What to Expect
Prior to pre-testing, you will need to provide a dental clearance from your dentist.
You should expect to spend at least three hours for your pre-surgical testing. Routine blood work and a chest x-ray will be completed and you will meet with the cardiac team, a physician’s assistant who will obtain a health history and obtain surgical consent, and an anesthesiology fellow.
The following medications must be stopped for surgery: Coumadin, Plavix, Ecotrin, and Aspirin. Vitamin E, Garlic and Ginger should be stopped as well.
The night before surgery you should shower and not have anything to eat or drink after midnight.
On the day of surgery you will first go to the registration area on the fifth floor of the Guggenheim Pavilion where you will receive important information regarding your rights as a patient and review the information in your file (e.g., spelling of your name, home address, insurance, and planned procedure). Your family will go to the Surgical Waiting area and register with the receptionist.
Next, you will go to the patient assessment area to change into a hospital gown. A registered nurse will verify your planned procedure, your medical history and condition, and review any allergies you may have. Your nurse will also review the results of any test(s) ordered by your physician and perform any necessary final testing.
You will then be escorted to the pre-surgical holding area, where you will meet the surgical team, which includes your surgeon, anesthesiologist, and nurse. The team will prepare you for the procedure and mark the surgical site. You will be connected to monitors and have your vital signs taken. Your anesthesiologist will also place some intravenous lines for subsequent drug administration. The anesthesiologist may give you a drug to help you relax. If there are any issues you would like to discuss regarding the operation, this would be the last opportunity to do so. From the holding area, your anesthesiologist will wheel you into the operating room where you will be transferred onto the operating table.
The surgical team consists of surgeons, anesthesiologists, perfusionists, physician's assistants, and nurses.
The atmosphere in the operating room can be daunting because there is a lot of equipment and sometimes a fair amount of noise from alarms or monitors and staff preparations. Staff are dressed in operative attire with masks and gowns. The operating room temperature may feel cold. Your anesthesiologist will give you an oxygen mask and place additional monitoring lines. While breathing oxygen, the anesthesiologist will administer an intravenous injection which will put you to sleep. You will remain asleep from this point until you wake up in the intensive care ward some hours after surgery. A tube is placed through your mouth to connect your lungs to a ventilator and additional monitoring lines are placed through veins in your neck. A urinary catheter is placed in your bladder. You will then be cleaned with antiseptic solution and then covered with drapes.
Your condition is monitored throughout the surgery by your anesthesiologist.
The surgery then commences with the surgeon making an incision in the midline over your breast bone. The surgical team usually consists of two or three surgeons who perform varying parts of the operation as a team (similar to a pilot and copilot in an airplane). If you also require bypass surgery, another surgeon may simultaneously make an incision in your leg to excise a segment of leg vein for the bypass. The breast bone is divided with a saw and the heart is exposed. The surgeon will place tubes into the blood vessels that emerge from the heart and connect you to a “heart-lung machine”. The heart-lung machine performs the function of the heart and lungs while the surgeon is operating on the heart. The surgeon then starts the heart-lung machine and then stops your heart using special drug infusions.
The surgical team performing mitral valve surgery.
With your heart stopped the surgeon can then open your heart and operate on the heart valves. The surgeon makes a cut into the appropriate chamber of the heart to expose the valve. The surgeons inspect the valve and then perform the repair or replacement as necessary. The surgeons also perform any other procedures you may require such as bypass surgery or surgery to treat atrial fibrillation.
Perfusionists operate the heart-lung machine during mitral valve surgery.
Once your procedure is complete, the surgeon closes the incisions he has made in the heart and restarts the heart beating. The heart-lung machine is gradually weaned off and your heart resumes full function of pumping blood round your body and lungs. The surgeon then stops any bleeding and places chest drains through your skin which will drain any blood from around the heart when you return to the intensive care ward. He will also place ‘pacing wires’ through the skin which are connected to a temporary pacemaker to increase your heart rate if required. The surgeon then closes the chest incision using steel wires to approximate your breastbone and dissolving sutures to close the other layers of the wound.
