Prior to your first appointment at Phoenix Cardiac Surgery, your surgeon will have already discussed your case with your referring physician. When you meet your surgeon at your first appointment, you’ll have the opportunity to ask any questions and review any concerns you have.
At this appointment, you’ll work with our scheduling coordinator to schedule your surgery. We’ll also make sure we have all the necessary information to work with your insurance company to obtain any necessary pre-authorization.
If pre-operative testing is needed, that will also be scheduled at this time. More information about the tests your surgeon may order can be found here.
Remember: If you have questions, ASK! Our goal is to make sure you understand your treatment plan and what to expect before, during, and after your surgery.
While heart and lung surgery is a common occurrence for us, we know it can seem like a huge undertaking for you, both emotionally and physically.
This guide is intended to help prepare you for your surgery so you can relax as much as possible, confident that you’re in good hands. Here’s what you can do to maximize your potential for a successful operation and speedy recovery:
Your surgeon may order any or all of the following tests:
❏ Blood work (“Labs”) – We will need to obtain many different lab tests for your surgery. One will be a “type and screen” for blood that may be used during your surgery. This lab test MUST be done at the hospital where the surgery will be performed. In addition, it will need to be drawn within 3 days of your scheduled procedure.
You will be given a blue sheet at the time of the blood draw; please be sure to bring this sheet the day of your surgery. You may also be given a wristband (also known as a hospital bracelet or blood band). It is critical to keep this wristband on until after your surgery. If you remove the wristband, your blood work will need to be re-done before surgery.
This test usually is complete in under an hour. NOTE: You cannot eat or drink 6 hours prior to this test.
❏ Chest X-Ray – This x-ray will look at the chest, lungs, heart, large arteries, ribs and diaphragm. Two views are usually taken: one in which the x-rays pass through the chest from the back (posterior-anterior view), and one in which the x-rays pass through the chest from one side to the other (lateral view). You stand in front of the machine and must hold your breath when the x-ray is taken. There is no preparation for this test. This test usually is complete in under an hour.
❏ Electrocardiogram – “EKG” – measures the electrical activity of the heart. Electrodes (stickers) will be placed at specific locations on your body (chest, arms and legs). A graphic representation (tracing) will be generated which can indicate one or more heart-related conditions (conduction disorders, arrhythmias, valve disease, etc). There is no preparation for this test. This test usually is complete in under an hour.
❏ Pulmonary Function Test – “PFTs” – measures how well the lungs take in and release air and how well they move gases such as oxygen. For the test, you will breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. This will give the surgeon an idea of how well your lungs work and your risk for being on the ventilator long term. There is no preparation for this test. This test usually takes one hour.
❏ Carotid Doppler/Ultrasound Study – “Carotids” - The major goal of carotid ultrasound is to screen patients for blockage or narrowing of their carotid arteries, which if present may increase their risk of having a stroke. For this test, warm water-based gel will be applied on your neck and then a transducer (ultrasound probe) will be firmly pressed against your skin, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure. There is no preparation for this test. This test usually takes 30 minutes.
❏ Surface Echocardiogram - “echo” – This is a non-invasive test that looks at your heart valves, chambers and how well your heart is functioning. For this procedure, a warm water-based gel will be applied to your chest and then a transducer (ultrasound probe) will be firmly pressed against your skin, moving it back and forth over the heart until the desired images are captured. There is usually no discomfort from pressure. There is no preparation for this test. This test usually takes 30 minutes.
❏ Vein Mapping – This is a non-invasive test that looks at the veins in your legs. It will create a "map" of your leg veins for the surgeon in preparation of bypass graft surgery. For this procedure, a warm water-based gel will be applied to your legs and then a transducer (ultrasound probe) will be firmly pressed against your skin, moving it back and forth until the desired images are captured. There is usually no discomfort. There is no preparation for this test. This test usually takes 30 minutes.
❏ Trans-esophageal echocardiogram – “TEE” – This is an invasive test that looks at your heart valves, chambers and how well your heart is functioning. It also looks at the diameter/size of certain areas of the aorta. For this procedure, you will be given sedation and a small probe will be placed in your mouth and passed down your throat (in the esophagus) while a camera captures pictures of your heart. You cannot eat or drink 6 hours prior to this procedure. You will need someone to drive you home. You will have an IV placed prior to the procedure. This test will take approximately 1 hour to complete and 2-3 hours for recovery from sedation.
