Would you do tests on me before the Heart surgery in India?
Yes, all heart surgery patients undergo angiography before heart or cardiac surgery. Other tests are also performed before any anesthesia is given. This includes:
• Blood tests to evaluate chemistries, blood count and blood type.
• Chest X-ray to evaluate lungs and heart size.
• Carotid Doppler to evaluate blood vessels in the neck leading to the brain.
Would I need blood transfusion during cardiac surgery in India?
The surgeon makes all efforts to avoid blood transfusion. If you may need blood, the blood banks are there at the hospital to supply blood. The blood banks at the hospitals in India are FDA approved and adhere to international standards of blood screening for all infectious diseases such as AIDS, Hepatitis etc.
Would I have severe pain after the cardiac surgery?
You will experience some pain and discomfort after the surgery which shall be controlled with medications. You shall be at the hospital for 5-7 days so that the acute recovery phase is over and you are comfortable and can be on your own at the time of discharge from the hospital.
What will happen after I leave the hospital following cardiac surgery in India? Will there be any nurse at the hotel to take care?
You will not need nursing care after you are discharged from the hospital. A stay of 7 days at the hospital would be enough for you recover and stay at the hotel without the nursing care. However, if your treating doctor feels that you still need medical supervision, he would advise you to extend the stay at the hospital at some extra cost.
Would I need to follow some instructions or take extra precautions after the heart surgery?
You need to be very careful in using your upper body to allow for your sternum bone to heal well. You should not push, pull or lift anything heavy for at least two months after the surgery. Your surgeon and the medical staff shall give you specific instructions about do's and don'ts after the surgery. The physical therapist will tell you how to strengthen the muscles.
Can I climb stairs after my operation?
Yes, you can climb stairs but that would be tiring for you. You should avoid climbing the stairs for 6-8 weeks till you have fully recovered.
Can I drive after the surgery?
Yes, you can but you should wait for at least six weeks after the surgery before you start driving again. .
When can I return to work following cardiac surgery in India?
Return to work is individual and depends on your profession. Desk or sitting activities can be resumed after about 3-4 weeks of surgery, while physically active jobs should wait for 8-10 weeks.
CABG
What is Multiple Bypass heart surgery?
Multiple bypass surgery is when the patient has blockages in more than one artery and requires bypassing of more than one artery for the treatment. For instance, if an individual has blockage in two coronary arteries and one branch, he would need three bypasses. This would be called triple bypass surgery.
Is the multiple bypass surgery heart operation more risky for the patient than single bypass?
No, Multiple bypass surgeries do not necessarily mean higher risk. The risk whether single or multiple depends upon various factors which include general health condition of patient, age, co morbidities like Diabetes, Kidney disease etc. A patient with renal disease and/or diabetes with single artery disease is more at risk than other with no co morbidities and multiple artery disease.
How do I prepare for my heart bypass surgery in India?
You should eat a balanced & healthy diet, rest well; do the exercises permitted by your doctor & walk regularly, before your surgery. Though it is always good to have a healthy lifestyle, you should follow this routine at least before your surgery.
On the night before the surgery, take a light meal & do not eat or drink anything after midnight. Your doctor would give you specific instructions before the surgery.
Is heart bypass fraught with much risk? Are there any alternatives to surgery?
As with any surgical procedure, there are risks of infection, bleeding and anesthesia. The surgery is chosen as the last recourse.
It is worthwhile to note that the current success rate for heart bypass is 96 to 98 percent, which means only between 2 and 4 percent of the patients have complications. This makes heart bypass one of the most favoured and safe surgery for heart blockages.
Would I require rehabilitation after my heart surgery in India?
Yes, rehabilitation is important aspect of post operative care. You will be put on a specialized postoperative rehabilitation and prevention program, which includes supervised exercise, dietary and lifestyle changes. Physical therapists & dieticians would guide you about the exercises and the diet you should take for early recovery and further prevention.
