Open heart surgery
Surgery where the chest is opened and the heart is operated upon has become one of the more common treatments of today. Far from the risky procedure of the past, it is now being performed successfully on many people into their 80s and 90s and gives hope of quality of life previously not thought to be possible. Most surgery is coronary artery bypass graft surgery (bypassing narrowed or blocked coronary arteries), but also heart valves can be repaired or replaced and in some cases, diseased parts of the heart are removed making it pump more efficiently. Whatever the surgeon does when he is in there, the effects on the patient for most of these procedures is the same, so I will discuss them as a group.
First, it is important to accept that this is a major procedure, not without risk and postoperatively there can be significant pain and many patients take months to recover from the operation. So before accepting that this is what you want to do, discuss carefully with your cardiologist, GP and surgeon on the benefits you will receive from having the surgery, the possible after effects and risks.
The operation time
Preoperatively your cardiologist will (if there is time) get you into your optimal state with medications, mild exercise if indicated and diet and supplements. You will have a talk with your anaesthetist who will cover the procedures he/she will be doing before and during the surgery, and you will be told about the risks and benefits and asked to sign a consent form. In today's litigious world, you must be told of all the possible complications that are possible, no matter how unlikely that they will happen, and this can be quite frightening to listen to. The important thing to remember is that you have discussed the operation with your cardiologist and you have agreed that this operation is the correct decision for you. But do ask any questions if you have them, this is your right.
You will be shaved almost from top to toe (chest, tummy, arms, and legs), change into a gown and taken into the anesthetic room where the anesthetist will insert an iv line and inject a drug which will gently put you into a peaceful sleep. You will remember nothing till you wake up post-op in the recovery ward. Depending upon the type of operation,, the surgeon will open the chest from the front, in most cases a bypass pump is used where blood is taken from the major vein through an oxygenator machine and returned into the major arteries, bypassing the heart which can be stopped to make the surgery possible. In coronary artery disease either arteries just under the breastbone (the internal mammary arteries), or arteries from the arm (radial arteries) or veins from the leg (saphenous veins) or sometimes the arm, are harvested and sewn from the aorta major artery leaving the heart (Aorta) and attached to the coronary artery beyond the blocks that had been demonstrated at your pro op angiogram. For heart valve surgery, some valves can be repaired, but in most cases, the damaged valve is removed and replaced with an artificial valve, usually made of a metal ring sewn onto the heart and a very hard carbon disc or ball which open and close when the heart beats. Some valves can be made of animal or human tissue and your surgeon will discuss the type of valve to be inserted with you preoperatively. Most mechanical valves will require lifelong anticoagulation but tend to last longer (usually for life) than tissue valves which may or may not need anticoagulation.
You will wake up in the recovery room with a number of tubes into your arteries and veins, a urinary catheter and on a ventilator with a tube in your mouth attached to a machine which will assist your breathing. It can be quite confusing and you will be given drugs for pain and to help you relax. You usually spend 1-2 days in ICU, the tubes will gradually be removed and you will be taken to the ward. It is very likely that you will feel confused, have poor short-term memory.
[Note this can also be a very hard time for your partner and family, who will see you with all these tubes, unable initially to communicate, and when you return from the operation you will feel very cold (they cool the body during the operation to protect the brain circulation). The nurses can be a huge support for the family at this time.]
You may spend a week or more in hospital as you get back onto your feet, healing for the chest and other wounds where the grafts were taken from, and you have physiotherapy. They will encourage you to breathe deeply and cough, this can be painful but it is important to follow their advice.
On returning home, take it quietly and gradually increase your activity, avoid heavy lifting and overdoing it. tell your doctor if your wounds appear to be infected, there is excessive pain or if you have a temperature over 38 degrees or you feel your heart racing or consistently beating irregularly.
You will be discharged on a number of drugs, depending on the type of surgery, and your doctor and pharmacist will discuss their use and possible side effects. Almost certainly this will include a statin drug - this is discussed further below*, I would strongly encourage you to take these despite what some people may say, unless they are giving you significant side effects.