Your aneshtesiologist will perform an intra-operative echocardiogram to confirm the quality of the repair.
After The Surgery
After surgery you will be admitted to the CSICU (Cardiac Surgery Intensive Care Unit) usually still under the effect of anesthesia, so fully sedated. You will still have the breathing tube down your mouth connecting you to the ventilator. You will be connected to several monitors and there will be several alarms and buzzers sounding repeatedly to continuously alert intensive care staff to changes in your condition.
You will be closely monitored and expertly cared for by our team of physicians and nurses, so there will be a lot of activity around your bedside as nurses and doctors make adjustments on a minute to minute basis.
You will also be connected to other special medical equipment, including some of the following:
- A breathing tube, connected to a ventilator. You will not be able to speak until the tube is removed. This resembles breathing through a straw. Try to remain calm and understand the breathing tube will be removed as soon as you are able to breath without support.
- Chest tubes, to drain fluid from the surgical site.
- A urinary catheter, to drain urine from your bladder.
- Multiple intravenous lines, to administer fluids and medications.
- An orogastric tube which is removed with the breathing tube.
Once it is established that your heart function has remained optimal and stable, that you are not bleeding and that your body metabolic functions are performing adequately then we will allow you to wake up and then take you off the ventilator. For some patients, this process will begin the night of surgery.
Most patients will remain on intensive care for one or two nights after which they will be transferred to the general telemetry floor. The majority of patients will be ready to leave hospital within 5 to 7 days of surgery. About 1 in 10 patients will have unique situations or complication that will require they stay in ICU or hospital for longer periods, but these are usually self limiting and do not have any lasting implications.
It is important to remember that each patient will recover at a different pace. Any questions about individual progress can be directed to the ICU medical and nursing staff.
Your family will be told when the surgery is over and will be sent to GP2W where the surgeon will meet with them.
Once you are admitted to the CSICU your family can visit you during standard visiting hours, 11:30am - 6:30pm and 7:45pm - 8:15pm. Only 2 people at a time, at the bedside.
Post-Operative Day 1 and 2
Most patients will transfer to the 7th floor the morning after surgery. You can expect to feel tired and will sleep for short periods throughout the day. It is important to do deep breathing exercises every 2 hours. You will receive pain medication by mouth and you will start drinking fluids and progress to soft food. Your IV, monitoring lines, and Foley catheter will be removed. The chest tubes will be removed when the drainage is low. Your activity will increase. You will be out of bed to your chair and walking to the bathroom. By the 2nd day, you should walk around the unit at least 2 times each day.
Post-Operative Day 3 and 4
- You will continue walking around the unit 2-3 times each day. As your appetite improves, you will begin to feel less tired.
- Your blood work and chest x-ray will be reviewed by the care team in preparation for discharge. The team will review how you are doing and let you know if you are ready for discharge in the morning.
- Post-operative teaching and discharge planning will continue. We encourage your family to participate and ask questions. Your discharge instructions will include information on wound healing, disease and risk factor modification, your medications, your home exercise program, stress management, and specific restrictions.
- Your pacing wires will be removed at least 24 hours before your discharge.
- You should make arrangements for transportation home and have your family/friend bring your clothes to the hospital.
Day of Discharge
- You will be given a discharge notice to sign.
- Your family/friend should arrive at the hospital before 9am.
- You will be given prescriptions for medications, your discharge instructions, and follow-up care information. All of which will be reviewed with you by your nurse.
- Our goal is to discharge by 9:30am. There is a discharge lounge on the second floor.
Things to Remember at Home
- See your cardiologist 7-10 days after discharge.
- Make a 4-week follow-up appointment with your surgeon.
- You can shower. Towel dry lightly.
- Do not lift more than 5 pounds for the first 6 weeks; no more than 12 pounds for the first 10 weeks.
- No driving for 6 weeks.
Signs and Concerns
- Report redness, swelling, increased drainage or excessive pain at the surgical incision.
- You should also call us if you are not sleeping or have shortness of breath.