.
- Your vital signs, height and weight will be checked. A urine sample and several blood samples may be collected depending on what your surgeon has ordered. Your neck will be measured to rule out any sleep apnea risks, and your nose may be swabbed to test you for MRSA, an antibiotic-resistant bacteria. Your nurse will determine if you need to be swabbed.
- Your nurse will review your list of medications, drug allergies, medical history and surgical history. Please tell your nurse if you have ever had any problems with anesthesia in the past including malignant hyperthermia, discomfort opening your mouth or being unable to open your mouth, nausea or vomiting.
- Your nurse will teach you how to use an incentive spirometer, also called an “I/S.” This breathing device will help prepare your lungs for surgery and should be practiced daily at home before your surgery. Be sure to bring your incentive spirometer with you the day of surgery.
- You will be asked for emergency contact names and numbers, as well as who will care for you when you go home.
- You will be asked for a living will/medical power of attorney. These questions are asked of all patients. They are not to alarm you but to better prepare our staff for your care. It is important that your family be aware of your wishes and know where you keep these important documents.
- All of the information gathered at this appointment will be available in TMC’s computer system for your surgeon, anesthesiologist and other physicians on your surgery day.
- After the appointment, you may take a shuttle, walk or drive over to TMC to get your chest X-ray. You will be given a map, along with a paper order sheet to give to the staff at the front desk of the Radiology department.
- After your X-ray, you are free to leave, or you can receive a personalized tour of the facility with an intensive care nurse. Your nurse will show you where you will be after surgery and provide some information about TMC’s Cardiac Rehab. This tour also offers your family a chance to see the waiting area and become familiar with the layout of the hospital including where your room will be, the cafeteria and restrooms. Our nurses are happy to spend this time with you and we encourage you and your family to take full advantage of this opportunity! Before leaving your PAT appointment, please check to make sure you have your bag that contains the incentive spirometer, a package of chlorhexidine wipes and your binder.
- Please note: You will not receive any anesthesia at your PAT appointment.
What to bring to your Pre-Anesthesia Testing
- A buddyThis person can be a spouse, a good friend or relative to help you absorb and organize the information and instructions you'll receive.
- Photo ID/insurance card/ pharmacy card if you have one
- Implantable device cards including pacemaker, ICD, deep brain stimulator (DBS), cochlear implants, pain stimulators, etc. Note: You will need to bring your programmer on the day of surgery
- Updated medication list (including the dosages and how frequently they're taken) or the actual bottles. Please include all over -the-counter medications, supplements, inhalers, patches, eye drops and nasal sprays. Note: You may list these on the Patient Medication List in the binder.
- Updated medical/surgical history with dates if possible
- List of current physicians (feel free to place their cards in the binder)
- Emergency contact names and numbers
- A copy of your living will/medical power of attorney
- Names and phone numbers of people who may receive your personal health information.
- Stop smoking! Smoking prolongs healing time by decreasing oxygen to the blood.
- Stop all herbal supplements, remedies, vitamins, multivitamins including occuvite, omega 3-6-9 fish oil, flax seed oil and any other over-the-counter medications. Check with the surgeon’s medical assistant or nurse if you are unsure about anything else you’re taking.
- If you have a dental problem, please have it addressed and treated before surgery. All antibiotics given by your dentist should be taken prior to your surgery. Bacteria from infected or loose teeth may infect the new heart valve. Your surgery may have to be postponed if you have an untreated tooth infection
- Stop nonsteroidal anti-inflammatories (NSAIDS) such as ibuprofen, Motrin, Advil, Aleve, Naproxen, Celebrex, Mobic, Meloxicam, Diclofenac, Etodolac, Relafen, Anaprox, Toradol, Feldene, Sulindac, Lodine, Dolobid, Voltaren, Arthrotec, Indomethacin, Nabumetone or Daypro as these act as blood thinners.
