Dental
Clearance :
It
is important for every patient to have a dental check
well before (atleast 2 weeks) prior to surgery. This is
critical because any rotten tooth (caries) is a source
of infection which can cause very serious heart infection
(endocarditis). This is of particular importance in patients
who are going to have a valve replacement.
So
check with your Dentist and get any bad tooth extracted
before surgery.
Note: Presence of caries tooth on admission
may cause postponement of the operation.
Smoking
:
Smoking
should be stopped well before surgery. Continuous smoking
till surgery may cause serious complication and lung infections
after surgery.
Anticoagulants/Antiplatelet
Drugs :
If
you are taking Warfarin or Acitrom it has to be discontinued
3 days before surgery. Also patients on Aspirin and/or
Clopidogrel are advised to stop these one week before
surgery to reduce bleeding problems. Aspirin may be continued
in selective patients with unstable angina. Please check
with your doctor.
Blood
Donation:
Each patient will be
advised regarding the number of units of blood required
for surgery .Volunteer donors, preferably friends or relatives
of the patient with the same blood group can present themselves
to the blood bank the day before surgery and donate the
required amount. Donors are requested to report to the
Blood bank before 12 noon to facilitate screening tests.
Diet
Restrictions :
Hospital
provides appropriate diet to all patients on admission.
Patients can have their usual food till midnight on the
day before surgery. After mid night no drinking or eating
is allowed in preparation for the anesthesia/surgery.
Day
of Surgery :
Patients
will be transferred from their bed to the pre-operative
holding area in the theatre complex atleast 2 hours prior
to the procedure. Here the anesthesia team will sedate
the patient and insert lines for monitoring and giving
fluids. Once the theatre is ready the patient will be
taken in, anaesthetised and surgery will commence.
Relatives
can wait in the room or the waiting hall. The surgeon
will speak to the relatives once the operation is completed
about the procedure and condition of the patient.
ICU
:
The
patient will be admitted to the Intensive Care Unit (ICU)
where specially trained nurses and respiratory technicians
will take care of the patient. Patients will be on a breathing
machine called ventilator till he recovers from
anesthesia.
He or she will be disconnected from ventilator and the
tube in the mouth (endotracheal) removed once the condition
is stable and patient is fully awake. This will be decided
by the ICU medical officer. The usual duration of ventilation
is between 4 hrs to 24 hrs.
Visitors
are usually not allowed inside the ICU. To reduce traffic
and infection, except for patients who are very sick and
small children where the mother or a close family member
is allowed.
The
usual ICU stay is 2 days. All the tubes and lines except
the one in the neck will be removed and the patient is
shifted to his bed.
Physiotherapy
:
Breathing
exercises and mobilisation are started in the ICU. Post-op
exercises are very important for fast recovery and to
prevent lung complication. The Physiotherapist will visit
each patient twice a day and advice regarding this.
Dietary
Services :
A Dietician will visit
each patient and tailor the dietary requirements to be
followed after surgery.
Discharge
:
Patients
are usually discharged 8-10 days after surgery .Please
check the following with your doctor on discharge.
Medications
Exercise
and activities
Resuming
work
Diet
Follow-up
date
Know more about your surgery --> click
Heart Guide
Follow-up
:
Patients should make an appointment to meet the surgeon
2 weeks from the date of discharge. It is also important
to schedule an appointment with the cardiologist 4 weeks
before from the date of discharge. He will monitor the progress
and adjust the medications. Patients on oral anticoagulation
(warfarin, acitrom) should get their INR checked every month
or more frequently in special situations as advised.
Activities
after surgery :
 Walking |
:
|
Patients
are advised to walk atleast 2-5 km/day at the
time of discharge. The doctor will also advice
each patient on the level of activity he can perform
after discharge.
|
| Diet |
:
|
Patient
should be on a strick diet protocol after surgery
particularly after coronary artery bypass surgery.
Dietary advice will be given before discharge.
|
| Resuming
work |
:
|
Patient
are advised to resume work 4-6 weeks after discharge.
Heavy manual work is to be avoided for 3 months.
Patients whose work involves only desk activity
or supervision can resume work 2 weeks after discharge.
Please check with your surgeon at first review.
|
| Driving |
:
|
Two
wheeler and 4 wheeler driving is strictly prohibited
for 8 weeks after surgery. |
| Sex |
:
|
Patients
can have sex usually 2 weeks after discharge.If
the patient can climb one flight of stairs without
chest pain or breathing difficulty he or she will
probably be able to cope with sex. Try to avoid
sex after a large meal, alcohol or when very tired.
Try to adopt positions that cause least discomfort
to the chest wound. Don't try to make the first
occasion after surgery a "Command Performance".
|
| Adventure
sports |
:
|
Best
avoid for 6 months.
Patients on anticoagulation after valve replacement
are advised not to participate in any activity
or sport where serious injury is a possibility.
|
Our
Experience ( till March 2003) :
Surgery
Type |
Total |
| Coronary
Artery Bypass Surgery (CABG) |
1865 |
| Off
- pump CABG (OPCAB) |
240 |
| Single
valve replacement |
1631 |
| Double
valve replacement |
282 |
| Mitral
valve repair |
110 |
| Atrial
septal defect (ASD) |
1346 |
| Ventricular
septal defect (VSD) |
510 |
| ASD
+ VSD |
22 |
| Intracardiac
repair for TOF |
333 |
| Other
Congenital defects / Cardiac tumors / Aortic
surgery |
300 |
| Closed
cardiac procedures (CMV, PDA, Coarctation,
etc.) |
3086 |
| Thoracic
and vascular procedures |
4761 |