What is recovery like after CABG operation? Would I be on bed rest for a month after the surgery?
After surgery, you would be taken to the intensive care unit for a day or two of close monitoring. You shall then be in your room under medical care for another 5-6 days and can then leave the hospital. You would be advised to start walking 3-4 times every day to fasten your recovery. Your physical therapist shall work with you to strengthen your chest muscles.
Once you leave the hospital, home recovery means progressively increasing activity over the next two to four weeks. Most patients are fully functional in six to eight weeks, although some people may take longer. But four to six weeks of progressive recuperation at home is needed. No, you will not be bed-bound preferably not leaving home.
What precautions do I need to take when I go back home after cardiac surgery in India?
Try to ease into the activities you enjoyed before your surgery. Do everything in moderation-not too much. If you feel tired, take rest.
Walking is the best exercise and it is important to walk every day. Begin walking for 5 minutes about 3-5 times a day, and gradually increase the distance so you're walking for 20 minutes.
- Do not lift anything heavy.
- Do not drive, until the surgeon advises (usually in 4-6 weeks).
- Do not engage in forceful movements
You should be careful to protect the area around the leg or arm from which the vein was harvested. This may take a few months to return to normal.
Valve Replacement Surgery
What are the various types of valves used for Heart Valve Replacement in India?
The different types of valves used are:
- Mechanical Valves - also called prosthetic valves. These valves are made of immunologically inert material that does not react with the body's own tissues. These valves are similar in structure and function as own heart valves permitting proper flow of blood through the heart chambers. The mechanical valves have an un-limited life span. Mechanical valves are resistant to the flow of blood and are prone to blood clot formation on the leaflets. As a result if you undergo Heart Valve Replacement with mechanical valves, then you will have to be on blood thinning medication for the rest of your life.
- Tissue Valves - also called biological valves, bio-synthetic or bio-prosthetic valves. These valves are made from animal tissue i.e. pig tissue (porcine) or cow tissue (bovine) with fine mesh sewn around it to provide support and stability. The most important advantage of tissue valves is that after Heart Valve Replacement there is no danger of clot formation.
- Homograft Valves - Homograft or allograft valves are obtained from human donors which are frozen under sterile conditions and used for qualified candidates. These valves are not as durable as mechanical or tissue valves.
However, the biggest advantage of using these valves is that after Heart Valve Replacement surgery, there is no danger of clot formation.
Which valve is best for me?
There is no single ideal replacement valve. The choice between an animal valve and a mechanical valve depends largely on the age of the patient.
Since valves obtained from animals have a life expectancy of 7-15 years, they usually are given to older patients. Mechanical valves are used in younger patients because they are more durable. Because the mechanical valves are made of foreign material, blood clots can form on their surface & thus the, patients who receive these valves must take anticoagulants for the rest of their lives.
Donor or pulmonic valves are limited in their use because of the small supply available from donors and the strain that could be caused by removing and transferring a patient's own pulmonic valve.
How should I prepare for Heart Valve Replacement Surgery in India?
The preparation for Heart Valve Replacement surgery is same as done for any Open Heart Surgery. A complete and thorough evaluation by physician, cardiac surgeon and anaesthesiologist is done prior to the procedure. All the routine pre-operative tests like blood and urine examination, x-ray chest, Electrocardiogram, Echocardiogram, Cardiac Catheterization, and Coronary Angiogram will be performed. It is mandatory that the patient informs the treating doctor about all the prescription and non-prescription medication that he/she might be taking.
One is instructed to eat a balanced diet, do some exercises to clear lungs and quit smoking completely before the Heart Valve Replacement surgery. One should not eat or drink anything for at least 12 hours before the surgery and get a good night's sleep. One is instructed to shower both on the evening before and the morning of surgery with a special antibacterial soap to prevent infection during and following Heart Valve Replacement surgery.
What is the aftercare and how long is the recovery period?
