FAQs

About Heart Surgery

Before You Enter the Hospital

Day of Surgery

Recovering at Home

About Heart Surgery

Q: What is the normal heart?
A: The heart is located in the center of your chest, just beneath the breast-bone (sternum). It serves as a pumping system to take blood in from the body, sending it to the lungs for oxygen and returning the enriched oxygenated blood back to the body.

Valves, similar to one-way doors, control the continuous flow of blood through the four chambers of the heart. The cycle begins when blood from the body enters the top right chamber, the Right Atrium, and passes through the Tricuspid Valve into the Right Ventricle. The blood is pushed through the Pulmonic Valve and enters the lungs.

Once the blood is re-supplied with oxygen, it re-enters the heart through the Pulmonary Veins into the Left Atrium. The blood then passes down through the Mitral Valve into the Left Ventricle. As the powerful left ventricular muscle of the heart contracts, the oxygen-rich blood rushes through the Aortic Valve and is circulated throughout the body via the Aorta.

Q: When is Valve Surgery needed?
A: When heart valves are seriously harmed by birth defects, inflammation, degeneration or infection, surgery may be required to repair or replace them. Damage to these one-way valves can place excessive strain on the heart muscle and interfere with efficient blood flow to the organs of the body.

Some common problems that are treated by surgery include valves that "leak" (regurgitation) and valves that are constricted by scar tissue, a condition known as stenosis. When replacement of a valve is called for, your doctor will discuss with you which type of valve you will receive, and describe how it works.

Q: How the Coronary Arteries supply blood to the heart?
A: Your heart requires its own system of blood and oxygen, which is supplied through a network of vessels known as the Coronary Arteries. These vessels originate at the Aorta and run across the surface of the heart.

The Right Coronary Artery supplies blood to the right side of the heart and to a portion of the back side. Two of the major vessels off the Left Main Coronary Artery are the Left Anterior Descending (LAD) and the Circumflex. The LAD provides blood and oxygen to the front of the heart and to the bulk of its muscle tissue, while the Circumflex supplies the left wall and part of the back of the heart.

Q: When is Bypass Surgery necessary?
A: The inner surfaces of the healthy arteries are smooth and flexible, which permit blood to flow freely and reach the muscle of the heart. When walls become clogged with scar tissue which includes fatty materials, the result is a condition known as atherosclerosis.

Many factors can contribute to atherosclerosis - some of which are: high blood pressure, elevated blood cholesterol, smoking, diabetes, a family history of atherosclerosis and lack of regular physical activity. In some cases the reduced flow of blood to the heart can cause angina (chest pain, arm or throat discomfort), shortness of breath, or a heart attack. When blockage is severe, surgery may be required to reroute the blood supply around a damaged or blocked coronary artery, a process known as "bypass grafting."

The purpose of coronary bypass surgery is to circumvent the blockages in your coronary arteries. Surgeons use an artery in your chest, the internal mammary artery, and/or segments of leg veins called the saphenous veins. When the internal mammary artery is utilized, one end is usually left attached to the subclavian artery supplying blood to your arms and the cut end is connected just beyond the blockage in the coronary artery. When veins are used, one end of the vein is attached to the Aorta and the other end is connected just beyond the blocked area of the artery to "bypass" the obstruction. Other conduits that can be used include the radial artery from either forearm or veins from the upper arm (cephalic veins). The resulting improvement in blood flow through the arteries can reduce or eliminate angina, prevent heart attacks, and improve long-term survival.

Q: How does the surgeon get to your heart?
A: Surgery may also be needed to correct other types of heart problems. An aneurysm is an irregular bulge due to heart muscle wall weakness that sometimes appears after a major heart attack. In surgery, the bulge is cut out or patched. Atrial Septal Defect occurs when the wall that divides the heart's upper chambers does not close all the way. Ventricular Septal Defect results from a hole in the wall between the heart's lower chambers. Surgery is sometimes required to close these openings.