Things you may also notice is a numb patch on the left or right side of the chest (if an internal mammary graft was used), difficulty in sleeping, nightmares or vivid dreams, increases sensitivity to the cold, poor memory for a while and noticing your heart beat more strongly.
It often takes 4-6 weeks sometimes longer to completely recover from the operation. Do not drive for at least 4 weeks, but check with your doctor before getting behind the wheel.
Long-term follow-up -
You will never want to go through this procedure again, so should take every precaution to stop the grafts and the original arteries from clogging up again. This means you should make a number of changes in your lifestyle:
- Diet is very important, but unfortunately, very few people give you the same answer to what is best. There is no doubt that lots of fruit vegetables grains and fish and limited red meat is probably the way to go, the information about saturated fat is now being debated, and although monounsaturated fats like olive oil are still good, the main fats that are damaging are the trans-fats found in margarine and many processed foods. Probably the best diet for heart patients is the Mediterranean diet, and it is certainly the easiest one to follow. Also cut down on the sugar.
- Exercise is important - start gently, your cardiac team may provide cardiac rehab classes, attend these if you can. Try to stand tall, with a sore chest it is easy to slouch and pull your shoulders forward, and when you walk, swing your arms like a soldier. Once the wounds have all healed completely, many people find exercising in a warm pool is helpful.
It is crucial to stop the blockages of the arteries from getting worse, and thus in addition to diet, it is essential to make certain that the body has all the assistance it can to repair and recover.
- A good multivitamin and multi mineral provide the heart tissue with all the nutrients required to be optimally, it can also contain vitamins B6, B12 and folic acid which lower the homocysteine which is believed to damage the artery walls. In areas where the selenium is low the soil, a good multivitamin should also contain selenium.
- Calcium and magnesium – calcium is required for the muscles to contract and magnesium for them to relax, and eliminate any spasm. 804,000 mg a day is the usual dose, and magnesium also has an additional effect of stabilising any heart rhythm abnormalities that might occur when the heart is starved of oxygen.
- Vitamin D – there is quite a lot of evidence that low vitamin D increases the risk of having a heart attack, sun exposure was good but this is difficult to achieve in many areas, and some vitamin D 5 to 8000 international units a day as a supplement seems wise.
- Omega-3 fish oils – these have numerous actions including improving cardiac function and slowing down the development of the plaque, but they also have quite a powerful rhythm controlling effect if any dangerous rhythm is occurring. Take at least 1 g a day, preferably 2 to 3 g a day but it is important to make sure that this is pure and does not contain mercury.
- Coenzyme Q 10 – this is an energy enzyme within the muscles in mitochondria of the heart and other tissues, and it is crucial for transporting energy around. Statin drugs block the development of coenzyme Q 10 which could lead to heart failure. All patients with heart disease should be taking coenzyme Q 10 supplements 100 to 200 mg daily.
- Hawthorne – although there are few studies on Hawthorne, it does appear that this is beneficial in patients with heart disease, and many practitioners are recommending this as well.
I believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round.
There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend. The Nutritional supplements I use and recommend to my heart patients - USANA - Cellsentials , Biomega, Active Calcium plus, Coquinone & vitamin D
* There is a strong anti-statin lobby making people resistant to taking these drugs. In part this is reasonable, and there is no doubt the pharmaceutical industry and some medical authorities are pushing the use of statin drugs in many situations, and there is even a suggestion that everyone over the age of 50 should be taking a statin as part of a 'polypill'. However the evidence for many of the claims is not strong, and just because the cholesterol is lowered, this does not necessarily reduce heart and other diseases. The drugs also have significant side effects - muscle pain, mental blunting, abnormal liver function tests, nerve pains. However in patients who have definite heart disease, statins in many good trials have been shown to reduce the risk of further heart attack, stroke or death by 10 - 20%. For a person who has had a heart attack, a 20% reduction for further events is significant, and my advice is to take a statin drug. If it causes side effects try another one (most doctors give simvastatin or atorvastatin - switch to Pravastatin which is water soluble). If the side effects are still present, then discuss with your doctor about stopping them.
I have also written in greater depth on this website - look under Statins.
Other therapiesThere are a number of other therapies which you might like to look at. They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help. They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner. My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.
Nutritional supplementsI believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.