patient education : 01067--What To Expect on the Day of Heart Surgery

What to Expect on the Day of Heart Surgery

On the day of surgery, you will be transported from the Surgical Admission Suite, or from your room in the hospital, to the holding area of the Operating Room. You will have an IV placed in your arm to receive medications to help you relax. Your chest and leg hair may be clipped.  Lines will be placed in your wrist and neck, and on your finger and chest.

Some of these lines will be attached to a monitor so the healthcare team can watch your oxygen level, heart rate and blood pressure during surgery. Right before surgery, you will be given medication to prevent pain and to keep you asleep. A tube will be inserted through your mouth into your lungs to help you breathe. Surgery will not start until you are completely asleep.

Your Surgical Team

You can feel confident that a team of skilled professionals will perform your surgery. You will meet some of the members of this team before the day of surgery. The team will include the following:

• The Attending Heart Surgeon and Fellow who will perform the surgery.
• The Physician’s Assistant, who helps during the surgery and prepares the graft from the leg for patients having bypass surgery.
• Nurses who assist with the surgery.
• The Anesthesiologist who monitors you and delivers medications to keep you asleep

during surgery.

• The Perfusionist who operates the heart and lung bypass machine to keep your blood circulating during surgery.

Reaching the Heart

An incision will be made in the center of your chest. The breastbone (sternum) is opened and held in place with special instruments.  These instruments might cause pressure on your nerves and muscles, which may lead to soreness and muscle spasms in your chest, back and shoulders after surgery.

Using the Heart and Lung Bypass Machine

Sometimes a machine will be used to do the work of your heart and lungs during surgery. The machine is called a “pump”. Because surgery is done on the heart, the “pump” works in place of the heart, pumping blood and oxygen to the rest of your body. The heart will be stopped temporarily while the bypass graft is being attached or the new valve is placed and attached. When this is complete, your heart and lungs will be restarted. In some cases, coronary artery bypass surgery may be done without stopping the heart and without the bypass “pump.”  This surgery is called “off-pump” or “beating heart” coronary artery bypass.

For Patients Having Coronary Bypass Surgery

The blockages in your arteries are not removed. Instead they are “bypassed” to create a new pathway for blood to flow to your heart muscle.  The surgeon or surgeon’s assistant removes a healthy blood vessel from another part of your body to use as the bypass graft. One end of the graft is placed beyond the blockage and the other end is attached to the aorta.

Preparing the Bypass Graft

When the bypass graft is removed from a part of your body blood flow to that area is not generally affected. If you have more than one blockage in your heart several blood vessels may need to be used. These vessels are the ones most frequently used:

• The saphenous vein located in the leg.
  
• The radial artery located in the lower arm.
• The internal mammary artery located in the chest wall.
  

Attaching the Graft

A small cut is made in the coronary artery, below the blockage.  If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end of the artery is sewn into the aorta. If the internal mammary artery is used, only one end of the graft is sewn into the opening. The other end is already attached to a branch of the aorta; therefore, it will stay in its original place.

For Patients Having Valve Surgery

If possible, your surgeon will repair your valve, rather than replace it.  A ring may be used to reshape the valve or the leaflets of the valve may be cut to make them open and close more effectively. If the damage to your heart valve cannot be repaired, the surgeon may choose to replace it.  Replacement valves can be done with a mechanical valve or a tissue valve. Your surgeon will discuss the advantages and disadvantages of each type of valve with you prior to your surgery.

Finishing Up

Blood flow will be assessed through your bypass grafts or your repaired/replaced valve when the surgeon is done.  You will be removed from the bypass machine.  Your breastbone is reconnected with wires that will remain in your chest permanently. The incision is sewn or stapled closed and you will be transferred to the Intensive Care Unit to recover.

Risks and Complications

Your doctor will explain the possible risks of heart surgery during your clinic visit. These may include the following:

• Excessive bleeding
• Infection of the incision sites
• Pneumonia (lung infection)
• Fast or irregular heart beat
• Nerve injury or muscle spasms
• Breathing problems
• Memory problems or confusion
• Heart attack, stroke or death