Before Surgery

A series of tests will be performed on patients having surgery on their heart or major blood vessels of the chest. These tests include but are not limited to:

• CBC - blood count to determine it's adequacy of red and white blood cells and the platelet count, which is an integral part of the body's ability to form normal clots.
• CMP - complete metabolic profile of the blood which checks for electrolyte balance, basic renal (kidney) function, basic liver functions and cholesterol level.
• Lipid Panel - evaluate blood cholesterol, lipid levels (HDL and LDL) and Triglyceride level.
• Urinalysis - check a urine sample to ensure normal function of the kidneys and urinary tract. This helps rule out pre-existing urinary tract infections, bleeding or kidney dysfunction.
• PT/PTT -  blood test that helps check for abnormal bleeding tendencies due to chronic bleeding problems or recent treatment by medications that effect normal clotting functions of the blood.
• Chest X-ray - to check for abnormalities in lungs, heart shadow, bone structure in chest or abnormal aorta size or calcifications.
• Carotid Dopplers - ultrasound pictures of carotid arteries in right and left neck to check for blockages in these important arteries that supply blood to the brain. If severe blockages are noted then further testing and/or consultation with interventionalist for stenting procedure vs. surgical removal of blockage may be warranted.
• Pulmonary Function Testing - a lung volume/lung function study performed before most open heart procedures to ensure that the patient has adequate lung function in order to tolerate major surgery and they are capable of being weaned from a breathing machine
• Type and Cross Match - the patients blood will be typed to determine and have available banked blood products (from the Red Cross) for transfusion, but only if absolutely necessary.

The patient will receive some preoperative teaching from nursing staff when an inpatient and/or instruction from the surgeon's office staff prior to admission/surgery. This will include:

• Risk factors
• Advance directives - such as naming a Health Care Proxy (HCP), typically a family member will make healthcare decisions for you in case you are physically or mentally unable to make decisions for yourself. Choose wisely.
• Antiseptic soap shower and cleaning under fingernail beds the night before surgery, hair clipping on chest, neck, axilla, legs, abdomen and groin on the day of surgery and repeat antiseptic soap shower or bed bath before going to surgery.
• NPO - Nothing to eat or drink after midnight before your surgery.
• IV's - insertion of intravenous lines and drainage tubes.
• Meeting the anesthesiologist the day of surgery.
• Time - approximately how long the surgery will take.
• Intubation and mechanical ventilation - patient will be placed on a mechanical breathing machine by the anesthesilogist after being given strong relaxation medications.
• Ambulation - patient will be out of bed the first day after surgery to begin walking.
• Respiratory therapy - a therapist or nurse will instruct  and reinforce the patient's participation in using a tool to increase inspirations to prevent colapse of lungs and to decrease risk for pneumonia after surgery.
• Coughing and deep breathing after surgery while protecting chest incision by hugging pillow around incision during coughing exercises to clear phlegm from throat and lungs.
• Pain medication - discussion on use and request for medication to decrease pain and discomfort following surgery and thus allow for improved ambulation, coughing and deep breathing exercises.
• Diet - discussion of progression of diet, dietary restrictions and importance of adequate nutrition intake after surgery to sustain the healing process of the patient's wounds.
• Duration of stay - 1-2 days in Open Heart Unit.  Overall hospital length of stay 3-5 days after surgery.
• Physical Therapy - patient will be assessed by physical therapy after surgery to ensure safe discharge to home or to recommend transfer to rehab facility if patient is not strong enough to care for self at home yet.
• Registered Nurses - play an integral and important part in the patient's entire hospital stay as they are involved in all aspects of the care of the patient in the hospital.