Facing cardiac surgery

Receiving the news that cardiac surgery is needed is a real shock, not only for the patient himself but also for his family. Sometimes it’s just out of the blue, following a routine check-up. Some other times this revelation could be the peak of a fast path: chest pain, a sudden and sharp shortness of breath lead to urgent and quick exams.
The impact of the words “open heart surgery” is strong, it touches the core. Is life at risk? Will everything run smoothly? And then? How will it be? How is everything organised? What is to be expected?

The answers are clearly tightly linked to the individual’s history and diagnosis. As I mentioned several times in this blog, the personal consultation with the physicians is irreplaceable.
The posts tagged as “preop” will treat the general aspects that according to my experience worry both the patient and his family.

How is the whole case handled?

Before setting an indication for heart surgery, the history, the symptoms and the results of various exams are discussed between cardiologists and cardiac surgeons. The final decision is made after having thoroughly examined the different treatment options and is then communicated to the patient and his physician (general practitioner).
A pre-operative consultation with the surgeon is organised and all needed information are given to the patient and his family.

Postoperative pain is among the most frequent worries.

Each surgical wound causes pain, most of all those whose margins are mobile (i.e. abdominal incisions or along the joints).
The standard access in cardiac surgery (the vertical incision along the sternum) is certainly frightening! However, considering that it is relatively motionless (also during breathing), the pain is usually less than feared.
Other surgical accesses, such as lateral ones, are more painful: in these cases special measures are taken, such as local anaestetic administered in the wound through catheters specifically inserted during surgery.
At any rate, the aim of the medical team is to have a pain free patient. As well as the human side of it, a patient with no pain is more cooperative and manages to breathe better, enabling him to draw the best benefit from the mobilization and the post-operative physiotherapy. This is the best way to avoid post-operative complications.
Painkillers are regularly administered and more can be given on the patient’s demand.

Another understandable worry is the feeling of insecurity regarding the course from surgery until discharge.

After surgery the patient is transferred to ICU (Intensive Care Unit), usually still under anesthesia. The patient is then woken up and he will find himself in his warm bed. If everything goes well, the awakening takes place in the few hours after the surgery. Sometimes the medical team prefers to keep the patient “asleep” during the night following the surgery, which enables them to optimize his conditions and wake him up the morning after (also taking the tube out that enables the patient to breathe safely).
The medical team will then decide when to transfer the patient to the ward, depending on his conditions.
Once in the ward, the attention is shifted towards the recovery of everyday life rhythms, on mobilization and respiratory physiotherapy and on the treatment of the surgery’s after-effects, which will be discussed later on.
Our body regards a heart surgery as a huge aggression, to which it reacts with a widespread inflammation (not to be mistaken with “infection”). Among its consequences there is a general “swelling” due to water retention in the tissues that is visible in hands/feet and in the body weight, that can increase quite considerably.
The inflammatory reaction reduces itself in its own accord day by day and the liquids are progressively expelled by means of diuretics.
At the same time the healing of the surgical wounds are evaluated and the drug therapy is adjusted.
Within 5 to 6 days the patient usually manages to regain his independence, to walk around freely on level ground and with the help of physiotherapists he will also climb the stairs.
At this point the next leg of this journey is discussed: return home (with outpatient cardiovascular rehab) or transfer to another hospital or clinic for the continuation of the medical care. In this case the cardiovascular rehab is postponed after the final discharge.
Therefore, if no complications arise, the discharge from hospital usually takes place about one week from the cardiac surgery, sometimes even earlier.
The autonomy is being regained, things are going fine and therefore the end of the hospital stay is approaching. What happens now?

After discharge 

The main target – if there are no medical constraints – is to return home. The highly recommended cardiovascular rehabilitation is to be carried out as an outpatient. Current consensus is that the rehab is more effective when spread over a few months rather than being concentrated during a 2-3 week clinic stay.
Instead of being discharged home, the medical staff could decide to transfer the patient for several reasons. The “post-acute treatment “ is then carried out in another hospital/clinic and the stay will last between 7 – 10 days until the patient can be discharged home. The cardiovascular rehabilitation is performed subsequently, again as an outpatient.
Before being discharged home or transferred to another facility, the patient will receive all necessary information such as care of surgical wound, diet and other aspects of daily life.
It is important to organise ahead of time an assistance for usual chores, such as shopping, cleaning, transferts, etc. If this cannot be done with family members or friends, the general practitioner can organise a home help.