Patient Resources

During the Operation

Robotic Heart Surgery:

Robot-assisted surgeries are used for a number of different heart-related procedures, including repair or replacement of stiff or leaky heart valves, coronary artery bypass grafting (CABG), heart defect repair such as atrial septal defect (ASD) repair or atrioventricular repair (AVSD), tumor removal, to correct atrial fibrillation, a common type of arrhythmia, patent foramen ovale (PFO) closure, and to treat congenital heart conditions. Your surgeon may have other reasons to recommend robot-assisted surgery which will be discussed with you.

Robot-assisted cardiac surgery is heart surgery performed through very small cuts in the chest. With tiny instruments and robot controlled tools, your surgeon is able to perform heart surgery in a way that involves less risk than open-heart surgery as the surgeon does not have to cut through the breastbone to open your chest. Smaller incisions mean that you can heal faster, have decreased chest trauma, have a lower risk of infection, less postoperative pain, and return to activities more quickly. Most people can resume their normal activities after a few weeks.

In some rare cases, your surgeon may not be able to complete the surgery with the use of the robot. In this case, you would need open-heart surgery.

Coronary Artery Bypass Surgery:

If one or more of your coronary arteries (the vessels that carry blood to your heart muscle) are blocked, blood cannot flow to the heart muscle. In this case, the heart muscle may die (heart attack). Coronary artery bypass surgery creates a path for blood to flow around a blockage and helps prevent a heart attack. First, a healthy blood vessel (graft) is taken from another part of the body. Taking this graft usually does not affect blood flow in that body part. These arteries or veins are then surgically connected to the coronary arteries on the surface of the heart to create a way for blood to flow around the blockage. If you have multiple blockages, more than one bypass may be done. A common abbreviation for this type of surgery is CABG, which stands for Coronary Artery Bypass Grafting.

Coronary artery bypass surgery can be done with the heart still (on pump) or with the heart beating (off pump). In the on-pump procedure, a heart-lung machine does the work of your heart and lungs during surgery. The machine supplies the blood with oxygen and pumps it back through the body. Your own heart and lungs start working again after the bypass is completed.

Heart Valve Surgery

Repair of the Valve:

Whenever they can, surgeons prefer to repair a valve rather than replace it. The most common kind of repair involves sewing a ring around the entrance to a valve to improve its size or shape. Another involves cutting tissue to let leaflets open or close better.

Replacement with a Mechanical Valve:

Mechanical valves are made of metal or hard carbon. Mechanical valves can last for decades, but blood tends to stick to them, forming clots. If you receive a mechanical valve, you will need to take Warfarin, an anticoagulant medication, for life to prevent blood clots.

Replacement with a Tissue Valve:

A tissue valve usually comes from a pig or cow. Blood does not clot as easily on tissue valves, so patients may need Warfarin for only a short period of time. Tissue valves may wear out faster than mechanical valves, so they may have to be replaced sooner.

Left Atrial Appendage Ligation:

This procedure is for surgical patients with and without atrial fibrillation. For patients with atrial fibrillation or history of atrial fibrillation, the most serious risk is having a stroke. Blood can pool and form clots in your left atrial appendage (LAA). If a blood clot breaks loose it may travel through your blood vessels and eventually cause an obstruction in your brain causing a stroke. Surgical patients who do not have atrial fibrillation are at an increased risk for developing atrial fibrillation post-operatively. Your left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium (top chamber of the heart). It is unclear what function, if any, the left atrial appendage (LAA) performs. Whether you have atrial fibrillation, history of atrial fibrillation, or are surgical patient with the risk of developing post-operative atrial fibrillation your most serious risk is having a stroke.

Impella

The Impella is a device that can support the body by doing some of the work of the heart when it is failing or needs to rest for recovery. It can be used for a short period of time in the OR or cath lab, or it can be left in for several days and the patient cared for in the ICU if needed. The Impella is a very small heart pump that is usually inserted into the left side of the heart and pulls blood from inside the heart and pushes it out into the aorta, the major blood vessel of the body. This helps take some of the workload off of the heart so it can heal and helps provide oxygenated blood to the body when the heart can’t. The Impella can also be placed in the right side of the heart to push blood into the lungs if the right side of the heart is failing. Your care will be similar for either type of heart support.

After Surgery

• 1.

  Follow up appointment with cardiologist.

• 2.

  Follow up appointment with cardiac surgeon.

• 3.

  Outpatient Cardiac Rahab appointment

• 4.

  Primary care provider to be seen within 2-4 weeks. Please call to setup follow up visit.

Minimally Invasive Valve Surgery

The following information highlights activity after discharge: Remember you did NOT have a sternotomy, therefore you do not have any restrictions in terms of arm movement. There is no restriction on your range of motion. You can raise your arms over your shoulders and use your arms to help you in and out of a chair and/or bed. Your only restriction is pain. If you do a movement that is painful, please stop.

Shower:

• Leave the shower door open about 6 inches and bathroom door open to reduce steam buildup.
• Use lukewarm water over the incisions.
• Use soap on your hand and gently pat the incisions. Rinse with water. Pat it dry.
• Shower daily until the incisions are healed and the scab has fallen off.
• Do not remove the scab. Leave it alone. Healing may take approximately 6 weeks.
• Do not apply lotions, powders, ointments, bandages or anything else on your incisions. Leave your incision dry and open to air. If you have drainage from any incision site, please call your surgeon.
• Do not take a tub bath, sit in a hot tub or Jacuzzi, or swim for at least 6 weeks or until your doctor says it is OK. (Do not submerge your incision)
• Protect your incisions from over exposure to sunlight, as they will sunburn more easily the first year.

Legs:

• Avoid crossing your legs because this impairs circulation.
• Avoid sitting in one position or standing for a prolonged period of time.
• Elevate your leg on a stool or coffee table when sitting. You can lie on a couch and elevate your legs on the arm of the couch.
• If you continue to have leg swelling or it becomes worse, notify your cardiologist.
• If TED hose are prescribed, wear them for at least two weeks after discharge. These are to be put on in the morning and removed in the evening.

Driving:

• Avoid driving until your follow-up appointment with the surgeon. Your surgeon must clear you to drive.
• Wear your seat belt while riding in the vehicle.
• Your surgeon may want you to be able to walk a total of 20 minutes at one time before releasing you to drive again.

Stairs:

• Unless your doctor tells you differently, you can climb stairs. Take them at a slow pace. Stop and rest if you tire.

Sexual Activity:

• You can resume sexual relations when you feel comfortable. For many people, this is about 2 to 4 weeks after discharge, unless instructed differently by your doctor.

Work:

• Check with your surgeon before returning to work. Depending on your job, you may feel like returning to light work 3 to 4 weeks after surgery.

Exercise Basics:

• You need a balance of rest and exercise while you recover. Plan to rest between activities and take a short nap as necessary. Resting also includes sitting quietly for 20 to 30 minutes. Rest 30 minutes after meals before you exercise.
• Walking is one of the best forms of exercise because it increases circulation throughout the body and to the heart muscle. It is important to increase your activity gradually. Walk at your own pace. Stop and rest if you are tired. Try to walk 10-minute intervals to begin with and increase the length of time to 20 minutes as you tolerate.
• Pace activities throughout the day. Try not to do too many things at one time.
• Begin using the Home Activity Progress Record.
• Before you walk, the stretching exercises can be done 1 – 2 times per day preferably.
• Do not hold your breath during activity.
• One stretching activity recommended post-operatively is to walk your arm gradually up the wall as tolerated on surgical side 2-3 times daily until full range of motion is restored.

Procedure Video