The surgeon can reach the patient's heart through several different types of incision. A full or median sternotomy involves an incision through the breastbone (sternum), which is then spread apart. After the operation is complete, the breastbone is closed with stainless steel wires and the skin is sutured. The stretching of the muscles, bones and ligaments during surgery usually results in some pain and discomfort following the operation; however, the breastbone will heal back to full strength.

Minimally invasive and robotic operations use a series of smaller incisions placed between the ribs. Surgical instruments and a camera are placed through these incisions and the surgeon views the operative field on a monitor. Since the breastbone remains intact, minimally invasive and robotic procedures typically reduce postoperative pain and require less recovery time.

Q: When is Coumadin® required?
A: Coumadin® is a potent blood thinner. By comparison, aspirin is also a blood thinner but less potent and works by different mechanisms. Coumadin® is most commonly used in heart surgery when a patient has a mechanical heart valve. Another common use is among patients with a rhythm disturbance called atrial fibrillation. The use of coumadin® can cause serious internal bleeding and therefore must be monitored closely with blood tests.

Q: How long will a porcine valve last?
A: A porcine valve usually lasts about 10 to 15 years.

Q: How long will a mechanical valve last?
A: A mechanical valve usually lasts forever.

Q: What is op-CAB?
A: Op-CAB refers to off-pump coronary artery bypass grafting. Ordinarily when performing a CABG (coronary artery bypass graft), the patient has to be placed on a heart-lung machine and the heart stopped during part of the operation. In Op-CAB, neither step is undertaken. The potential advantages, which are still being studied, include less bleeding, less need for blood transfusion, fewer strokes, and a faster recovery. However, Op-CAB is not suitable for every patient.

Q: How can I prevent infection of my new heart valve?
A: Infection of a heart valve can be reduced with antibiotic taken before any invasive procedures, such as a dental procedure.

Q: How long will my coronary bypass last?
A: A coronary bypass will last a very long time, although the exact time varies from individual to individual. In general, the mammary artery bypass will last much longer than the vein bypass. Most individuals will require only one operation, although some will require a second or even a third one.

Q: What is the internal mammary artery?
A: The internal mammary artery is located behind the chest wall. This artery is frequently used in one of the bypasses because it lasts longer than a vein bypass.

Q: Why is an IM artery different from a vein graft?
A: The internal mammary artery is an artery, whereas the vein graft is a vein. There are other properties unique to the internal mammary; for example, it seems to be protected from atherosclerosis.

Q: What is post-pericardiotomy syndrome?
A: Post- pericardiotomy syndrome is an inflammation of the tissues around the heart and is seen after an open-heart operation. Symptoms include fatigue, a sensation of not feeling well, and fever. Blood tests may show an elevated white count or inflammation.

Before You Enter the Hospital

Q: Do I need to quit smoking before surgery?
A: If you smoke, quit. Smoking makes you more prone to developing pneumonia and pulmonary complications after surgery. It also makes your heart work harder, and accelerates the atherosclerotic process. You must quit smoking at least 3 weeks prior to surgery.

Q: Should I stop my medications before the day of surgery?
A: Consult your physician if you are unsure about the continuation of any medications you may be taking. It is advisable to discontinue blood-thinning medications such as aspirin, Coumadin®, Persantine, Ticlid and Motrin 5-7 days prior to surgery.

• Aspirin. Please check with your cardiologist regarding continuing aspirin (salicylates) prior to surgery. Aspirin should also not be used as an over-the-counter medication in the week prior to surgery. Many over-the-counter medicines, such as Anacin, Bufferin, NSAID'S (non-steroidal anti-inflammatory drugs) contain salicylates and should be avoided.
• On the morning of your surgery, you may take your medications with a minimal amount of water.

Q: Who should speak to my doctor after surgery?
A: It is beneficial to designate one family member or friend to maintain communication with your surgeon and the healthcare team. This will enhance the flow of information and decrease the chance for miscommunication.

