Before Heart Surgery

Overview

After being diagnosed with a heart disease, such as coronary artery disease (heart disease), aortic valve disease, mitral valve disease, or tricuspid valve disease, you likely will have a meeting with a cardiothoracic surgeon to discuss your treatment options.

He/she will describe the operative procedure, including the risks and benefits and other potential options. It is also likely that someone from his/her office, such as a physician assistant or nurse practitioner will describe the postoperative course in more detail.

The more you know about your operation and what to expect in the first few days after, the smoother your recovery will be. Don't hesitate to ask questions, so that you are comfortable with your decisions going into the operation.

Pre-operative Testing

Pre-operative Testing

Before your operation, you may require tests to help your surgeon make decisions about your risks, anesthesia choices, and managing your recovery.

These tests may include: 

  • Carotid ultrasound - An ultrasound of the arteries in your neck to ensure you do not have blockages in these vessels. This test is usually for people with a history of strokes. 
  • Chest x-ray - This test serves as a “pre-op baseline” to show the size and shape of your heart and lungs.
  • EKG (Electrocardiogram) - This test serves as a pre-op baseline for your heart rhythm.
  • Blood work - Must be completed within a few days of surgery to ensure that the results are the most up to date. Your blood will help show if your liver and kidneys are working properly and also help match you with a blood donor in the event that you require a blood transfusion.
  • Dental clearance - Oral bacteria is the most common cause of prosthetic valve infections, so if you are having a valve replacement, you should see your dentist to ensure that you are not at risk for dental infection.  

For more information on these tests, visit our common diagnostic tests page

Planning for Surgery

Planning for Surgery

Before surgery, it is essential that you notify your cardiothoracic surgeon of all medications or herbal supplements you take and their dosages, especially if you are taking blood thinners (anticoagulants).

These medications and supplements include, but are not limited to: 

  • Anticoagulants
    • Warfarin (Coumadin)
    • Dabigatran (Pradaxa)
    • Clopidogrel (Plavix)
    • Enoxaparin sodium (Lovenox)
    • Apixaban (Eliquis)
    • Rivaroxaban (Xarelto)
  • Platelet inhibitors
    • Prasugrel (Effient)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Aspirin (Excedrin)
    • Celecoxib (Celebrex)
    • Ibuprofen (Motrin)
    • Naproxen (Aleve)
  • Fish oil
  • Green tea

It can be dangerous to undergo surgery without stopping these medications far enough before your surgery date (generally 5-7 days). Because these medications have various effects on bleeding and take different times to wear off, your surgeon’s office will give you specific instructions about when to stop them. If you know that you are on a blood thinner and this discussion has not taken place, be sure to call your surgeon’s office to get specific instructions.  This will keep your operation from being postponed at the last minute because these medications haven’t been stopped in time.

Planning Ahead for Your Return Home
Even before going in for your surgery, it is important for you to think about what you will need when you get home. It is best not to have to make these kinds of arrangements while you are in the hospital. Your surgeon will give you an estimated day on which you will be discharged. Use that estimated date to make sure that you have a ride home, as well as everything that you need for the first few days. Once you are medically ready to leave the hospital, you do not want your discharge delayed by inadequate preparation.

If you live alone, consider making and freezing meals for yourself ahead of time. Consider asking a friend or relative to stay with you for a few days after your surgery to help you get around the house.

If you have pets, consider boarding them or asking someone else to care for them while you’re away. You also might want to consider having them boarded for a few days after you arrive home so you can focus on your own care.

If you live with family, make sure that they can be around when you are discharged and understand any help that you may need as you recover.

Consider moving into a bedroom on the ground floor, if you have one, and move furniture, if necessary, to make moving around easier. 

Medical Directives

Medical Directives

Preparing for surgery can be scary, but any time you are undergoing general anesthesia it is important for your family to understand your wishes. Be sure to appoint someone in your family to make decisions about your care in the event that you are unable. Discuss your medical history with whomever you appoint so that he or she is aware of any allergies or prior conditions that may affect your surgery.

It also is good to discuss what could happen if you have a complication during or after surgery so that your wishes are known.  

Sometimes patients require additional care after surgery. This can range from a skilled nursing facility to at-home physical therapy. If you anticipate needing additional care, be sure to let your surgeon know as soon as possible so that any medical equipment or consultants can be ordered. 

Also, keep in mind that your insurance may not cover everything, so you should plan ahead for additional expenses.

Often, home nurses are not covered unless you have a specific medical need (IV antibiotics or wound care, for example). This is not typical after heart surgery. If you would like to hire a home nurse, you should contact agencies before surgery.

If you qualify for a nursing facility, a discharge planner will be contacted after surgery to help make this placement. Encourage family members to look at facilities early so your discharge is not delayed.

Many hospitals and extended care facilities also offer cardiac rehab.

Cardiac rehabilitation programs offered through your hospital or one nearby benefit patients who are already at home as a way to ease back into exercise and a healthier lifestyle. You will require a prescription for admittance (usually from your cardiologist) and should wait at least 4-6 weeks after surgery to start the program.

 

The Day Before Surgery

The Day Before Surgery

You may have been given a skin prep (usually with a name like Hibiclens scrub) to shower with the night before surgery. You also may want to pack a bag with some essentials (toiletries, books, slippers, etc.) to take with you to the hospital. This is not necessary, but may make your stay more comfortable. Do not bring anything valuable.

You will be given specific instructions from your surgical team, but you likely will be instructed not to eat or drink anything after midnight. This includes chewing gum or sucking on candies. If your anesthesiologist finds out that you have violated this rule, your surgery may be postponed for your safety.

The morning of your surgery, do not take any of your medications (unless otherwise directed by your surgeon), chew gum, or drink liquid.

 

Reviewed by Robbin G. Cohen, MD, MMM
May 2017