After Heart Surgery

Overview

Immediately following surgery, you will be transferred directly to the intensive care unit (ICU), with a breathing tube still in place. Your anesthesia will not have worn off, so you likely will wake up in the ICU after surgery. While in the ICU, a nurse will constantly monitor your vital signs, chest tube drainage, breathing status, test results, and pain level. The anesthesia medications will be stopped slowly so that you wake up gradually.

In the Hospital

In the Hospital

When you are awake and able to breathe on your own, you will have the breathing tube removed. This is called being extubated. After the tube is removed, you will be monitored closely to make sure your breathing is normal. Usually this happens a few hours after surgery, but can be delayed for many reasons.

Once you are extubated, you will be encouraged to participate in breathing exercises. You also will be expected to communicate your pain level with your nurse so that your medication can be adjusted if necessary. It is very important to breathe deeply and cough (against a pillow) frequently after surgery because your lungs were not working during the procedure. Taking deep breaths can help prevent complications like pneumonia or fluid build-up around your lungs. Once you are ready, your nurse will help you out of bed to a chair and eventually start walking. Early activity is important to help reduce surgical complications, such as pneumonia, blood clots, and muscle weakness.

Once your surgery team feels that you are ready, you will be transferred from the ICU to another unit in the hospital. 

Over the next several days, you will be working on recovering in the hospital. This may include daily labs and chest x-rays, walking in the hallways, removing your drainage tubes, and monitoring your vital signs, glucose, and breathing status. 

Your catheter will be removed so that you can urinate on your own, but you may be  constipated (unable to poop) after surgery. This is due to a number of factors, including medication and not eating much. Do not be surprised if it takes 3-4 days after surgery to have a bowel movement.

 

Going Home

Going Home

Your surgeon and his/her team will determine when you are able to go home. This generally this occurs when:

  • Your pain is controlled with pain pills and you do not require IV medications to control your pain
  • You are able to walk to the bathroom with assistance
  • You are breathing well and able to be weaned off supplemental oxygen
  • You are stable on your current medication regimen
  • Your lab results are stable and chest x-ray is satisfactory
  • Your chest tubes and temporary pacing wires have been removed
  • Your vital signs are within a normal range

This list is not exhaustive and there are many exceptions to each of these items depending on your individual condition. 

Leaving the Hospital

Leaving the Hospital

If you do go home there are a few basic rules to follow after heart surgery:

  1. Do not drive for 1 month – Driving puts too much pressure on your sternum while it is trying to heal. It also is dangerous to be too close to the steering wheel.
  2. Do not lift, push, or pull more than 10 pounds for 6 weeks – This also puts too much pressure on your sternum.
  3. It is okay to shower – Gently use soap and water over your incisions and gently pat them dry. It is okay if shampoo or conditioner gets on the wound, just rinse it off.  
  4. Do not soak in a bath, pool, or hot tub until your wounds are healed completely  – Soaking the tissue as its healing could introduce bacteria from the water into your incision.
  5. Monitor your incision – If you notice any redness, drainage, swelling, or separation of your wound, notify your surgeon right away. Also notify your surgeon if you have a temperature greater than 101 degrees Fahrenheit or notice excessive chills or night sweats.

Once you are home, try to get back to your normal routine as much as possible while keeping the above restrictions in mind. 

Walk at least a few times a day for as long as you can. There is no upper limit on walking, but do not overdo it and wear yourself out. 

It is a good idea to have someone with you when you are walking outdoors in case you have any difficulty. Stairs should not be a problem, just take them slowly and take breaks on your way up if needed. Be cautious about pulling too hard on the railing so you don’t put extra stress on your sternum.

You likely will be scheduled to see your surgeon within a couple weeks after surgery. This usually is a quick appointment when your surgeon will remove the stitches from your chest tubes, examine your incision, and address any concerns you have regarding your recovery. You also should see your heart specialist within a few weeks of discharge, as well as your primary care physician for any additional follow-up . It is important to continue regular appointments with these physicians to make sure your recovery stays on track.   

Recovery time after open heart surgery is about 6-8 weeks. During this time you likely will feel tired easily, and you may have some pain and soreness or muscle tightness. Your appetite also likely will be limited, and you may experience swelling in your legs or feet, trouble sleeping, and constipation. 

All of these are normal. It also is common to feel depressed after surgery. This generally improves as you heal, but if these feelings last longer than a month or two, speak with your primary care physician. You may resume sexual activity when you feel comfortable, but make sure that you are not putting pressure on your sternum.

Feel free to address any of these concerns with your surgeon. Urgent problems that need immediate attention include:

  • Chest pain (similar to heart-attack pain) that is different from pain at your incision
  • Shortness of breath that is not relieved by rest
  • Blood in your bowel movements
  • Coughing up bright red blood
  • Heart rate faster than 150 beats per minute with shortness of breath or a new irregular heart rate
  • New onset of abdominal pain, nausea, vomiting, or excessive diarrhea
  • Sudden numbness or weakness in arms or legs
  • One sided facial droop or slurring of words
  • Sudden, severe headache

Should any of these issues occur, please seek help immediately.

 

Going Back to Work and Diet

Going Back to Work and Diet

You can go back to work earlier if you feel able, but keep in mind you cannot drive for 1 month, so you may need to find another way to get to and from work. It also is important to be off all narcotic pain medications prior to going back to work or driving. If your employer allows it, try going back part time or with light duty as a transition back to full-time work. Also ensure that you are also not lifting anything heavy for 6 weeks after surgery.

A high protein diet may be recommended for you following surgery because proteins can help your body heal faster; however, any previous diet restrictions that you had before surgery, such as a low-salt diet, low-cholesterol diet, diabetic or renal diet, likely will still be required after surgery. These guidelines have not changed!  

Contact your heart specialist for specific heart healthy diets. If you are overweight, weight loss is important, but immediately after surgery you want to make sure you are getting enough calories, protein, and water to allow your body to heal. Also, be sure you do not combine alcohol with narcotic pain medications.

Everyone responds differently to surgery, medications, and recovery.

If you have any questions at any point in your heart surgery course, always reach out to your heart specialist or surgery team to address your concerns. The better educated you are about what to expect and how your body heals, the better you can expect to recover from surgery. Always defer to your cardiothoracic surgeon’s guidelines for you, though, because they are tailored to your specific requirements. Be sure to ask questions and clarify any information that is unclear so that you can be better prepared for your surgery and recovery.   

For more information, you can print this brochure, “What to Expect After Heart Surgery”.

 

Reviewed by Robbin G. Cohen, MD 
October 2015