Some diagnostic tests may be repeated. This depends on how recently the tests were done and the specifics of the test. These may include an echocardiogram, a pulmonary angiogram, a MRI (magnetic resonance image) and a CT (computed tomography) scan. You may need a coronary angiogram. Usually, Dr. Rubens asks that this be done before you come to Ottawa. It is better to have this done well in advance of surgery because some intravenous dye is used.
Assessments will be completed by your surgeon, the anesthesiologist, the nurse, and the physiotherapist. You may also be seen by other specialists as requested by the team.
You will have a six-minute walk test before surgery. Also, a new medication to relax the blood vessels in the lungs may be added to your treatment plan if you are not currently on this type of medication.
Once the tests are completed, you may be discharged to the Intern’s Residence (or other local accommodation) or given day passes until the surgery date.
Anxiety before surgery is a normal part of the process. We will do our best to help you prepare for this operation and keep you informed every step of the way.
The Day Before Surgery
On the day before your surgery, some blood tests may be repeated. In the evening, you will take a shower with special antibacterial soap.
Eating or drinking are not permitted after midnight. You will rinse your mouth several times using an antibacterial mouthwash.
The Day of Surgery
The surgical area will be prepared with clippers to remove hair. This will be followed by another shower with the antibacterial soap. You will receive medicine ordered by the anesthesia doctor to help you relax.
Sometime between 7:00 a.m. and 7:10 a.m., you will go to the operating room. Your family is welcome to come and stay with you any time after 6:30 a.m. until you go to the operating room. The operation will take between six and ten hours and possibly longer. This depends on many factors such as body weight, the extent of disease and other surgical procedures that need to be done at the same time, for example, bypass or valve surgery.
While you are in surgery, your family is welcome to stay in the family lounge on the main floor of the Heart Institute. It is a very long day for families and many choose to go back to the Intern’s Residence (or other local accommodation) and return in the afternoon.
The nursing coordinator will contact your family in the early afternoon (around 1:30 p.m.) to give them a progress report and let them know when to come back to the family lounge.
Dr. Rubens will meet your family in the lounge (main floor, behind the volunteer desk) or telephone them (your preference) when the operation is finished.
The volunteers who are at the front desk will arrange a visit for your family in the Cardiac Surgery Intensive Care Unit (CSICU) one to two hours after you arrive from the operating room.
The nurse who is caring for you will call your family between 9:00 and 10:30 p.m. on the night of your surgery to give a condition report and again the following morning between 9:00 and 10:30 a.m.
If you have any questions or concerns, the Nursing Coordinator is available 24 hours a day: 613-696-7000, press 0 and ask for the Nursing Coordinator.
In the Cardiac Surgery Intensive Care Unit
You will be transferred from the operating room directly to the Cardiac Surgery Intensive Care Unit (CSICU). The average time in CSICU is three to ten days but some patients stay longer because of medical problems.
You will have a nurse with you constantly until you are awake, breathing on your own and able to sit up. When you first arrive in the CSICU, you will be asleep and breathing with the help of a ventilator or breathing machine. You are connected to this machine by a breathing tube which was put in by the anesthesiologist after you were asleep in the operating room.
The most important thing to remember is you cannot speak while the tube is in place. You can still communicate with your nurses by answering yes and no to questions or writing notes. The breathing tube stays in place until the oxygen levels in your blood are satisfactory. When your condition is stable, the breathing tube will be removed and your activity will be increased gradually.
You will also be connected to specialized equipment to monitor your heart rate, blood pressure, and oxygen levels. You will have intravenous tubes in place.
Also, you will have a small tube (called a catheter) placed in your bladder to take care of urine.
Your nurse and physiotherapist will help you with your activity and teach you how to support your breastbone incision.
You will receive several types of pain medicine regularly when you arrive in the CSICU. Once you are able to take fluids, the pain medicine will be changed to oral tablets. Work with your nurse to stay comfortable.
Most patients report feeling a generalized muscle weakness after the surgery. The longer the patient stays in CSICU and is not able to move about, the higher the incidence of this problem. It will take some time for you to build your strength up again.
Some patients report feeling disoriented after surgery. This is likely due to the nature of the surgery, the medicines used, and the stay in the CSICU. In most instances, as you get stronger and able to do more, this passes.
Some patients find their emotions are changeable for a few days or they occasionally see spots or lights or images. This is related to the nature of the surgery and generally goes away quickly.
Your family may visit with you at any time during the day by contacting the volunteers at the front desk. The volunteers will call the CSICU to make arrangements. Visitors should contact the volunteers each time they wish to visit.
Transfer to the Nursing Wards (H3/H4)
Take your medicine for pain regularly, especially at first, to stay comfortable. The work of recovery is walking, resting, eating and sleeping, and this work is difficult if you are not comfortable. Let your nurse know if you are having problems with pain.
You will start on a walking program with assistance from the physiotherapists and nurses. Each day, you will walk a little farther. Your oxygen levels and heart rate will be monitored very carefully. When you are able to walk at least 120 meters several times a day and maintain good oxygen levels, you can expect to go home in a few days. You can expect to climb stairs before discharge if you need to do this at home.
You may be taking Coumadin® after surgery again and blood studies will be done regularly to measure your INR (international normalized ratio). The INR indicates how long it takes for your blood to clot. Your dosage of Coumadin® will be adjusted until your INR is within a target range. This may take a few days or more to regulate. Some patients will be on blood thinners given as regular injections if Coumadin® is not indicated.
Additional diagnostic tests such as an echocardiogram, blood tests, and X-rays will be done during your stay on H3/H4.
You will receive oxygen continuously while in the Heart Institute and at home for about six weeks, possibly more, after surgery. We will assist you in organizing the oxygen for your transfer home after surgery.
Once you are transferred from intensive care, you can start to plan for your return home. Discuss this with the nursing coordinator or the social worker before arranging your travel home.
Preparing for Discharge
Before you leave the Heart Institute, you will attend a physiotherapy class to learn how to do your exercise and walking program.
The nursing coordinator will arrange a meeting for you and your family to help you understand all the things you need to know to care for yourself at home.
Expect to stay in Ottawa for a few days after discharge.
Before you leave Ottawa, a clinic visit will be arranged with Dr. Rubens for a check-up, especially if you live far away.