❏ ECG-gated SPECT myocardial perfusion imaging – “Stress Test” – This is a cardiac perfusion scan which measures the amount of blood in your heart muscle at rest and during exercise. It can identify areas in the coronary artery blood vessels that may not be getting adequate blood flow or areas of the heart muscle that have been damaged. During the scan, a camera takes pictures of the heart after a special test medicine (radioactive tracer) is injected into a vein in the arm. The tracer travels through the blood and into the heart muscle, allowing images to be taken. You will have an IV placed for this scan. You may not eat or drink 4 hours prior to the test. You cannot have caffeine or tobacco 24 hours prior to this test. There are certain medications that cannot be taken the day prior to this test (such as beta blockers, calcium channel blockers and long-acting nitrates). The scheduler will discuss specific medications with you. This test may take up to 3-6 hours to complete.
❏ Heart Catheterization – “Cath” – This is an invasive test that looks at the coronary blood vessels for any blockages (coronary artery disease). If blockages are identified, you may need an intervention prior to your surgery or bypass at the time of your surgery. For this procedure, you will need to lay flat while a catheter is placed in your groin blood vessel (or sometimes your arm blood vessel) while a camera captures images of your heart blood vessels. You cannot eat or drink 6 hours prior to this procedure. You will have an IV placed prior to the procedure as IV contrast dye is administered for this test. You will need someone to drive you home. This test will take approximately 1 hour to complete and 4-6 hours to recover (looking for no signs of bleeding from the groin site).
❏ Computed Tomography Scan – “CT” – This test that looks at the aorta (largest blood vessel in the body), lungs and other organs. It will identify if an aneurysm is present or other issues that may need to be addressed before or at the time of surgery. If your surgery is a re-operation, it will allow the surgeon to see how safely they can enter the chest cavity. You will have an IV placed prior to the procedure as IV contrast dye is administered for this test. You cannot eat 6 hours prior or drink 2 hours prior to this procedure. This test will take one hour to complete.
❏ Cardiac Magnetic Resonance Imaging – “MRI” – This test provides detailed pictures of the heart. It also reveals how well the heart is functioning and the overall size and shape of the left ventricle (pumping chamber of the heart). In addition, it allows the visualization of abnormal tissue in the heart muscle. Because they interfere with the magnetic field of the MRI unit, metal and electronic objects are not allowed in the exam room. You will need to complete a questionnaire prior to your appointment - be certain to tell your surgeon if you have a history of metal implants, shrapnel and/or claustrophobia.
*** PLEASE NOTE: Every effort will be made to keep your surgery date and testing on the original dates provided. However, due to unexpected emergencies, your surgical date and/or testing may have to be rescheduled. If this occurs, everything possible will be done to reschedule you to the earliest available surgical date.
Even before your surgery, start thinking about what you’ll need for a smooth recovery after your operation. The last thing you want is the added stress of trying to arrange your life while you should be focusing on recovering.
Prior to your surgery, your surgeon will give you an estimated hospital discharge day. Using that day, be sure to arrange your ride home as well as any other support you’ll need for the first few days. You cannot be discharged without the assurance that you have adequate support at home!
Department of Labor Information on FMLA
Guide to the Family and Medical Leave Act from National Partnership for Women & Families (PDF)
American Heart Association Q & A on FMLA
FMLA Forms from the Department of Labor
The day of your surgery, the most important thing to do is to relax. You are in excellent hands at Phoenix Cardiac Surgery!
Be sure to arrive at the hospital a few minutes before your scheduled arrival time so you have time to find the right location in the hospital to check in.
Be sure to leave all valuables such as money, credit cards, jewelry, etc. at home.
Family members can stay with you and meet your anesthesiologist and surgical team. Be sure to let your anesthesiologist know if you’ve had previous issues with anesthesia.
When you are escorted in for surgery, your family can wait for you in the surgery waiting area.