Q: How can blood be donated for me?
A: Columbia University Medical Center relies on voluntary blood donors and extensive testing to maintain safe blood supplies. Please speak with your surgeon well in advance of surgery regarding blood banking and the possibility of donating blood for yourself or having family and friends donate blood before surgery.

Q: Who is the best professional to speak with about discharge planning?
A: Social workers are available to help you with a range of concerns you may have about the hospitalization and discharge arrangements. If you would like to take advantage of these services, ask your doctor or nurse about speaking with a social worker.

Q: How do I plan for myself in case of post-operative issues?
A: Patient representatives are available to provide patients with Health Care Proxy forms and organ donation cards. An Advance Directive is verbal or written instructions made by you in advance of illness that communicate your wishes regarding treatment. Advance directives include, but are not limited to a health care proxy, a living will and a consent to a do-not-resuscitate (DNR) order recorded in your medical record. If you have any questions, you may call Patient Relations at 212.305.5904.

• Health Care Proxy: New York State has a law that enables you to appoint someone you trust, (a family member or close friend) as your Health Care Agent, to decide about your treatment if you lose the ability to decide for yourself. You can appoint a Health Care Agent by signing a form called a Health Care Proxy.
• A Living Will is a written document that expresses, in advance, your specific instructions /choices about various types of medical treatment. Living wills are recognized as evidence of your wishes if you are seriously ill and not able to communicate.

It is encouraged that the patient designate a Health Care Proxy or write a Living Will before any major surgery.

Q: What is Same Day Surgery or being a Same Day Patient?
A: As a same day patient, you will arrive at the Milstein Hospital Building Lobby 2 hours before your scheduled operation time. (For example, if your surgery is scheduled for 8 AM, arrive at Admitting at 6 AM.) Changes in the schedule due to unanticipated emergencies, such as heart transplants, may occur. We request that you are accompanied by either a family member or a friend. Security will direct you to the Admitting Office and from there you will be directed to the Operating Rooms on the 4th Floor.

Q: What happens if I am an inpatient or transfer patient?
A: If you are admitted to the hospital before your day of surgery, you will be assigned a room where you will spend the night. You will meet with a physician who will discuss your surgery and answer any questions you or your family may have. You will also be visited by members of your surgical team, an anesthesiologist and the Cardiac Education Coordinator. The aim is to obtain the clearest possible picture of your medical history while offering you a chance to get information about your treatment from a wide range of sources.

You will be asked a series of questions about any previous health problems or operations you have had and any allergies you may have to foods or medicines. Be sure to provide the exact names and dosages of all medications you are taking, including aspirin, cold medicines, vitamins and homeopathic(or botanical) pharmaceuticals.

Q: What happens with my medical insurance for my heart surgery?
A: Most insurance companies require pre-certification for hospitalization. Your surgeon's office will obtain pre-certification for the surgical procedure only. It is your responsibility to verify coverage for all other aspects of your hospital stay. At the Admitting Office, you will be asked to pay in full or for estimated charges not covered by your insurance. The hospital will accept cash, checks and major credit cards for payment. Any questions regarding finances may be handled in advance by calling the Admitting Office at 212.305.4681. Please be aware that there is an additional charge for a private room, television and telephone usage. Television and phone are paid for on a daily basis.

Q: How can I prevent infection of my new heart valve?
A: Infection of a heart valve can be reduced with antibiotic taken before any invasive procedures, such as a dental procedure.

Q: How can I prevent infection of my new heart valve?
A: Infection of a heart valve can be reduced with antibiotic taken before any invasive procedures, such as a dental procedure.

Q: How long will the operation take?
A: The operation itself usually takes 3 to 5 hours, but preparation for surgery, administration of anesthesia, and preparation for the transfer to the Cardiothoracic Intensive Care Unit, or CTICU, extends the time in the operating room to 4 to 6 hours. In the operating room, time is required to insert intravenous lines and set up other equipment to monitor body functions and keep them functioning smoothly during surgery.

Q: How will my family know when the surgery is completed?
A: While the operation is in progress, your family can wait in the hospital waiting room (4th floor of the Milstein Hospital Building) or leave a telephone number where they can be reached. When the surgery is completed your surgeon will contact your family and inform them of your condition.