The patient usually spends 1-3 days in the hospital intensive care unit (ICU) after heart valve replacement so that the working of his or her heart and circulation can be monitored closely. The patient continues to breathe by means of a tube inserted in the trachea at the time of surgery. This mechanical ventilation is not withdrawn until the patient is fully awake from anesthesia, shows signs that he or she can breathe satisfactorily without mechanical support, and has steadfast circulation.
Once stabilized, the patient is transferred to a standard medical unit (the patient's room). The patient is administered drugs that prevent excess fluid from building up around the heart. As soon as possible, the patient begins walking and exercising to regain strength. He or she is also placed on a diet that is low in salt and cholesterol. After being released from the hospital, the patient continues a daily exercise program that includes walking, and he or she may also join a recommended cardiac rehabilitation program. He or she usually can return to work or other normal activities within two months of the surgery.
What to expect during the recovery period following Heart Valve Replacement surgery in India?
The initial few days following the Open Heart Surgery for Heart Valve Replacement can be crucial. There will be pain and discomfort which can be relieved by pain medication. Some of the common unpleasant experiences after Heart Valve Replacement surgery will be forgetfulness, mood swings, lack of energy, tiring easily, lack of appetite possibly even nausea or constipation, difficulty sleeping through the night or perhaps nightmares or vision changes. Your doctor will provide you a list of specific discharge instructions to follow for the first three weeks at home, after your Heart Valve Replacement surgery to help you return to a normal pace of life. Some of the post-operative Heart Valve Replacement surgery guidelines will include:
- Get plenty of rest and sleep, this will help you heal and recover.
- Avoid extreme temperatures i.e. very cold and very hot weather including wind chill factor and humidity.
- Do not perform strenuous activities like lifting, pushing, pulling, mopping, vacuuming, yard work, car washing, laundry etc.
- Eat a well balanced, low salt, low calorie, nutritious diet comprising of fruits, vegetables, dairy and protein.
- Avoid alcohol and limit your caffeine intake.
- Continue coughing and deep breathing exercises.
- Bathe or shower daily with warm water.
- Keep your incision clean; do not apply oils, lotions or creams over your incision.
- Avoid driving or going for long outings.
- Avoid sexual intercourse for at least 4 - 6 weeks after Heart Valve Replacement surgery.
- Avoid constipation, eat lots of fruits and vegetables and drink plenty of water to keep your stool soft.
- Follow the Cardiac Rehabilitation Program as outlined by your health care professional team to provide emotional support and information about the recovery process.
- Make long term lifestyle changes like regular walking, exercising, eat low fat, low calorie diet, quit smoking etc - in short make healthy lifestyle choices.
What are the risks associated with the Valve replacement surgery?
Complications following heart valve replacement are not common, but can be serious. All valves made from animal tissue will develop calcium deposits over time. If these deposits hamper the function of the valve, it must be replaced. Valves may become dislodged. Blood clots may form on the surface of the substitute valve, break off into the general circulation, and become wedged in an artery supplying blood to the brain, kidneys, or legs. These blood clots may cause fainting spells, stroke, kidney failure, or loss of circulation to the legs. These blood clots can be treated with drugs or surgery.
Infection of heart muscle affects up to 2% of patients who have heart valve replacement. Such an infection is treated with intravenous antibiotics. If the infection persists, the new valve may have to be replaced.
How successful is Valve replacement surgery in India?
Valve replacement surgery has a very good prognosis & gives extremely gratifying results. The vast majority of patients who undergo the procedure return to normal activity after the surgery. Depending on the type of valve they receive, these patients have no symptoms of valve abnormality for at least seven years. Also, their quality of life improves because they no longer have difficulty breathing, fainting spells, or palpitations.
The mortality rate is also quite low after the surgery. The average mortality rate during or immediately after the surgery, is approximately 3% for the general population and less than 1% for patients below the age of 65.
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