What to expect from Cardiac Surgery?

[wetvet]

Hi all. Some of you might remember me posting a report of a stroke following a dive, and that I have a ventricular septal defect (Thread was called "heres one for you", not sure how to link it.) To make a long story short, through much investigation and discussion, my cardiologist and cardiac surgeon believe that many other maladies that I have had over the past few years have been caused by clots passing thru the VSD and landing in various spots (brain, gut, appendix, possibly others). I am having the VSD repaired on Thursday. I have had an initial meeting with the surgeon, and will have a full day pre-op in the hospital to discuss stuff with them, but was wondering if anyone here has first hand experience with cardiac surgery (full sternotomy, bypass pump, insertion of dacron patch). What should I expect for complications, recovery, severity/duration of pain, resumption of activity, resumption of diving, etc, etc. This is probably not that crucial in my recovery, but I am trying to plan out the rest of my year (returning to work, playing hockey, diving, etc), and would be interested in getting a rough timetable estimated. If it matters (and my surgeon indicated it might), I am a big guy, with a 48" chest who spends a fair bit of time in the gym.....he indicated that this may make the recovery more painful.....yee-haw :depressed:

Thanks in advance for any advice.

Wetvet

 

[TSandM]

I haven't had cardiac surgery, but I've taken care of a lot of cardiac surgery patients.

You can expect to be transported to the ICU postop, and you may be on a ventilator for a few hours to a day or two, depending on how your heart and lungs cope with bypass. People with good lungs and normal ventricular function generally do well, and may be off the ventilator the same day as surgery, but it can't be guaranteed. There are sometimes bleeding complications that can extend the ventilator time, as well as heart rhythm disturbances.

After you are extubated, the big challenge is adequate pulmonary toilet. The median sternotomy essentially creates a fractured breastbone, and although it is wired together, it still causes pain. Some patients simply do not want to take a deep breath or cough, and pneumonia is a real postoperative risk. It should be possible to get enough pain medication to make breathing and coughing feasible, but you will have to grit your teeth a little.

The average patient with no complications goes home at about five days postop. You will still have pain in your chest wall at that point. You need to be active. Walking is excellent recovery, but you can't indulge in anything that makes undue use of your arms. (Walking a large dog with poor leash manners is OUT!) The healing of the sternum is like any other fracture -- you have to figure about six weeks before the bone is solid enough to take stress.

Late postoperative complications include leaks from the patch and heart rhythm disturbances. I do not know if patients are routinely discharged on digoxin any more; they were when I was doing cardiac surgery.

I would say that planning a resumption of all normal activities six months after surgery, if there are no complications, would be a reasonable goal. You will be able to run or use a treadmill or elliptical trainer before that; it's the lifting and heavy use of the arms that has to wait a bit.

Good luck with it. Please let us know how you do.

 

[Dive-aholic]

I can only speak from the experience of taking care of post op cardiac patients. In the US, we really push for a fast recovery. The timetable we like to see is extubation 4 hours after surgery, removal of invasive monitoring lines the following morning, sitting up in a chair before 6am, ambulating the unit the day after surgery with distance getting progressively longer. We like to transfer our post op hearts to the step down unit on day 2. Not all cases go that well, but that's the goal. A younger person has a better chance of accomplishing this than an older person (let's split it at 60).

Post hospital, you should be looking at about a 4-6 week restriction on any type of weight lifting (meaning 10lbs or more) - you don't want those wires in your chest to snap...

Complications can range from minor infection to death. (you asked) The pain will probably last you at least a couple of weeks, possibly longer, but it will ease as time goes. It shouldn't be too severe. Like I said, you should be up and walking the day after surgery. If you deal with small animals in your practice, you could possibly return to work in as little as 4 weeks, if all goes well and as planned. I'd guess you'll be out of hockey and diving for a least 4-6 months.

All of this is dependent on how well your body recovers from the massive stress it's going to be subjected to. We do these all the time and most of the patients come out of it fairly well. Based on your current level of activity I'd expect the same for you.

Good luck and keep us updated on your progress!

 

[wetvet]

Thanks....much appreciated info. My job is looking after poultry (I know.....). The big deterrent for me practicing again is the ability to drive and sit in a car for extended periods (I average about 4 hours per day driving). Otherwise for work, no real lifting required. As for the diving, I have the opportunity to help with a class this winter as a divemaster and to work on my instructors ticket. Would 2 months post op be a rediculous goal for pool diving? Putting my gear on in the shallow end, etc. I know that the recovery will be a fluid event, and I will re evaluate it as I go, but was just wondering if it would even be feasible to help with the class starting in mid January.


Thanks again

Wetvet

 

[TSandM]

There are really three variables: How quickly the bone heals, how quickly you get your stamina back, and what your own tolerance for discomfort is. (And, of course, whether there are any complications to retard recovery.) I think that, for the majority of people, two months would be pushing it.

 

[cutlass]

... If it matters (and my surgeon indicated it might), I am a big guy, with a 48" chest who spends a fair bit of time in the gym.....he indicated that this may make the recovery more painful..... ...

Bulkier chests/breasts tends to produce more post-op tension on the incisions. The integrity of closures have to be a little more carefully monitored for signs of separation and infection.

 

[texdiveguy]

I wish you all the best....stay positive it does wonders.

My now 26 year old son hand open heart surgery several years ago to replace one of his 2 main heart valves....it was a painful recovery at times but he was so positive through the whole time. He is doing great and I bet you will also.

 

[Dive-aholic]

There are really three variables: How quickly the bone heals, how quickly you get your stamina back, and what your own tolerance for discomfort is. (And, of course, whether there are any complications to retard recovery.) I think that, for the majority of people, two months would be pushing it.

I completely agree. I'd be surprised if you feel up to being in the pool in full gear in 2 months. At that point you should still be pretty active in your physical therapy and increasing your ability to do things.

 

[wetvet]

Hi all;

Thanks for all the advice previously....I posted this update on TDS, and will put it here also....Thanks for any advice or opinions.

UPDATE:

I am now 2 weeks post surgery for open heart repair of my VSD. The surgery went exceptionally well, and the recovery has been uneventful and MUCH easier than I thought it would be. I already have clearance to drive, and have been off pain meds for almost a week. Im walking a mile to 2 miles per day, and my only problem seems to be fatigue. I have already had my first post op appointment with my family doc, with anemia being the only concern. Post op ultrasound showed no leakage thru the patch on doppler, and will be repeated in a couple weeks when I have my visit with my cardiologist.
I am hoping to DM a pool course in mid January, and was wondering if anyone had an opinion on how much I should "push" my recovery. Everyone says I should just do what I feel up to, but if that was the case, I would be back at work and starting to do light weights at the gym, which I know is a bit aggressive. Also, any opinions or advice on diving fitness and the ability to do tech diving would be appreciated. My assumption is that now my heart is better than ever, and I should have no contraindications for diving in caves or deep water, but would appreciate advice from y'all who actually know what they are talking about.

Thanks for any input.

Wetvet

 

[Lopaka]

Glad you are up and about with things healing nicely. Your operation makes my piddly little thing sound like a dental exam.

I think waiting to get stuff done is worse than the operation and recovery. The mind can really get imaginative...........