Q: Where will I be when I wake up?
A: Following surgery you will be brought to the CTICU, where you will remain for approximately 12 to 48 hours. Subsequently, you will be moved to either the Stepdown Unit or a regular bed on the surgical floor (7 Hudson North). The CTICU is located on the 4th floor of the Milstein Hospital Building.

Q: When will I be able to see my family?
A: Once you have been moved to the CTICU for recovery after surgery and comfortably settled, your family will be allowed in for a brief visit. It is recommended that your family not skip meals before visiting in order to maintain their well-being during the time you are in the CT Intensive Care Unit.

Q: What are the visiting hours?
A: CTICU: 11:00 am to 6:30 pm and 8:00 pm–10:00 pm.
General Surgical Floor and Stepdown (5 Hudson North or 7 Hudson North): 12 noon–8:00 pm

Q: How should my family communicate with the health care team?
A: It is beneficial to designate one family member or friend to maintain communication with your surgeon and the healthcare team. This will enhance the flow of information and decrease the chance for miscommunication.

Recovering at Home

Q: What can I expect when I am recovering at home?
A: Within 5 to 10 days, most patients are eager to leave the hospital despite some apprehension about giving up the security of an expert medical team. It is important to be patient with the pace of recovery, even after discharge from the hospital.

Remember, fatigue is normal after a major operation like heart surgery. You shouldn't be surprised to find that one day you feel strong, while the next day you feel tired and weak. Don't get discouraged; your recuperation period will allow the body to heal, replenish its blood content, and increase its strength and endurance.

CUMC has both in-patient and out-patient cardiac rehabilitation programs. We can refer patients to a variety of home health care agencies if necessary for post-discharge home care and cardiac rehabilitation. Please speak with your physician and social worker about these options.

Q: How do I pace myself once I am home?
A:

• Rapid change of position (sitting to standing or vice versa) may be accompanied by dizziness if done too quickly.
• Rest whenever you get tired.
• Rest between activities. If you need to rest for more than one hour after an activity, you may be pushing yourself too hard. Do a little less the next day.
• Avoid placing undue strain on your chest region by sitting in one position for long periods of time.
• When sitting or standing, use your leg muscles—do not use your arms to lower or raise yourself from your chair.
• Do not cross your legs—it interferes with blood flow.
• Avoid prolonged periods of inactivity (like long car trips or air travel).

Q: What does a daily routine look like?
A: We suggest you identify and stick to a regular daily routine. This will I help you build your strength and help you recover faster.

• Try to get 6 to 8 hours of sleep each night. Go to bed at the same time each night.
• Wake up and shower each morning at approximately the same time.
• Weigh yourself daily.
• Take your temperature (if you feel warm or if you have chills).
• Get dressed in regular daytime clothes. This will make you feel more like being active.
• Eat breakfast.
• Take your medication.
• Plan your day during breakfast to help you from getting too tired.
• Follow the walking plan provided by your physical therapist.
• Avoid prolonged naps in the daytime—they may prevent you from sleeping at night.

Q: How should I shower and take care of my incision(s)?
A: You may shower if your surgeon has approved this prior to discharge. Your incisions may itch or feel sore, tight or numb for a few weeks. Some bruising around the incisions is also normal.

• Use warm (not hot) water.
• You may wash your incisions gently with soap and water, but do not scrub them.
• Pat your incisions dry.
• Do not take baths or use powders or lotions near the incisions.

You may have white pieces of tape on your chest. These are called "steri strips". They will gradually fall off. If they have not fallen off in two weeks, gently peel them off.

If you find it more comfortable, a thin layer of gauze may be placed over the incision (s). Women may wish to place cotton or soft material between the bra and incision.

Q: Should I weigh myself?
A: Weigh yourself daily. Rapid weight gain can be a sign that your heart is not pumping efficiently. If you gain more than 2–3 pounds in one day or more than 3–5 pounds in one week, call your cardiologist.

