Heart Surgery (Cardiac Surgery) | Froedtert & the Medical College of Wisconsin (2024)

This video will explain what will occur during your visit to our Cardiothoracic Surgery Clinic. At your consultation appointment, you will meet your care team, including:

• Cardiac surgeon
• Advanced practitioner provider
• Medical assistant
• Nurse

Our medical assistant will take your height, weight, blood pressure and heart rate.

Staff will review your allergies and medications. Please be sure to know the names, doses and how you take your medicines, so we can ensure we have an accurate list for your safety.

You will then be seen by the nurse practitioner who will review your health history, which includes your family history, medical history, substance and surgical histories. They will also review any current symptoms you are having that is related to your visit.

Next, you will see the surgeon and the nurse practitioner to discuss your plan of care, which surgery, the associated risks and answering all your questions. All heart surgery patients will receive the following pieces of information.

• Cardiac surgery booklet
• Skin prep solution
• Directions on how to properly clean your skin prior to surgery
• Coumadin® education booklet (if you need to be on blood thinners after surgery)
• After-visit summary

We provide pre-operative teaching for all of our surgical patients. If your surgery is scheduled within 30 days of your office visit, we can complete this the same day or, if you prefer, you can come back at a later date. The nurse will review this with you in great detail and answer all your questions. We will talk about preoperative testing. This required testing includes:

• Blood work
• Urine sample
• Chest X-ray
• EKG
• Nasal swab

Some procedures require dental clearance. If you need this, we will give you a form to take to your dentist.

To decrease your risk of infection, we will review how to properly clean your skin both prior to surgery and after surgery.

You will receive a call the day prior to surgery with your confirmed surgical time and requested time of arrival. Please keep in mind if your surgery is on a Monday you will be called on Friday. We will also provide you with written information on when to arrive and where to park, options for those waiting for you during surgery, where you will typically go after surgery and how to take medications prior to surgery.

After surgery, you will be brought by the anesthesia and surgical team to the Cardiovascular Intensive Care Unit or the CVICU. The CVICU team members will begin taking care of you the moment you arrive. This group consists of a provider from the critical care team.

• Your cardiac surgeon
• Your nurse
• A respiratory therapist
• A critical care tech

You will be your nurse's only patient for the next few hours. Nurses in the CVICU have received specialized training in taking care of patients after open-heart surgery. Your nurse will monitor your vital signs and make adjustments to medications to help control your blood pressure and pain. You are in good hands.

After the team has settled you in and you are stabilized after surgery, your family will be able to come up from the Family Center to see you even though you will still be asleep.

After surgery, you will have several lines that we use to monitor your vital signs. You will have a breathing tube connected to a ventilator to help you breathe. It is our goal to have you weaned off the ventilator and breathing tube removed within six hours of your arrival to the ICU. This is called extubation. You may experience discomfort during the weaning of the breathing tube. We will do all we can to provide you comfort during this time.

In order to keep you safe while you wake up from sedation, your arms will be restrained. Try not to be alarmed when you notice this and remember it is just for your safety. Once you are fully awake and calm, the respiratory therapist can remove the breathing tube, and the restraints will also come off.

You'll also have something called a central line — an IV which can be used to give IV medications, as well as monitor the pressures in your heart and lungs with something called a pulmonary artery catheter. You may be on medicines to help raise or lower your blood pressure, as well as sedating medications which will be turned off as we wake you up after surgery.

After open-heart surgery, patients have chest tubes in place to help drain fluid from the surgical site. Most patients also have temporary pacing wires which can be used to manage your heart rate if needed.

It is important for us to keep track of how much urine you're making, so you will have a tube to your bladder called a Foley catheter to allow us to monitor urine output.

Activity is very important to your recovery after surgery. After your blood pressure and other vital signs are stable, your nurse will start helping you to get moving. You'll begin with sitting at the edge of the bed the night of surgery. Starting activity early on helps make it easier to cough, take deep breaths and use your incentive spirometer which you will use throughout the rest of your hospital stay. Your nurse will help you get up to the chair in the morning after surgery.

The first day after surgery, you'll also work with a physical or occupational therapist — another team member who will help you get one step closer to home. The therapist will also teach you how to increase activity and protect your incision following surgery. Physical activity and mobility are a vital component to your recovery. You should expect to be out of bed for every meal and walking in the halls at least four times a day starting the day after your surgery. Our staff are trained on how to help you ambulate with the drains and devices you may have after surgery.

Pain control after surgery is important, especially so you can participate in activity. After heart surgery, you should expect to have some pain. Our goal is to manage your pain. We might not be able to get rid rid of it completely, but we do want to get it to a tolerable level so we will work together to reach that goal.

Once your labs and blood pressure are stable without using IV medications, you will be able to transfer out of the ICU to the cardiac stepdown unit.

Following your cardiac surgery, you will use the rules of Keep Your Move in the Tube™ to help you return to everyday activities.

You'll be allowed to move your arms in any direction during self-care activities that are not putting weight through your arms. This includes things like bathing, dressing and toileting and even dancing.

During activities that do put weight through your arms, imagine a tube around your body. You should keep your arms within the tube for any lifting, pushing or pulling activities. This will avoid any stress on your incision so it heals well. The images in the video with a green tube around the chest demonstrate safe ways to perform loadbearing activities, while the images with the red tube around the chest demonstrate unsafe ways to perform the same activities. We will demonstrate how to safely complete several common activities while following Keep Your Move in the Tube rules.

