Questions about Open Heart Surgery

For many people, the blockage of coronary arteries and chest pain leads to emergency open heart surgery.  With very little or no time to prepare, you often don’t know what to ask your doctor.  When your life is at risk, you don’t have the luxury of exploring other less-invasive options, or seeking a second opinion.  You don’t have the time to research hospital infection rates or interview surgeons.

When open heart surgery is a planned event for a non-emergent diagnosis, such as valve replacement, you have the time to explore all of your options and ask the questions that will help you and your physician to make a plan for your optimal outcome. When you ask questions, it is helpful to have a notebook where you can write down the answers and have a second person present during discussions to help you remember what is discussed.  What to ask your doctor before open heart surgery:

            1.  What is the name of the operation I need?

            2.  Is there a less-invasive option for my condition?

            3.  What hospitals in my area offer this?

            4.  From whom could I seek a second opinion?

If you are discussing your surgery with the surgeon who will perform the procedure, you may want to ask more detailed questions about the operation. The doctor may also give you printed information about the procedure and expectations during recovery.  In addition to that information, you can ask:

            1. How long is the hospital stay and at-home recovery?

            2.  How much pain will I have and how will the pain be manage?

            3.  What do I need to do to prepare for surgery? What medications should I take or stop taking before surgery?

            4.  Will I need special equipment at home after surgery?  Will I have a homecare nurse or a cardiac rehab program?

Open heart surgery involves an incision from just below the neck to the end of the sternum, the bone between the breasts.  The sternum is also cut and pulled apart to give the surgeon access to the heart. General anesthesia with an endotracheal tube placed in your windpipe and an intravenous line, usually inserted in a vein in your neck are required.  In order to work on the heart, the surgeon will need to stop its normal beating, and you will be kept alive during the procedure by a heart bypass machine.

Open heart surgery can take a few hours or many hours depending on the complexity of the procedure and whether any complications occur during surgery.  Add to the actual operating time, the set-up and closing times and the operation can be a long wait for family members.

After surgery, you will go to the post-anesthesia care unit, formerly called the recovery room, until you are stabilized and some of the effects of anesthesia wear off.  Then you will be transferred to another critical care unit for constant observation. The breathing tube may stay in place for some time and you will be sedated during those hours.  The intravenous will remain in place for several days.  You will also have chest tubes below and to one or both sides of the sternum to collect blood and fluids and relief pressure from this normal drainage.

As soon as possible, and usually within only a few hours after surgery, the nurses will begin helping you to get up and begin moving around. This is critical to your recovery.

Within a few days, the medical team will begin planning your discharge from the hospital.  This is the time to ask about whether you will go to a rehab facility or directly home.  Keep in mind that the staff may not be fully aware of your home situation.  If you live alone, or your spouse is elderly and debilitated, you might qualify for a short stay in a facility.  Many patients are anxious to return home, but need a few more days of care and therapy that can be provided in a rehab facility. You should inquire about this possibility if you are not able to get out of bed on your own, if you are not able to walk more than ten feet with a walker independently, and if you do not have someone who can prepare your meals, and administer your medications.

During this phase of recovery, ask your doctor:

            1.  What special dietary or equipment needs do I have?

            2.  What should I expect for the next two weeks? What precautions are needed at this time?  When can I shower? How long will I need extra help at home?

            3.  How soon can I resume activities such as walking, exercising, swimming, sports, work and sex?

            4.  Will there be any restrictions on my normal activities?

            5.  Will you send a report about my surgery to my primary care physician?

            6.  When should I have an appointment to see you again?

            7.  How can I reach you in case of an emergency?

Having open heart surgery, whether planned or emergency, can be very frightening for you, the patient, and your family.  Learning to ask the right questions can help remove some of the anxiety and prepare you for every phase from preparation to recovery.