Q: Should I take my temperature?
A: If you feel warm or chilled, take your temperature 3 times a day (morning, afternoon and evening).Call your cardiologist if your temperature exceeds 100.4 degrees.

Q: What is the best meal plan to follow?
A: You may notice that after surgery you have lost your appetite for food or just feel too tired to eat. This is very common, but you need nourishment to enable your body to heal and get stronger.

• Eat a balanced diet and drink adequate fluids to encourage a return to your normal bowel pattern. Do not take laxatives unless specifically instructed by your doctor.
• If your physician recommends a diet based on your individual needs, you should have received written information to help you follow the plan at home.
• Eat a variety of foods. You may want to eat many small meals throughout the day instead of three larger meals.
• Avoid too much saturated fat and cholesterol.
• Eat foods with adequate starch and fiber.
• Avoid too much sodium/salt.
• Avoid too much sugar.
• Maintain ideal weight (consult your physician).

Q: What are the rules about medications?
A: Take all medications prescribed by your doctor as directed. Do not change the dosage of your medication without your doctor's approval.

Q: How is pain relief managed?
A:  If your doctor did not prescribe a pain medication prior to discharge, Extra Strength Tylenol™ is an effective painkiller for pain around your incisions or your chest. If Tylenol™ does not control the pain or the pain becomes more severe or happens more often, call your surgeon or your cardiologist.

Q: What if I have swelling?
A:  Your legs may swell a little, especially if you had veins removed from your legs during surgery. This occurs because excess fluid collects in the tissue when you are not moving around as much. To control the swelling:

• Get up once an hour and walk around for a few minutes.
• When sitting or sleeping, keep your leg(s) elevated. To help with circulation, avoid crossing your legs.

Q: Exercise Program.
A: The following exercises are to be done in conjunction with the walking program.

	Leg Strengthening-Sitting Purpose: To strengthen your thigh muscles. Position: Sit on a firm chair with both feet flat on the floor. Action: Lift your foot slowly until leg is completely straight. Hold. Slowly lower your foot down. Repeat.
	Foot Taps-Sitting Purpose: To increase motion in your ankles, to improve circulation, and to improve the strength of your ankle muscles. Position: Sit in a chair and place both feet flat on the floor. (This can also be done lying in bed). Action: Leaving your feet on the floor, tap your foot up and down. Each time, raise your foot as high as possible. Repeat.
	Knee Raises-Sitting Purpose: To Strengthen your hip muscles. Position: Sit in a chair with both feet flat on the floor. Action: Raise one knee up towards your chest as high as possible. Slowly lower it. Repeat.
	Shoulder Exercise Purpose: To increase the motion in your shoulder and/or to strengthen your shoulder muscles. Position: Stand with your arms at your side Action: Raise your arm straight up above your head. Lower it back down and raise other arm up. Relax. Repeat.

Q: What is the usual walking program?
A: Studies have shown that people who exercise at least 30 minutes per day, 5 days a week remain healthier and experience fewer problems. They may also live longer. Most patients should be capable of walking at least 1-1.5 miles per day at one month after surgery.

As you recover from heart surgery, walking represents the best form of exercise for you. You should consult with your doctor before taking up more vigorous forms of activity such as swimming or biking.

When you begin a walking routine, or using a treadmill, pick a time that is convenient and stick to it. Walk on level ground, in a rhythmic and even pace, letting your arms swing at your sides. Wear comfortable walking shoes and dress appropriately for the weather.

Avoid exercise for up to 1-1/2 hours after eating, and don't walk outdoors when the temperature or weather makes you uncomfortable. When the weather is severe, walk indoors at a shopping mall or at a health club with an indoor track or treadmill.

If you begin to feel very tired, short of breath or dizzy, rest immediately and reduce the distance you walk the next day. If you experience chest pain, nausea or vomiting, headache or pain in your jaws, teeth, arms or ears, or any of the symptoms you experienced before your surgery, contact your doctor immediately and do not resume walking unless your physician approves.