• When standing up, it is safe to use your arms to push up from the chair, however, make sure you keep your elbows close to your body.
• Avoid pushing and pulling with an outstretched arm. For example, when opening a door, keep your elbows next to your body and in the "tube."
• When lifting and carrying objects keep the weight close to your body. When retrieving items from a shelf overhead, keep both arms close to the body and within the "tube."
• During bed mobility, bend up your knees, roll onto your side and push up through your arms from side-lying.

When following Keep Your Move in the Tube, you are allowed to resume normal loadbearing activities at your own pace as long as you stay within the "tube." In review, you will not have a specific weightlifting restriction, so let pain be your guide as you start to resume normal activities please reach out to your therapist or care team if you have questions about any activity following your cardiac surgery.

Eating well before and after heart surgery is a way that you can get yourself home faster, stronger and feeling better. We think about eating right in three parts.

• Getting enough energy and protein
• Controlling blood sugar
• Eating in a way that's healthy for your heart

Getting the right amount of energy and protein before and after surgery could help to make sure your incision heals better and you get your strength back faster. This can typically be accomplished by eating three meals per day and including a protein-rich food with each meal. Some examples of protein-rich foods include meats, fish, poultry, eggs, nuts, soy products, beans or dairy.

After heart surgery, you may find that you don't want to eat, but your body still needs fuel to heal. If you have a poor appetite, you might find it helpful to include one or two snacks per day to split up the food you eat over more opportunities rather than trying to eat a lot of food in one sitting. Nutritional supplements such as Ensure® or Boost® can also help to get more energy and protein if you're struggling to eat enough solid foods. These can be particularly helpful after surgery, and we will recommend that you drink at least one or two per day if you're struggling to eat much food.

If you have diabetes, keeping your blood sugar under control can help to reduce the chance of infection after surgery. Make sure to continue checking your blood sugars, taking your medications and limiting very high-carbohydrate meals, sweets soda and juice. If you want to use a nutritional supplement, there are several low-sugar options like Ensure® Max or Premier Protein^® that are available in stores and here in the hospital.

After you recover from surgery, it will be important to make sure you are doing what you can to prevent more problems with your heart.

• Eating plenty of fruits and vegetables
• Eating more poultry and fish than beef or pork
• Limiting sweets, pastries and sugary beverages
• Flavoring your food with herbs and spices rather than salt or seasoning salt.

A dietitian will be available in the hospital after your procedure if you'd like to talk more about eating to keep your heart healthy.

Following cardiac surgery, care of all incisions should be the same whether the incision is on your chest, your leg, your groin or on your side. It is very important to look at your incisions before leaving the hospital with your nurse. Then you can tell if there are any changes that should be reported to your doctor when you're at home. Whenever possible, also have your caregiver look at your incisions with you while you're in the hospital. The location of all your incisions may be difficult for you to see.

General care of all incisions should include the following.

Cleansing

Wash your incisions each day. At your follow-up appointment, we will instruct you on decreasing the frequency depending on how you are healing. Make sure to use a clean washcloth each time and liquid antibacterial hand soap. A good choice is orange liquid Dial^®. You are expected to shower daily. Most people find it easiest to do washings in the shower, however, there is a sink option if you prefer.

In the shower:

1. Use a clean washcloth every time you wash your incision.
2. Get the washcloth soapy with liquid antibacterial soap and water.
3. Squeeze the soap suds over your incisions. You can gently pat if you prefer, but do not rub or scrub your incisions.
4. You may then wash the rest of your body like you normally would.
5. Pat your incisions dry with a clean towel and do not submerge your incisions in any water until they are completely healed. Remember, scabs and flaking skin are healing skin.

At the sink, remember not to fill your sink bowl with water as that is filled with bacteria.

1. Use three clean washcloths every time.
2. While leaning over the sink, soap up the first washcloth with antibacterial hand soap as you do in the shower.
3. Follow the same procedure by either dabbing all the incisions or squeezing out the bubbles and letting them run down over the suture line.
4. Next, take the second washcloth and get that wet. This water can then be squeezed out of the cloth over the incisions to rinse them.
5. Lastly, take the third washcloth to pat all of the areas dry. All three washcloths now need to go through the laundry before using again.

Keeping your skin clean and dry will decrease your risk of infection.

Inspection

Watch for and contact our office if you see any of the following signs of infection — redness, swelling, warmth, increased drainage or an incision that is opening. You may be asked to send a picture through MyChart.

It is also important to check your temperature in the morning and evening for one to two weeks after surgery or if you are feeling chills or sweats. Call our office if you have a fever greater than 100.4 as this could be an early sign of infection. Some patients find it helpful to record their temperatures along with their daily weights following cardiac surgery.

Care

While you are healing, do not apply any lotions, powders, cream, ointments or Band-Aids anywhere near an incision site. We know that scabs can be itchy as they heal, but ask that you not pick any scabs or sleep with any animals in your bed until all your suture lines are 100% healed.

The timeframe for healing is different for everyone, but there are five things that you can do to help yourself heal as fast as possible.

1. Keep your incisions clean and dry.
2. Maintain good nutrition.
3. Stay hydrated.
4. Change clothing daily and as needed.
5. Keep your incisions open to air.

The weight of breast tissue can also pull on your suture line. We recommend wearing a bra or a tight-fitted shirt to help support the breast tissue as you heal. We recommend either a front-closing, sports bra or a tight-fitting shirt, T-shirt or camisole for support. Do not wear underwire bras during the healing process.

We ask that you contact our clinic if you see any changes in the appearance of your incisions, which include the development of any blisters or pimples on or near the incision. If you have a leg incision, please call our office if your leg becomes cool, pale, painful or discolored.