- You may continue to take Vicodin, Percocet, Tylenol, extra strength Tylenol and Tylenol PM for pain up until the day of surgery. (No Tylenol arthritis please).
- Stop aspirin and products that are an aspirin combination such as Pamprin, Excedrin, Fioricet, etc.
- Stop blood thinners such as Plavix (Clopidogrel), Pradaxa, Effient, Xarelto, Brilanta, Eliquis and Coumadin (warfarin).
- Your doctor may want to “bridge” you with Lovenox. This should be discussed with your doctor before surgery.
Three days before surgery
- Start Allopurinol if ordered by your surgeon. Continue taking this as directed up to and on the day of surgery with a sip of water only.
- Stop Metformin, or any medications with Metformin in them such as Glucophage, Janumet, Fortmet, Glumteza, Riomet, Avandamet, etc.
- Stop ACE inhibitors such as Lisinopril, Ramapril, Accupril, Lotensin, Capoten, Vasotec, Monopril, Zestril, etc. These are considered blood pressure medications. Continue all your other blood pressure medications unless you are told otherwise.
- Only take your blood pressure medications if it is a beta blocker such as Atenolol, Sotalol, Metoprolol, Carvedilol, Bisoprolol, Nadolol, Propranolol, etc.
- It is ok to take your blood pressure medications, such as Allopurinol (with a sip of water), if your surgeon ordered it.
- Take these as early as you can (two hours before your surgery if possible).
2 days (48 hours) before surgery
- DO review all prescribed and OTC medication instructions to make sure you have stopped them as instructed. Refer to the calendar on page 5 in the PAT section of the binder if you have filled that out.
- DO remove all toe/fingernail polish along with all body jewelry or piercings including earrings, necklaces and wedding bands. If you are unable to remove your jewelry, you may need to go to a jeweler to have it removed. Rings that are not removed will be cut off during surgery. All body/facial piercings must be removed including dermals!
- DO practice deep breathing and coughing in addition to using your incentive spirometer (I/S) several times a day. This breathing exercise will be extremely important during your entire recovery experience. It helps to keep your lungs expanded, to remove secretions, to promote coughing and to avoid lung complications, especially pneumonia.
- STOP shaving any body parts 48 hours before surgery. This is especially important for infection control. To avoid infections, you will be surgically clipped as necessary in the hospital.
- DO NOT get your hair or nails done before surgery. Please remember that any skin, hair or nail product may complicate events prior to surgery.
- DO NOT smoke anything or drink any alcohol. Get plenty of rest and stay hydrated.
- DO drink plenty of fluids until midnight.
- DO NOT have anything to eat or drink (even water) after midnight unless you are instructed otherwise from your surgeon or Pre-Anesthesia Testing. You may take a small sip of water with your medication in the morning.
- DO NOT smoke anything or drink any alcohol.
- DO review the instruction forms you received from Pre-Anesthesia Testing and your surgeon’s instructions.
- DO refer to your calendar page again if needed.
- DO change your bed sheets and pajamas. Wear clean pajamas after your pre-op shower.
- DO shower. After you’ve dried off, use the 2% CHG wipes that were provided to you all over your body, as instructed on the paperwork. Do not use any other skin or hair products. Let the CHG wipes dry on your skin and then go to bed on clean sheets. Please make sure the CHG product is on your skin for a minimum of six hours before surgery. Remember – no lotions! And do not rinse off in the morning.
- DO initial the form labeled TMC SSI Prevention and be prepared to give it to your pre-op nurse when you arrive for surgery. This paper should have your name and label on it
- Take only the medications indicated for your day of surgery with a sip of water as soon as you get up. If you are instructed to bring any medications to the hospital, please leave them in their original containers with the labels intact. These will need to be given to the nursing staff once you are checked in. If you carry an inhaler with you on a normal basis, please be sure to bring that as well.