Q: What other activities should I do or avoid?
A: As you feel stronger, you can go out and do more. At first, keep activities to about an hour.

Q: Is sexual activity OK?
A:  Thousands of heart patients have learned that having heart disease, a heart attack, a stroke, or undergoing surgery does not mean an end to a satisfying sex life. After the first phase of recovery is complete, patients find that the same forms of lovemaking that were pleasing before are still rewarding.

Many myths surround sex after heart disease. The most common one is that resuming sex often brings on a heart attack, stroke or sudden death. This simply isn't true. There's no reason why a heart patient can't resume usual sexual activity as soon as they feel ready to do so. Talk with your doctor if you have any concerns.

Fear about performance and general depression are two psychological factors that can greatly reduce sexual interest and capacity. After recovery, heart patients may feel depressed. This depression is normal, and in 85 percent of the cases it disappears within three months. However, it tends to exaggerate whatever previous sexual problems were present between partners.

• Feel free to resume sexual activity once you've checked with your doctor.
• Until your sternum has healed to its full strength (approximately 6 weeks), it is suggested that the patient is located in the bottom position or a side-by-side position is utilized.
• Choose a time when you are rested, relaxed and free from the stressful feelings brought on by the day's schedules and responsibilities.
• Wait one to three hours after eating a full meal so that digestion can take place.
• Select a familiar, peaceful setting that is free from interruptions.

Q: When do I call my doctor?
A: If you experience any of the following symptoms, it is essential for you to let your doctor know:

Q: What should my caregivers know?
A:  Open heart surgery affects not only the patient but family and friends, too. Caregivers can be the most important person in the patient's recovery. That is why you are an important part of the healing process. Patients, family members and friends have helped us to develop this section so that you are aware that you are not alone.

• Take care of yourself because you need your physical and mental strength in order to support the recovery of the patient.
• Recognize that in addition to your loved one, you may also feel angry or depressed. Try to talk openly about your feelings. You may want to talk with a friend or other family member first.
• It is beneficial to designate one family member or friend to maintain communication with your surgeon and the healthcare team. This will enhance the flow of information and decrease the chance for miscommunication.
• Respect the privacy of other patients and families by observing the visiting hours and rules of the floor.
• If you are sick, please limit your visits to the floor. Open heart surgery and transplant patients are more susceptible to infection during their recovery.
• Encourage loved ones to exercise. If you can, exercise with your loved one to give support and stay healthy too!
• Join the Heart of Hearts Support Group that meets once a month at Columbia University Medical Center or join one in your area. Call 212.305.9470 for more information.

Q: How should I take care of my heart?
A: Now that you've got your heart back in optimal working order, you owe it to yourself and your family to keep it that way.

The continuing threats to coronary health, even after successful bypass surgery, are numerous: smoking, high cholesterol levels, high blood pressure, inactivity, diabetes, obesity, and a family history of heart disease.

The good news is that many of these risk factors are largely within our power to change. One of the best things you can do for your heart is to steer a course in your lifestyle that reduces these risks as much as possible.

Cigarette smoking deprives the heart of needed oxygen and contributes to the build up of fatty deposits in the coronary arteries. If you smoke, do yourself a favor and kick the habit. If you can't do it alone, join a smoking cessation group, or get help from friends, family or your primary physician.

High blood pressure is another risk factor that can be controlled by careful adherence to proper diet, exercise and medication. During the recovery period after heart surgery, individuals who are troubled by chronic stress can benefit from relaxation therapy and the avoidance of conflict.

Q: Some tips to remember.
A: During your first few weeks at home, keep these tips in mind:

• Take your medications as directed
• Call your cardiologist if you have any of the warning signs.
• Move carefully to protect your incision and your breastbone.
• Pace yourself so you don't feel rushed or overtired.
• Exercise at least 5 days a week. Increase your time and pace slowly to reach a minimum of 30 minutes a day.
• Talk with your family and close friends about how you feel and what you need from them.