What you need to know about recovering from heart surgery

Heart surgery is performed for many different reasons, such as when there are blockages in the arteries that supply your heart with blood (coronary arteries) or your heart valves aren’t working properly. 

One of the most common types of heart surgery is a coronary artery bypass graft (CABG). The procedure is used to treat coronary artery disease by improving blood flow to your heart. It involves bypassing any narrowed or blocked coronary arteries by attaching a blood vessel taken from elsewhere in your body above and below the narrowed or blocked area of the coronary artery. 

CABG can cure angina caused by coronary artery disease, reduce the chances of a fatal heart attack and prolong your life. In most patients, CABG is low risk but if you have other health problems the risk may be higher. Your surgeon will advise you about this.

The second most common heart surgery, after CABG, is heart valve replacement, which is performed if one of your heart valves is faulty and can’t be repaired. It involves replacing the valve with either a tissue valve, usually made from pig or cow tissue, or a mechanical valve made from carbon. Today, heart valve replacement can often be performed using keyhole surgery, which has many benefits over traditional open surgery, including a faster recovery, less pain and a lower risk of wound infection.

If your doctor has recommended that you need heart surgery, your care team will advise you about exactly what your recovery will involve. You should always follow the advice of your care team, however, here we’ll discuss what you can generally expect during your recovery. 

Looking after your wound site and showering

You should wash or shower daily — do not be afraid to get your wounds wet as this will keep them clean and encourage them to heal. However, you should avoid getting in and out from the bottom of the bath for eight weeks as this will put too much uneven pressure on your arms and through your breastbone (sternum), which will strain your wound site and hinder the healing process. 

Depending on how long you’re in hospital (potentially up to a week), you may have your stitches removed before you leave. If not, you will be asked to make an appointment with your GP’s practice nurse to have them removed. If you have restricted mobility or are unwell, a district nurse will make arrangements to visit you at home to remove your stitches.

Looking out for signs of infection

It’s important to stay alert to signs of infection and if you’re concerned that you have developed an infection, contact your GP or district nurse immediately. In some cases, treatment may involve being admitted into hospital. 

Signs of infection include fever and/or redness, pain, warmth and discharge from your wound site. 

Monitoring your weight

Immediately after your surgery, your body weight will go up as your body will be retaining fluid. This is normal and it's part of your body’s stress response to surgery. 

However, in the days after your surgery, your weight should start to come down so that you end up at or below the weight you were before surgery (your preoperative weight). You may be prescribed water tablets to help this resolve more quickly.

After you go home, it is good practice to check your weight every morning. If it starts to rise above your preoperative weight again, you should ask to be reviewed by your GP as this may suggest that your body is once again retaining fluid.

Managing your diet

Your body needs a healthy, balanced diet to ensure it gets all the nutrients it needs. This should, ideally, include a range of fresh fruits and vegetables, whole grains and lean protein. You should also avoid foods high in fat, sugar and salt, and ensure you’re getting enough fibre in your diet. 

Managing your pain

Your care team will aim to keep you as comfortable as possible after your surgery. Effective pain relief (analgesia) will help you recover faster and reduce the risk of complications. 

For example, if you can breathe deeply and cough easily after your operation, you’re less likely to develop a chest infection, and if you can move around freely, you’re less likely to get blood clots (deep vein thrombosis or DVT).

While you’re in hospital, your care team will ask about your pain levels at rest and on movement, and provide you with appropriate pain relief medication, which may include paracetamol, ibuprofen and/or dihydrocodeine or codeine phosphate. If your pain relief medication isn’t working effectively enough, your care team can adjust the dose, frequency or combination of pain relief medications. 

It is important to remember that everybody is different and some people need more pain relief than others; anxiety can also increase the amount of pain you feel. Always be honest about your pain levels as occasionally pain is a warning sign that all is not well. 

Many strong pain-relieving drugs (opiates) can make you constipated, so while you’re taking these medications, whether that’s in hospital or at home, you should follow a high-fibre diet and mobilise ie get up and move around whenever possible. 

Alongside the pain-relieving medications that your doctor will prescribe when you’re discharged from hospital, they may also prescribe laxatives if you will be taking strong pain-relieving drugs regularly. 

Patient-controlled analgesia (PCA)

You may be offered PCA during the first 24–72 hours after your surgery. This involves using a machine that allows you to control your pain relief yourself. It has a pump that contains morphine, which is linked to a handset with a button. When you press the button, you receive a small, pre-programmed dose of the drug painlessly into your bloodstream via a plastic tube (cannula) inserted into a vein in your arm. This gives you immediate control of your own pain relief.

It is very unlikely that you will receive too much of the pain-relieving medication as the pump is programmed so that you will be locked out and not receive a further dose until the programmed time limit has elapsed, which is usually five minutes.