- Brush your teeth, swish with water and spit. No gum, hard candy, mints or cough drops after that please. You may wash your face to freshen up, but do not apply any hair or skin products including creams, lotion, any makeup, perfume, deodorant, hair spray, gel, talc, oil, etc. These attract bacteria which can increase your risk of infection. Additionally, many hair and skin products are flammable, especially around oxygen and cautery, which are both used in surgery. Do not rinse your CHG wipes off before coming to the hospital.
- If you use a CPAP machine for sleep apnea, please bring it to the hospital before surgery. You may dump the water as TMC stocks distilled water. Please bring easy instructions with written settings if available. Be sure to label your machine with your name. Very Important! Bring your incentive spirometer (I/S)
- Bring your photo ID, insurance cards, a copy of your living will and medical power of attorney and your initialed Surgical Site Infection Prevention form, stating you used your wipes the night before surgery.
- Arrive at TMC’s Orthopaedic and Surgical tower two hours before your scheduled surgery time. Free valet parking is available from 5 a.m. to 7 p.m., Monday – Friday. Take the elevator to the second floor and check in at the desk.
- Once you’re done checking in, you will be instructed to stop by another desk close by that is staffed with a TMC volunteer. This volunteer will give you a color-coded paper with a unique identifying number on it. Your family and friends who are with you can track the progress of the procedure using the monitors in the lobby.
- Remember: any personal items you may need after surgery when you are in the intensive care unit (ICU) may be brought in once you are awake after surgery. You will be resting a lot after the operation and on pain medications. TMC will provide mouth-care items immediately after surgery.
- Shortly after you are checked in, you will be taken back to pre-op holding.
- A patient care technician will take your vitals and then ask you to change into a gown. All of your clothing (including underwear and shoes) will need to be taken off and placed into a bag that your family will hold onto.
- Your tech will then clip your chest, belly and the area from your groin all the way down to your ankles as necessary. The tech will then use the CHG wipes on you again, and you’ll be asked to change into a different gown.
- All personal items will need to be removed including dentures, glasses, contact lenses and any remaining jewelry you may have on. Please give any valuables to your family for safekeeping, along with your ID, insurance cards and cell phone.
- You’ll be attached to special equipment to monitor your blood pressure, heart rhythm and oxygenation before, during and after your surgery. You will be attached to these monitors during your entire surgery and your subsequent stay in the ICU.
- Do not be alarmed by the beeping and the different noises these machines make. The staff needs to be able to hear these alarms and will be monitoring your vital signs frequently.
- Your tech will let you know when a member of your family may come back and join you. Please know that we will protect your privacy, but if you wish to have a family member with you before surgery, we will make every attempt to allow that when it’s possible and safe to do so.
- Your pre-op nurse will then come in to go over any questions you may have. The type of surgery to be performed will be verified. If you have hearing aids, please let your nurse know. You’ll be asked a series of questions and asked to sign some consent forms if they haven’t been signed already. Your nurse will go over your medical history and medication list with you as well as the last time your meds were taken.
- Many of these health professionals will ask you the same questions including asking you to verify your name, birthday or medical record number on your wristband. Please keep in mind these are important procedures that are in place for your safety.
- An IV will be started and your nose will be swabbed with an antibiotic ointment. You’ll be hooked up to oxygen and a pad will be placed on your bottom to help prevent pressure ulcers.
- An EKG and any other necessary tests may be performed.
- You will meet the other members of your surgical team including your anesthesiologist who will likely give you some medicine to help you relax before surgery.
- Your anesthesiologist will give you some numbing medicine and start an IV. The anesthesiologist will also place what’s called an arterial line. It’s like an IV in your wrist that is used to monitor your blood pressure. Your loved one may be asked to step out of the room for these procedures, if necessary.
- Your surgeon will also come in, followed by your operating room nurses.
- When everything is ready, your health care team will wheel you to the operating room. Your family member will be asked to head back to the lobby.
- We ask family members who need to step away from the lobby to please do so in the first hour after you are wheeled back, as much of that time is spent preparing you for surgery in the operating room.
