What to Expect Before, During, and After Open-Heart Surgery

There are different types of open-heart surgeries performed for various medical reasons. The most common types include coronary artery bypass graft (CABG), heart valve replacement, and heart transplants. During this procedure, the surgeon will make a long cut in the chest to gain access to the heart.

Why would I need open-heart surgery?

Open-heart surgery is used to correct a problem or condition of the heart that can be life-threatening. Your doctor may try to fix the condition by other means, such as medications, minimally invasive procedures, and lifestyle changes. If these alternate treatment methods do not work, your doctor may suggest having open-heart surgery.

Conditions that may need open-heart surgery include:

• Coronary artery disease or blocked coronary arteries.
• Leaky heart valve.
• Heart valve stenosis or narrowed heart valves.
• Congenital heart defects or abnormal heart structures from birth.
• Heart failure needing a new heart from a donor.

Heart conditions are the leading cause of needing open-heart surgery. When damage happens to the heart, it is usually not reversible. Still, risk factors can increase your chances of developing heart disease and needing surgery.

Risk factors for heart disease that may need open-heart surgery:

• Smoking.
• Diabetes.
• Obesity.
• Unhealthy eating.
• Family history of heart disease.
• High cholesterol.
• High blood pressure.

How should I prepare for open-heart surgery?

Once you and your doctor have discussed and chosen the option to have open-heart surgery, you will likely get bombarded with a wealth of pamphlets and information. It can feel overwhelming to go through and remember all of this when you are about to go through major surgery.

Your doctor may give you orders for specific tests like blood work, chest X-rays, ECGs, and sometimes ultrasounds. These tests ensure that all your levels are safe for operation and that you get the best care possible.

Before the surgery, your doctor may give you a list of medications to hold and take beforehand. Most of the time, doctors will have you take any beta-blockers for blood pressure and stop any blood thinners or anticoagulants.

The night before the surgery, you will be asked to not eat or drink anything. During the surgery, you will have a breathing tube placed, and if you have anything in your stomach, it can cause you to become sick during surgery. If you vomit, you have the chance of inhaling the contents and developing pneumonia.

What should I expect pre-surgery?

After you check in with registration for your surgery, they will bring you back to an area called pre-op, where they will prep you for surgery. During this time, the nurses will have you change into a hospital gown and take off all jewelry or metal items.

Once dressed, a nurse will place two IVs in your arm for anesthesia and provide fluids and antibiotics. A blood sample can be taken when the IVs are inserted to test your blood type and updated lab results. Your blood types are taken in case there is a need for blood products during or after the surgery.

While waiting to talk to the surgeon and other operating room staff, your surgical site will be shaved with an electric razor. The nurses or a certified nurse’s aide will also clean the surgical areas with a special soap to kill germs. This is typically done twice and keeps an antibacterial film on the skin from the soap.

Once you have met your surgical team, they will take you to the OR suite. If your family is in the room with you, they will be asked to wait in the waiting room to hear from your surgeon. You may receive medication from anesthesia that will make you relaxed before going back.

What happens during the surgery?

Before the surgery, the anesthesiologist will give you medication through your IVs to make you sleep. You will be placed on heart monitors that will take your heart rate, rhythm, blood pressure, and other vital signs to ensure you are safe during the surgery.

Once asleep, the nurse in the room will cleanse your body with special substances and scrubs to sterilize your skin as best as possible. The surgeon will ensure you are in the best position and cleaned before starting.

Several team members will be in the room to ensure you are safe. Everyone is assigned a particular function, so everyone works as a team. The type of open-heart surgery you have will designate what people are in your surgical room

Different types of open-heart surgeries depend on the heart condition being fixed. Each surgery has unique skills and techniques the surgeon may use during the procedure. For the surgery to be considered open-heart, the doctor will make a large incision down your chest to gain access to your heart.

Depending on the surgery needed, temporary tubes and wires may be placed to help monitor and collect fluids. These could be external pacemaker wires, chest tubes, urinary catheters, or special IV catheters in your neck.

When the doctor is done operating on your heart, they will close your chest bones (the sternum) with metal wire called sternal wires. Sutures will be used to close the inside of the skin, and the outside is usually glued shut and bandaged.

What can I expect after the surgery?

Immediately post-surgery, you will be taken to ICU to recover. The ICU nurses will watch closely over you and make adjustments to keep your vitals stable. Once your vitals are stable, your family can make a brief visit to see you before you wake up if you wish.

It is important to stay calm when you wake up after the surgery. You will wake up with a tube in your mouth, helping you breathe. You may still have some wires and tubes from the surgery that will be taken out before you go home.

If you panic when waking up because of the equipment, your vital signs may change and can cause damage to the work completed during surgery. If this happens, the nurse may have to use medicine to help you sleep and try again in a short while.

Once you are awake, it is important to start moving as soon as possible. You will be taught to obey sternal precautions while moving from bed to chair or walking the halls. Sternal precautions include:

• Do not push yourself up with your arms when sitting or standing.
• Do not pull with your arms.
• Do not reach arms overhead or behind you.
• Use a pillow or special sternal stuffed animal to support your sternum when moving.

As you heal, your physician will order the tubes and wires to be removed, and you can be transferred to a step-down unit or telemetry floor. Before you can go home, physical therapy will want to assess you to see if you need cardiac rehab.

Cardiac rehab is a special physical therapy designed to improve heart health after open-heart surgery. When discharged, the nurse will review the new and changed medications the doctor has ordered. They will also educate you on caring for your surgical wounds and when to ask for help.

Many conditions may need to be treated with open-heart surgery, and the cause can dictate what happens during the surgery. Suppose you are planning on having open-heart surgery. In that case, your doctor’s office will give you a special set of instructions to follow at home before coming in.

During the surgery, a specially coordinated team will help care for you and keep you safe. Each team member has a special job function, so nothing gets missed. Once the surgery is complete, you will go to ICU for further recovery.

Once all the tubes and wires can be removed during recovery, you can be transferred to a different unit with less monitoring. Rehabilitation will continue outside the hospital; some people may need cardiac rehab after going home.