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Heart Valve Surgery

After Surgery
When you wake up, you will be in the Cardiovascular Intensive Care Unit (CVICU). The nursing staff will be at your bedside to care for you.

Recovery in the CVICU

• The nurse will assist you to turn from side to side every two to three hours. This promotes comfort and prevents lung problems.
• Because you are not yet fully awake you will breathe through a tube in your throat with the assistance of a breathing machine. While the tube is in place you will not be able to speak. As soon as you are fully awake the machine and tube will be removed.
• You will have tubes and wires attached to your body:
• Chest tubes collect blood and fluid.
• A catheter (tube) in your bladder drains urine.
• A monitor records your heart rate.
• Wires placed during surgery will be connected to a temporary pacemaker to assist with fast or slow heart rates as needed.
• IV (into the vein) lines are used during and after your surgery to give you fluid, medicines and blood if needed.
• One by one, all of these tubes and wires will be removed when you no longer need them.
• Once your breathing tube is removed, the nurse will have you begin coughing and do deep breathing exercises to prevent mucous and fluid build-up in your lungs and avoid complications such as pneumonia.
• Your nurse will show you how to splint your incision with a pillow when coughing.
• You will learn how to use a hand-held device (incentive spirometer) to promote deep breathing. It is important to cough and use your incentive spirometer 10 times every hour while awake.
• Pain relief can help you be more active and speed your recovery. Let your nurses and doctors know how your pain medicine is working. Rate your pain on a scale of zero to 10, zero meaning no pain and 10 meaning the worst pain you could imagine.
• All heart surgery patients will have a pain control pump. The pump is connected to a very thin catheter inside the chest wound along the length of the incision. The pump delivers an ongoing flow of pain medicine directly into your incision site. A clear dressing and tape holds the catheter in place while a belt with a small pouch supports the pump and the tubing.

Diet
Your first meal on the day after your surgery will be clear liquids. Then you will progress to solid foods. A dietitian may visit you to explain any specific diet guidelines.

Activity

• The day after surgery, your activity will be increased. You will first dangle your legs at the side of your bed and sit in a chair. Then your nurse will assist you with a short walk in your room. You will slowly progress to walks in the hall. You will feel weak and wobbly at first. Always ask your nurse for help with walking to the bathroom or in the hallways.
• You will be in the ICU for one to two days. Sometimes your condition may require a longer stay.
• Slowly increase your activity each day. Walk in the halls three to four times each day and sit in the chair for meals. Use your incentive spirometer to cough and deep breathe 10 times every hour while awake.

Transfer to Stepdown
As you continue to improve, you will be transferred to the Cardiac Stepdown Unit. Your heart will continue to be monitored. You will play a more active role in your recovery.

Wound Care and Bathing
With help, you will bathe at the bedside or at the bathroom sink. Once your tubes and drains have been removed you may take a shower with help. Your chest incision may appear bruised and be discolored from the antiseptic used to wash your skin before surgery.

Discharge
Discharge time is 11 a.m. Let us know if you need special assistance in planning your discharge from the hospital or help at home after discharge.

Home Care
Patients who have had minimally invasive surgery are back to normal routines in about two to four weeks. Full recovery is about six to eight weeks. Patients who have had a full sternotomy have a longer recovery time. Many patient activities are limited for a full eight weeks.

During the first weeks after surgery, it is common to tire easily. You will need someone to help you with daily chores and meals. Plan your activities and allow for rest periods. Feeling blue, forgetfulness and problems sleeping are common and will pass over time. Remember to take things slowly and talk about your feelings to friends and loved ones.

Recovery

The following guidelines will help you through your recovery:

General

• Weigh yourself daily at the same time, with the same scale and wearing the same amount of clothing.
• Report weight gain of more than three pounds within one week to your surgeon.

Diet

• Eat small meals with healthy snacks between meals.
• Foods high in protein will promote healing.
• Include fruits and vegetables to help avoid constipation.
• Follow guidelines provided by the dietitian or your doctor.

Activity

• Keep active.
• Walk every one to two hours.
• Slowly increase the distance you walk each day.
• No strenuous exercise until approved by your doctor.
• Do not lift more than 10 pounds for the first eight weeks after surgery. Forceful movement or pressure can affect the healing of your chest incision and breastbone.

Sexuality
If you feel good and well rested, you may resume sex. Avoid positions that put pressure on your upper arms or chest area for six to eight weeks until your breastbone heals.

Driving

• Motion from turning the steering wheel can affect the healing breastbone. Do not drive until you talk with your doctor.
• Minimally invasive surgery patients often resume driving four weeks after surgery.
• Sternotomy patients often resume driving six to eight weeks after surgery.
• Do not drive until you are fully pain-free and taking no pain medication.

Work

• Do not return to work until you have your surgeon's approval.

Bathing & Wound Care

• Have someone nearby to assist you when showering.
• Avoid long showers and using very hot water.
• Keep your incision clean and dry.
• Use a mild soap to gently wash the site.
• Carefully pat dry; do not rub.
• Do not use powders, colognes or lotions near your incision to prevent infection.
• Inspect the site daily. Your chest incision will look bruised and may be numb, itchy or sore.
• Report any signs of infection to your doctor, such as increased redness, swelling or pain at the site or thick drainage or pus coming from the incision.

Medication

• Follow your doctor's medication guidelines.
• If you are taking an anticoagulant, refer to the Warfarin information.
• If you become constipated, a stool softener may be taken.
• Incision pain and tenderness will lessen over the next two weeks. Pain and discomfort can be relieved with your prescribed pain medicine or Tylenol. Take pain medicine as directed. If your pain medicine has acetaminophen or Tylenol® in it, do not take more than eight tablets or 4,000mg of acetaminophen or Tylenol® in a 24-hour period.
• To prevent nausea, take pain medicine with food.
• Contact your doctor if the medicine does not control the pain.

When to call the doctor
Call your doctor if you have any of the following:

• Chest pain not related to your incision site
• Temperature of 101.5 degrees or above
• Shortness of breath
• Increased redness, pain or drainage from your wound sites
• Weight gain of more than three pounds in one day
• Heart seems to be beating very slow, fast or is skipping

If you are taking anticoagulants (Warfarin, Coumadin, Lovenox), call your doctor if you have any of the following:

• Bloody or dark tarry stools
• Dark or bloody urine
• Unexplained bruising or bleeding
• Frequent or severe headaches

Follow-up Appointment
Before leaving the hospital, call the Cardiac Surgery Clinic hotline (312) 695-4965 to schedule a chest X-ray and an appointment with Cardiac Surgery Outpatient Clinic one to two weeks after discharge. The outpatient clinic is located at Galter Pavilion, 675 N. Saint Clair St., Suite 19-100.

In addition, you must schedule an appointment with either your referring physician or cardiologist within two to three weeks after going home.

Special Instructions

• Keep all appointments for blood work, tests and doctor exams.
• If you are taking an anticoagulant you will need routine blood tests (INR, prothrombin time) to make sure the dose is right for you.
• After valve surgery, you will need to take antibiotics before medical or dental procedures. This helps prevent the risk of infection to your heart valve. Always inform your other health care providers before undergoing any minor medical or dental procedures that you have had heart valve surgery.
• Exercise guided by a cardiac rehabilitation program or your doctor could help in your recovery and promote you to adopt a more healthy lifestyle.
• Once you recover from surgery, talk with your doctor about the need for a diet low in salt, cholesterol, and fats.

 

Review Date: 1/05