PCA is suitable for a wide range of patients after surgery. Your doctor or nurse will help you decide if PCA is appropriate for you. You will need to be able to press a handheld button attached to the PCA pump.

Walking and exercise after leaving hospital 

It can take up to 12 weeks to fully recover from heart surgery if you have no other health conditions or mobility issues and have had open surgery, such as a sternotomy, where a cut is made along your sternum to access your heart. 

Here is how your activity levels will likely progress over the course of 12 weeks after your surgery: 

Week 1

Remember to carry on with the breathing exercises your physiotherapist will have taught you. Plan your day to include a walk around the house and/or garden for five minutes, as well as three trips up a staircase, or if you don't have stairs, use a low stool to step up and down. Repeat this during the day if you feel well enough, and have a sleep or a rest in the afternoon. 

Accept your limitations and don’t overtire yourself.

Weeks 2-3

Aim to do more activities around the house. Walk for 10–15 minutes twice a day but don’t overtire yourself. You shouldn’t lift, push or pull anything more than a full kettle of water as this will put pressure on your breastbone. You can shop for light items, within 10–15 minutes walking distance, and take short rides in the car as a passenger.

Weeks 4-7

At this stage, cardiac rehabilitation will have been organised for you. Many of your activities may be guided by what you’re doing during your rehabilitation classes. You will probably be able to manage most household tasks but should still avoid activities that involve lifting, pushing and pulling, such as heavy gardening and digging. You will also be seen in the outpatient clinic by your surgeon at about six weeks after surgery.

Weeks 8-12

Try to be as active as you were before your operation. Take regular exercise and gradually increase the intensity. You should be able to do all your usual household tasks but should rest in between.  

You can take longer car trips and may do other activities. If you’re unsure, you should check with your cardiac rehabilitation team. You should continue to avoid heavy lifting and digging.

Week 12 onwards

You should be able to do everything you were doing before your operation. If you want to take part in contact sports, you should ask your surgeon. 

It is important that you continue with the exercises you were taught in hospital and remember that it is normal to get aches and pains. The ligaments around your neck, back, chest and shoulders will still be stiff. By continuing with the exercises prescribed, you can help limit the discomfort.

Driving

Do not drive following discharge from hospital until you have been reviewed at your outpatient appointment (which usually occurs six weeks after your surgery) and have been advised by your surgeon that it is safe to do so. 

It is your responsibility to inform your insurance company of your heart surgery. If you have an LGV or PSV licence, you must inform the DVLA.

Taking care of your mental health

Immediately after your operation, you may have days when you feel down or depressed — this is known colloquially as the “post-op blues”. You may feel irritable or overly emotional and tearful. This can happen at any time and without warning. It usually settles down within the first two to three months and is completely normal. 

Both you and your family will be affected by these feelings, so it is important that you talk with them about how you’re feeling. 

If you’re still feeling this way after three months, or you feel unusually depressed, lacking concentration or are experiencing memory loss, contact your GP.  

It is also in your best interests to try to avoid situations that you know will cause you stress during your recovery.

Rest, sleep and relaxation

During your first few weeks at home you will find that you tire easily, so adequate rest and sleep are just as important for your recovery as exercising.  

Tell your friends and relatives when you’re planning to rest. This will help cut down the amount of disturbance you get during this time. 

Try to get eight to 10 hours of sleep each night. You may find it difficult to sleep for the first week after leaving hospital as your usual sleep pattern will have been disturbed. You may also find it uncomfortable. If you do, make sure you’re taking your pain relief medication. 

You may also be more aware of your heartbeat at night, especially if you have had a mechanical valve implanted, which you may hear as a quiet ticking sound. You will get used to this over time and eventually not notice it.       

Sexual activity

One activity that is rarely brought up by patients is intimacy after cardiac surgery. Asking about sexual activity may feel embarrassing but lack of knowledge about what is safe can be a huge source of stress during your recovery. You should, therefore, talk to your surgeon and/or cardiologist about this.

It is generally accepted, according to guidelines issued by the American Heart Association, that sexual activity can be safely resumed six to eight weeks after surgery if your sternum has healed well. 

This is because movement during sex could place considerable stress on your sternum and hinder the healing process. Even after six to eight weeks, certain positions may still need to be avoided if they cause you discomfort at your surgical site. 

Sexual activity is typically equivalent to mild to moderate exercise (such as brisk walking, mowing the lawn or deep house cleaning). So it is important to gradually ease back into sexual activity, listen to your body, and keep open communication with your partner about your level of endurance and any pain you may experience.

Regarding sexual enhancement drugs, prescription erectile dysfunction drugs are generally safe if you have stable heart function but you should discuss them with your doctor before you start taking them. These medications can lower your blood pressure, which when combined with other blood pressure medications, could lead to symptoms of low blood pressure (such as dizziness, nausea, weakness and blurred vision).