- When the screen in the lobby indicates surgery has started, please make sure your family is seated in the lobby.
- Most open heart surgeries last from three to five hours. Talk to your surgeon about what to expect with your procedure. If possible, a member of the surgical team will come out to the lobby and update your family on your progress
- When your surgery is done, the surgeon will talk with your family in one of the consultation rooms located just off the lobby. Afterwards, your loved ones will be instructed on how to get to Rosenstiel Lobby, right next to the intensive care unit (ICU). It’s about a five-minute walk so a TMC volunteer can arrange transportation to the ICU if needed.
- Immediately after your surgery is over, the surgical team and an ICU nurse will transport you directly from the operating room to the ICU, Unit 480. It will take about an hour for staff to get you settled into your private room.
- The nurse will let your family members know when it’s OK for one or two people to come see you inside the ICU. We ask that no more than two people at a time come back as the ICU rooms are not large. You can find more information about what to expect on page 5 of this section.
- You will likely be asleep and hooked up to many monitors. You could have a breathing tube down your throat, unable to talk. The breathing tube doesn’t hurt, but can be uncomfortable.
- An important note for family: Please warn your loved ones that it could be shocking to see you in this condition, but that all of the machines and tubes are there to do a job and help you recover. Also note that some of these machines will sound alarms and beep so you and your visitors should not be scared. The ICU staff will constantly be attending to these alarms. It is important that family and other visitors not touch any of these buttons to silence the alarms.
- About four to six hours after you arrive in the ICU, staff will slowly wake you up.
- When you wake up, in addition to the breathing tube, you’ll have a urinary catheter and a chest tube. The chest tube drains blood and helps expand your lungs.
- As you wake up, you will become aware of lights and noises in the ICU room. You may be shivering as your body temperature comes back up to normal. You will likely be extremely thirsty, but you will not be able to speak or drink until your breathing tube is removed.
- When your nurses wake you up, they will ask for your help in removing your breathing tube. You’ll then be put on oxygen by either a mask or nasal prongs.
- You will have numerous pieces of equipment attached to you including: temporary pacing wires to keep your heart beating regularly, a naso-gastric tube to control nausea and gas, multiple IV fluids infusing by pumps into large IVs (these large IVs are called central lines and may be in your neck or upper chest area), an aterial line (similar to an IV) in your wrist, and an oxygen saturation monitor on your finger or ear. All of this equipment will be removed bit by bit as you recover
- While your pain will be managed as best as possible, it is expected to be the worst during the first 72 hours after surgery. Like any other procedure, cardiac surgery is associated with significant pain that peaks within the first few days after surgery. The pain gradually gets better and finally goes away.
- You will be asked to use the pain rating scale to communicate your pain level to your nurse.
- It is normal to feel a certain amount of discomfort after surgery. Your nurse will give you sedatives and pain-relieving medications as needed. Most patients do not remember the first few hours after surgery including the removal of the breathing tube.
- If your pain is not adequately controlled after surgery, it can cause stress and depression, which may make recovery more difficult. Pain also may make it difficult to breathe deeply, possibly exposing you to cardiac and pulmonary complications including infection and cardiac arrhythmias (irregular heartbeats). This is why the deep breathing exercises and the I/S are so important after surgery. It helps immensely if you have practiced how to use your I/S at home before surgery.
- The nurse will explain what all the machines are doing. You will need to use your I/S 10 times an hour, every hour you are awake, until you go home. You will be encouraged to do deep breathing and coughing exercises. You will be given a small pillow to hug that allows you to brace your sternum and help reduce the pain.
- Various complementary therapies including guided imagery, music therapy, breathing exercises, massage therapy, meditation, yoga and hypnotherapy, have been shown to reduce pain, anxiety and stress. They also help your natural healing ability. Your family may bring music, aromatherapy, oils and may give you massages after surgery. No candles or open flames are allowed. Please make sure your family checks with your nurse before starting any of these therapies.
