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PATIENTS GUIDE To

OPEN-HEART SURGERY

Dr. Donald L. Bricker, M.D


Edited by Anwesa Bagchi

Human Heart ~ Heart Surgery ~ Pre& Post Care ~ Risks of Heart Surgery ~FAQ ~ Glossary & Other Sources

Patients Guide to Open-Heart Surgery

July, 2010

I. HUMAN HEART
The heart is the organ that pumps blood to the rest of the body. It is located on the left side, in the chest cavity behind the breast bone. It is about the size of human fist and is made of cardiac muscles.
A. Hearts function

All organs require blood in order to function accurately. The right atrium receives the blood from the organs after they have extracted the needed oxygen. This blood is pumped into the right ventricle, which then pumps the blood to the lungs. In the lung, the carbon dioxide present in this blood is removed and new oxygen is added. This oxygenated blood then reaches the left ventricle via the left atrium. The left ventricle then pumps this newly oxygenated blood back to the bodys organs. Fig.1:Parts of a human heart
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B. Nerve controls the heart

The heart is controlled by the autonomic nervous system of the brain that tells the heart to speed up or slow down depending on the bodys needs. The heart functions non-stop throughout ones life time. Fig.2: Blood vessels
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Heart Patient Guide. University of Southern California http://www.cts.usc.edu/hpg-index.html

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Patients Guide to Open-Heart Surgery

July, 2010

II. HEART SURGERY


Heart surgery is performed to correct problems with the heart. More than half a million heart surgeries are done each year in the United States for a variety of heart problems. 2 Traditional heart surgery, often referred to as Open-Heart Surgery, is performed by opening the chest wall to
operate on the heart. Open refers to the chest, not the heart. Open-heart surgery is used to bypass

blocked arteries in the heart, repair or replace heart valves, treat atrial fibrillation, and do heart transplants.3 Open-Heart Surgery is performed under general anesthesia. A breathing tube is placed in the lungs through the throat and then is connected to a ventilator (breathing machine). During the surgery, the surgeon makes a 6- to 8-inch incision (cut) down the center of the patients chest wall to open the rib cage so that the surgeon can get to the heart. The chest is opened by cutting through the patients breastbone. Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the pumping action of the heart. The bypass machine allows the cardiothoracic surgeon to operate on a heart that is static and not full of blood.

Fig.3: Heart-Lung Bypass Machine working during surgery


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Diseases and Conditions Index. National Heart Lung and Blood Institute, U.S. Department of Health & Human Services http://www.nhlbi.nih.gov/health/dci/Diseases/hs/hs_all.html
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Diseases and Conditions Index. National Heart Lung and Blood Institute, U.S. Department of Health & Human Services http://www.nhlbi.nih.gov/health/dci/Diseases/hs/hs_all.html

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Patients Guide to Open-Heart Surgery

July, 2010

III. PRE & POST CARE


A. Patients Medical Evaluation before Surgery B. Diagnostic tests

The doctor will discuss: The kind of heart problem patient has, the symptoms and how long the patient has had symptoms. Patients history and past treatment of heart problems, including surgeries, procedures, and medicines as well as other health problems and conditions, such as diabetes or high blood pressure and Patients family history of heart problems Note: Blood tests, such as a complete blood count, a lipoprotein panel (cholesterol test, may also be needed).

EKG (Electrocardiogram) Stress Test & Echocardiography Coronary Angiography Aortogram & Chest X Ray Cardiac Computed Tomography Scan Cardiac Magnetic Resonance Imaging

C. Recovery in the Hospital

Depending on the type of heart surgery, the patient may spend a number of days in the hospital's intensive care unit (ICU). He or she may have an intravenous (IV) needle inserted in a blood vessel in his/her arm or chest to give fluids until the patient is ready to drink on their own. Extra oxygen through a face mask or an endotracheal tube (breathing tube)4 can also be given. When the patient leaves the ICU, he or she will be moved to another part of the hospital for several days before going home. The entire time the patient is at the hospital, doctors and nurses will closely watch his or her heart rate, blood pressure, breathing, vital signs, and incision site(s).
D. Recovery at Home

Each person responds differently to heart surgery. After-effects of heart surgery are normal. They may include muscle pain, chest pain, or swelling. Other after-effects may include loss of appetite, problems sleeping, constipation, and mood swings and depression. After-effects usually

Heart Patient Guide. University of Southern California http://www.cts.usc.edu/hpg-index.html

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Patients Guide to Open-Heart Surgery

July, 2010

go away over time. Recovery time varies for different types of heart surgery. Full recovery from traditional open-heart coronary artery bypass graft (CABG) may take 6 to 12 weeks or more.