Once your surgical team is ready and you’ve been prepped, you’ll be taken to the operating room and you’ll be put to sleep with medication through an IV. Additional IV lines may be added, as well as a breathing tube to help you breathe while you’re asleep, and a catheter to remove urine.
Depending on the type of surgery you’re having, your surgeon will choose the appropriate incision and technique. You can read more about the various types of heart and lung surgery here.
After cardiac surgery, your doctor will admit you to the hospital's cardiovascular intensive care unit (CVICU). Most patients are still intubated on a breathing machine at this time. When you are awake and strong enough, the breathing tube is removed, usually within 3-6 hours after surgery.
To keep you comfortable and calm, you may receive additional medications. In most cases, your family can sit with you during this recovery time.
Immediately after surgery, you may have chest tubes (drains), as well as an arterial line in your arm and central venous lines in your neck. These will be removed over the next few days as you continue to improve.
During recovery, you may receive extra oxygen through a face mask or nasal prongs that fit just inside your nose. You’ll wear these until your doctor determines you’re receiving sufficient oxygen on your own.
Be sure to check the individual hospital websites for information on visitor hours, parking and other available amenities.
The average post-op hospital stay is 4-7 days, but how long you stay in the hospital depends on the type of procedure and your pre-operative condition.
Your doctor will discuss your new medications, the instructions for wound care, and any restrictions with you and your family before you’re discharged.
When you’re discharged, you’ll usually receive new medications. Your surgeon will determine when you should resume your pre-operative medications. DO NOT start taking your previous medications without your doctor’s instruction and supervision.
If you qualify for a skilled nursing facility or acute (in a care facility) rehab, the hospital’s discharge planner will help make the placement. You’ll want to explore facility options as soon as possible to avoid any delays in your discharge.
If you need cardiac (outpatient) rehab your cardiologist will prescribe a program. Typically, it’s advised that you wait 4-6 weeks after surgery before you begin.
This structured program offers medical support and assistance in making heart-healthy changes to your lifestyle. Through cardiac rehab, you’ll participate in exercise monitored by a medical professional, and receive nutrition and psychological counseling. Research shows that patients who complete cardiac rehab are more likely to be alive in five years than those who do not participate in the program.
Cardiac rehab is covered by Medicare for eligible patients.
Once you return home, we want you to continue to be active. Walking is the perfect way to gradually increase your strength and endurance. You’ll also be instructed to continue your breathing exercises.
If you find you’re fatigued easily, this is common. It will improve as you recover, but it generally takes about 6-8 weeks before you return to your pre-operative state.
During your recovery, it’s important to weigh yourself daily and monitor your heart rate and blood pressure at least once per day. Keep a log of this information, so your doctor can review it and make any needed changes to your medication.
Wound Care. It’s safe to wash your incisions daily, over the tapes, with mild soap and warm water. Don’t scrub or use very hot water. You can remove any remaining tapes 7 days after discharge. Do not apply any lotions, creams, oils, or powders to your incisions until after they are completely healed unless prescribed by your cardiac surgeon.
Check your incisions daily. Notify your doctor if you notice any of the following:
Because incisions sunburn easily, be sure to protect these areas from overexposure to sunlight for the next 12 months. The scar will darken if it’s exposed to the sun.
Activity. During recovery, stop any activity immediately if you feel short of breath, if you notice irregular heartbeats, or if you feel faint or dizzy or have chest pains. Rest until these symptoms subside. If the symptoms do not go away within 20 minutes, contact your doctor.
Physical therapists will give you an individual plan for exercise before your discharge. It’s important to pace your activities throughout the day. Do not try to do too many things at one time.
Dress. During recovery, wear comfortable, loose fitting clothes that do not put undue pressure on your incisions.
Rest. Recovery requires a balance of rest and activity. Rest between activities and take short naps as necessary.
Walking. Walking is ideal because it increases circulation throughout your body and to your heart muscle. Increase your activity gradually, walking at your own pace. Stop and rest if you get tired. Each person progresses at a different rate after heart surgery. In poor weather (lower than 40 degrees F or above 80 degrees F) you can walk at indoor shopping malls. In cold weather, wear a scarf or mask around your mouth and nose.
Stairs. You can climb stairs unless your doctor tells you differently. Take them at a slow pace and stop to rest if you tire. When using the handrail, do not pull yourself up with your arms. Instead, use your legs.