- Please note all plug-in appliances must be examined by hospital staff prior to use in the hospital.
- Atrial fibrillation is an irregular heart rhythm caused by erratic beating of the upper chambers of the heart, the atria. It is one of the most common complications after heart surgery and may develop in up to 30 percent of all open heart surgery patients.
- A-fib usually develops within the first 72 hours after surgery. Many patients have some A-fib after surgery but are in a normal heart rhythm by the time they go home from the hospital.
- A-fib can make you feel like your heart is racing. This may cause fatigue, sweating, mild chest heaviness, shortness of breath and a sense of restlessness or anxiety. Your TMC nursing staff is trained to watch for these symptoms on your monitors and will respond quickly if it happens.
- A-fib can usually be controlled by medication alone. Occasionally though, medication is not enough. When this happens, the heart needs a small electrical shock called a cardioversion. This often brings the heart back into a normal rhythm.
- When A-fib is prolonged, rapid, or goes back and forth from A-fib to a normal rhythm, blood clots may form in the heart. These clots can be dangerous. If a clot is pumped out of the heart, it could block blood flow to the brain and possibly cause a stroke. To help prevent clots, you may be placed on a blood thinner such as Heparin, Lovenox or Coumadin for a short time.
- Later that surgery day, when you are in the ICU, you will get up and move from the bed to a chair with staff assistance.
- A few days later, the chest tube, most IV lines and the catheter will be removed.
- TMC does have unrestricted visiting hours, but we ask that all visitors are healthy and no visitors sleep inside the patient’s room. They may, however, stay in Rosenstiel Lobby as it never closes. Your nurse is in charge of visits and will do what is best for you.
- Due to possible infection risk, babies and young children are discouraged from visiting you in the ICU but they can certainly visit you when you are moved to the post-cardiac care unit, (PCCU).
- Patients typically stay in the ICU for one to two days before being transferred to the PCCU, where they’ll remain for another three to four days before being discharged, depending on how they’re healing.
- The nurse will go over instructions for you and your caregiver about what to expect.
- In the hospital, you will be visited by a respiratory therapist (RT) whose sole purpose is to keep you from having lung complications after surgery. Once you are off the breathing machine and your breathing tube has been removed, your RT will make sure you know how to use your I/S correctly.
- Remember, the I/S will help to keep your lungs expanded, to remove secretions, to promote coughing and to avoid lung complications, especially pneumonia.
- After surgery, deep breathing is more difficult because of pain from your incision. It is normal not to want to take big breaths or cough because of pain, so make sure you are taking the pain medications as needed. Without these deep-breathing exercises, the air sacs at the base of your lungs have a tendency to collapse. This can lead to complications such as shortness of breath or pneumonia so please make sure you are using your pillow!
- Please let your RT know if you were receiving breathing treatments at home but are not receiving them in the hospital. You may need these treatments throughout your stay at TMC. Also, please let your RT know if you used any of these at home before surgery: – Home oxygen – BIPAP or CPAP machine for sleep apnea – Nebulizer or inhaler for breathing problems
The stress of hospitalization, pain, surgery and some medications can elevate your blood sugar even if you do not have diabetes. If you do have diabetes and your blood sugar is normally well controlled, it will most likely be higher than usual after surgery. We will monitor your blood-sugar finger sticks closely, whether you are a diabetic or not, especially in the ICU. Why is my blood sugar so important? Normal blood sugar, or blood glucose, is important for wound healing and the prevention of surgical-site infections. We like to keep blood sugar well controlled after surgery. The best way to do this in the hospital is to use insulin, either though your IV line infusion or at intervals throughout the day as an injection just under the skin.
- During IV insulin infusion, your blood sugars will be monitored every hour.
- During injection therapy, your blood sugar will be monitored every two to four hours depending on how high or low your blood-sugar levels are.