IV. Risks of Heart Surgery


Heart surgery has risks, even though its results often are excellent.
A. General Risks B. High Risks

Bleeding

Are older than 70 Have diseases or conditions such as high blood pressure, diabetes, kidney disease, lung disease, or peripheral arterial disease Mortality (Heart surgery is more likely to be life threatening in people with pre-existing conditions.)

Infection, fever, swelling, and other signs of Have had previous heart surgeries inflammation

Reaction to the medicine used to temporarily put you to sleep during surgery

Arrhythmias (irregular heartbeats) Memory loss and problems concentrating or thinking clearly

Damage to tissues in the heart, kidneys, and lungs

Sometimes patients need to be readmitted due post-operative complications.


Table 1: Top 10 Causes of Readmission 30 Days after CABG Surgery Was Performed, 20015
Primary Diagnosis Other Post Operative Infections Congestive Heart Failure Coronary Atherosclerosis of Native Coronary Artery Atrial Fibrillation Functional Disturbances Following Cardiac Surgery Cardiac Complications Respiratory Complications Unspecified Pleural Effusion Number of Patients Readmitted 167 141 84 48 40 39 38 36 % of Readmitted Patients 12.7 10.7 6.4 3.6 3.0 3.0 2.9 2.7

5 A SUMMARY REPORT ON NEW JERSEY HOSPITAL READMISSIONS 30 DAYS AFTER CABG SURGERY 1999-2001. Health Care Quality Assessment Division of Health Care Quality & Oversight http://www.state.nj.us/health/healthcarequality/documents/cabg_readmissions99-01.pdf

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Patients Guide to Open-Heart Surgery

July, 2010

Pneumonia Other Chest Pain

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2.5 2.3

V. FAQ
1. When can I go home following open-heart surgery?
Not before five to seven days following the surgery.

2. Does minimally invasive surgery reduce the amount of pain from


conventional open-heart surgery? One of the advantages of minimally invasive surgery is a smaller incision, which means one can heal faster. However, you will still experience some pain at the incision and at the surgical site.

3. When can I return to work following open-heart surgery?


In about two months. If your job requires a lot of physical effort, such as heavy lifting, it could be as long as three months. 4. How does diabetes affect heart surgery? The healing process for diabetics may be affected, i.e. slower healing time or increased chance for infection. However, nearly one-third of all of cardiac patients are diabetic. 5. Will I receive blood during surgery? If your blood count is normal before undergoing the procedure, then it is highly unlikely that you will need blood. Approximately, 10 percent of patients do receive blood based on their blood counts during the remainder of their hospital stay. 6. How active can I be after surgery? Most people will walk within one to two days after heart surgery. You will most likely be up to a normal 10-12 hour day during the second month of recovery. 7. When will I be able to drive? You will be able to drive for short periods of time in two to four weeks after the procedure.

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Patients Guide to Open-Heart Surgery

July, 2010

8. Is bypass surgery considered open-heart surgery? Anybody requiring cardiopulmonary bypass is considered to have had open-heart surgery. 9. How far can I travel after I have had surgery? It is recommended that any trip that is more than two to three hours long should not be taken for at least four to six weeks after your procedure. 10.Does Medicare pay for heart surgery? Yes, at least 80 percent.

VI. Glossary
Autonomic Nervous System: a part of the peripheral Atrial: of or referring to the atrium or atria nervous system that affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of Breast bone: also known as sternum is a long flat bone shaped like a capital 'T' located in the the pupils, urination, and sexual arousal. center of the thorax (chest). Aorta: the large single artery arising from the left CABG: coronary artery bypass graft; vein or ventricle carrying blood to the systemic circulation artery grafted surgically to permit blood to travel Atrium: a chamber affording entrance to another from the aorta to a branch of the coronary artery structure or organ; at a point past an obstruction Right. atrium the upper right cardiac chamber that Cardiac: of or referring to the heart receives blood from the venae cavae and delivers Ventricle : a small cavity or chamber, as in the blood to the right ventricle brain or heart Left. atrium the upper left cardiac chamber that Right v. the lower chamber of the right side of receives blood from the pulmonary veins and delivers the heart, which pumps venous blood through blood to the left ventricle (pleural form is atria) the pulmonary trunk and arteries to the capillaries Artery: a blood vessel that carries blood away from of the lung the heart; arteries usually carry oxygenated blood Left v. the lower chamber of the left side of the Arrhythmia: irregularity or loss of rhythm of the heart, which pumps oxygenated blood out heartbeat through the aorta to all the tissues of the body

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Patients Guide to Open-Heart Surgery

July, 2010

VII. Other Sources


1. Click: What Happens After Heart Surgery? 2. Click: Heart Surgery Terms 3. Click: Open Heart Surgery 4. Click: Healthy Eating 5. Click: Heart bypass surgery - discharge 6. Click: Patient's Guide to Heart Surgery 7. Click: Life after Open-Heart Surgery 8. Click: Heart Disease Prevention Tips

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