Sexual activity. You can resume sexual relations when you feel comfortable. For many people, this is about 2-4 weeks after discharge unless instructed differently by your doctor. Please ask your nurse for more detailed information, if needed.
Driving: You can ride as a passenger in a car at any time. Avoid driving, outdoor bicycling, or motorcycle riding. Depending on your recovery, you may drive again in 4-6 weeks and ride a motorcycle in 8-12 weeks. Your surgeon will advise you when you can resume these activities. When traveling, be sure to get out of the car every two hours and walk around for a few minutes.
Bicycle riding. Wait at least 6 weeks after surgery to allow your breastbone (sternum) to heal.
Lifting. Do not put too much strain on your sternum while it is healing. Avoid lifting, pushing, or pulling anything heavier than 10 pounds for 6 weeks after surgery. This includes carrying children, groceries, suitcases, mowing the grass, vacuuming, and moving furniture. Do not hold your breath during any activity, especially when lifting anything or when using the restroom.
Work. Most patients will feel like returning to light work 6 to 12 weeks after surgery. Check with your surgeon before returning to work.
Visitors. Limit your visitors for the first couple of weeks. If you get tired, excuse yourself and lie down. Your visitors will understand.
Other effects after heart surgery. You may experience some or all of the following:
Follow up. Close follow up after discharge is necessary to make sure your surgical wounds are healing and that you are recovering well. Your follow-up office appointment with your surgeon is usually scheduled for 2 weeks after discharge.
Make sure to follow up with your cardiologist and primary care physician within 1-3 weeks after discharge as well.
If any questions or concerns arise at any point during your recovery, please contact our office.
Heart surgery affects not only the patient but his or her spouse, children, and significant others as well. In addition to the physical recovery for the patient, there’s an emotional aspect of adjustment that the patient, as well as family, experience. Knowing that it will take time for life to return to “normal” will help you all navigate the recovery.
Facing the possibility of changing one's lifestyle can be overwhelming. Some modifications, such as changes to diet and smoking cessation, will take place immediately. Others may be more gradual, such as building up to and maintaining an exercise program, or incorporating long-term stress management.
It’s critical for everyone to realize that it’s the patient’s responsibility to initiate the changes and maintain healthy new habits. Spouses, children, and significant others often struggle with the impossible task of taking on the role of “enforcer:” Making sure the patient never deviates off course and stays on plan. While encouragement and support is valuable, only the patient can “do” what he or she needs to!
Some of the lifestyle changes brought about by the need for open heart surgery can directly impact the entire household. When a patient is forced to make changes for health reasons, often, others in the household follow suit -- especially for those who may also be predisposed to coronary artery disease. For instance, if the recovering patient has stopped smoking, family members who smoke are now motivated to quit. And when meals now need to be prepared in a heart-healthy fashion, those who eat together will likely make the same changes just for practical purposes.
Recovering from open heart surgery can create temporary role changes and responsibility shifts among family members. When the recovering patient returns home, he/she will have temporary physical limitations and dependencies, and other family members will compensate. For instance, the husband will need to shop and carry packages for his recovering wife who can’t drive, or lift bags of groceries. The son or daughter will have to mow the lawn and take out the garbage for their recovering father, who now has to limit exertion while he rebuilds his strength.
The family will coordinate efforts while the patient is limited. They also need to enable the patient to increase his or her independence and self-care during recovery. This can be a delicate balance to strike, and can cause tension and friction in the home. If everyone is informed and aware of the doctor’s recommendations for recovery, you can minimize the stress of this transitional period for both the patient and family.
Recovery can be challenging for all involved. There will be days of high energy and of fatigue, accomplishments, moments of temptation, feelings of exuberance and even days of feeling blue or angry, all of which are a part of the physical and emotional healing process that takes place. Know that this is normal, and will pass as the patient recovers and regains his or her active lifestyle.
The information provided on this website is for educational and informational purposes only, and is not intended as medical advice. This information should not be used for diagnosing or treating a medical or health condition. You should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition. Phoenix Cardiac Surgery makes no warranties, express or implied, as to the value, usefulness or completeness of any information that is made available on this website.