You will be ordered a cardiac diet during your hospital stay which has limited fat, cholesterol and sodium to optimize heart health. Your diet may be tailored for you in other ways as well. If you also have diabetes, for example, you will be ordered a cardiac diabetic diet. If you have any serious food allergies, be sure to let your nurse know. It will be placed under the “allergies” section in the computer and will alert the dietary staff.
- Once you are eating after your operation, you will be able to order your food by phone. TMC is committed to providing you with fresh, appealing and nutritious meals during your stay. Our on-demand food service is available to bring you food between 6:30 a.m. and 7:30 p.m. daily.
- For on-demand food service, your nurse will provide you with a menu that is changed daily. Simply dial 4-1111 from your hospital room to speak with a nutrition representative and place your order. Your nurse can answer any questions you have about this service. Guests may order a tray as well for a small fee. The main cafeteria is also available for friends and family who are visiting.
- It is important to eat balanced meals after surgery as your body needs to get the nutrients needed for proper healing. A registered dietitian is available to help you if you have any special dietary needs or a poor appetite after surgery. Please talk to your nurse if you would like more information on dietary guidelines for your specific needs
After open heart surgery, patients often have feelings of sadness or varying degrees of depression. Usually these feelings disappear within several weeks. Sometimes, however, the signs of depression don’t go away and become worse.Signs of depression include:
- feeling sad or empty
- loss of interest or pleasure in daily activities
- significant weight loss or weight gain
- significant change in sleep patterns such as inability to sleep or sleeping more than usual
- restlessness
- fatigue or loss of energy
- feeling worthless or extreme guilt
- difficulty making decisions
- difficulty concentrating
- thoughts of death or suicide
- planning or attempting suicide
Hospital staff considers your surgery day as day zero. Post-op day one, for example, is the day after your surgery. An important part of your recovery is to get out of bed and move. As uncomfortable as it may be, increasing activity improves circulation, breathing and your sense of well-being. The key is having your pain well controlled.These are some of the activities you will be assisted with:
- Get up with help from ICU staff to sit in a chair
- Keep legs elevated and uncrossed while in a chair
- Get to the restroom with help from ICU staff
- Use your I/S at least 10 times an hour every hour you’re awake to expand your lungs and prevent pneumonia
- Take a deep breath and cough using your arms or the pillow to splint your breastbone or sternum
- Increase diet from ice chips to clear liquids to solids (goal: full cardiac diet) as tolerated. If you are nauseated please let staff know
- Fluids will be limited to 1 ½ liters or 6 ½ cups per day (the staff will keep track in the ICU)
- Ask for pain meds to stay ahead of pain. Nurses will administer IV meds in ICU until you are tolerating an oral diet
- Ask for laxatives or stool softener to stay ahead of constipation
- Cardiac rehab staff will work with you to help you safely increase your activities
- Staff will let you know if it’s OK to move around your room and get up and walk by yourself. If you are unsteady on your feet or feel dizzy or woozy from medication, you will still need some assistance. Increase your walking time and distance based on what your health care team recommends.
- Once you are transferred to the Post-Cardiac Care Unit (PCCU), you will be more independent, and more family and friends will be able to visit you. Be sure not to wear yourself out. Napping is encouraged.
- Continue to keep your legs elevated and uncrossed while you are sitting in the chair. If you notice any breakdown in your skin, or any sores that have developed, notify your nurse.
- Try to eat every meal sitting up in the chair or stay up in the chair most of the day while staying comfortable with repositioning and pillows.
- Continue to limit your fluids. By post-op day four, your fluid restriction may be lifted.
- Continue to use your I /S frequently. Take deep breaths and cough often. You will need the support of your pillow to splint your chest. Your supplemental oxygen may not be needed anymore.
- Let your nurse know if you have not had a bowel movement yet, as it is a MUST before you can be discharged.
- Continue to keep your pain under control and continue to use stool softeners and laxatives as needed.
- Start planning for discharge with the help of your nurse, other staff, cardiac rehab staff and your case manager.
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This health information is provided by the
Mayo Foundation for Medical Education & Research.
