These notes have been prepared by me based on my experience with patients in England and of late in India. I have tried to answer the most common questions that come after such operations. I hope you find this useful !

These notes have been prepared for you to take home, so that you and your close family can consult them as and when the need arises. In the next few days you will be leaving the hospital after your heart operation, but your recovery is not yet complete. Advice will be given to you on what to do & what not to do, but it is difficult to memorize everything, especially soon after a major operation. An attempt has been made to cover the most likely questions that might crop up in the next few weeks and to give some general advice that will help you complete your recovery quickly and stay well in the months and years to come. Sister or one of her staff Nurses will give you these notes and introduce you to them. Members of the team will help by explaining parts of them to you if they do not seem clear. Remember that some patients know quite a lot about medicine and how the body works, others know very little. If some of the explana- tions seem too simple or too complicated for you, please understand that intention is to make the meaning clear to as many as possible.

What actually happens at your heart operation :
More than half of heart surgery patients have operations to bypass blocks or narrownings in their coronary arteries. You have had this operation & you will probably have received the the following explanation before surgery. Narrowing or blockages in the coronary arteries prevent sufficient blood reaching the heart muscle. Veins from the leg, and sometimes an artery from inside the chest or from other parts of your body (the mammary artery or other arteries),have been used to bypass these narrowed arteries so that blood now flows through the new channels and reaches the heart muscle freely once more. It is expected that this will relieve angina and may also reduce the risk of a major heart attack.

Your chest incision :
To operate on the heart, an incision through the chest is necessary. This means dividing the chest bone, on sternum. The bone is wired together afterwards. The wires or sternal sutures remain forever and usually can be forgotten. The amount of pain is variable, but some discomfort around the chest and shoulders will persist for a few weeks. Following the physiotherapist’s exercise plan should help and you may be glad to have the help of a mild pain killer such as proxyvon or voveran. These pain killers are non-habit forming and can be taken as frequently as advised (usually not more than thrice a day). Generally as the days go by, the amount of painkillers required should reduce. If the pain persists or does not seem to reduce please consult your surgeon.

Some amount of clicking or a sensation of movement in your breast bone is to be expected during the recovery period especially when you cough or sneeze or turn in your sleep. This is because the sternal bone like a fracture anywhere else in your body takes at least three months before it is soundly healed; you are strongly advised not to lift anything over about ten pounds in weight during the period.

Inflammation:
Redness and inflammation around the wounds should usually have receded by the time you leave hospital. However, sometimes there are small remaining areas. If these are close to wound edges they are not usually important. Your doctor can advise you.

Stitches appearing later:
Occasionally, patient’s report that it looks as though a “stitch” has Come out from the wounds. This does happen and it is of no importance. The body usually absorbs this material but, sometimes it remains beneath the skin and emerges later. If the stitch is troublesome, arrange to see your surgeon, who can remove it immediately.

Leg incision:
Those who have had a vein bypass graft will also have an incision in the leg. In order to obtain the very best material available for construction new blood vessels to the heart, a length of your own vein, called the ‘long saphenous vein’ has been taken from your leg. Usually the cut extends from the ankle, up the leg to the thigh. The position of the cut and its length is of no particular significance as
far as the heart operation is concerned because we need the vein for an important job we try and use the best part of it.
Like all wounds, this can be rather sore, especially around the knee and the ankle. This is normal and settles down with time, but you may need to use some mild pain killer in the meantime. By the time you leave hospital healing should be well underway. There are a few things which may well cause you some concern after you have gone home so we have listed some of the common ones.

Swelling :
The leg from which the vein was taken often has a swelling, usually
around the ankle and the foot. It is most obvious towards the end of the day and is usually gone in the morning, after a night in bed. The
reason for this swelling is that the veins are responsible for returning fluid to the circulation, and since the saphenous vein has been removed one of your other veins will take over this job usually over a period of three months.

In the meantime the following advice should be followed :-

• When you are not actually up and about, it is helpful to sit with your leg up, so that the foot is higher than your bottom. This encourages the fluid to drain more readily away from the leg.
• The support stockings which you had in hospital are helpful in reducing this swelling. They help keep the fluid from accumulating in the tissues. At this stage you may not want to wear them in bed but instead, you could put on just one stocking, on the affected leg, when you get up.
• In general, it is wise to avoid the habit of crossing your legs for a while as this restricts the normal flow of blood in the veins.

If the swelling is worse than this description suggests, or if it is associated with a lot of pain or redness, then the advice may not be appropriate and you should consider consulting your surgeon. If this is a new thing for you, tell your doctor.
Numbness :
Around the lower end of your leg wound there may be a small area which feels rather numb. This is because a small nerve, which runs to this area of the foot and ankle, lies immediately alongside the vein and often fails to function after being disturbed. The numbness always improves and usually disappears completely over a period of time.

Hand Incision:

Most of the patients will also have a wound on their left/right forearm. This is the site from where the RADIAL ARTERY has been harvested. Removing this artery has no harmful effects on the function of your forearm, as the other artery (ULNAR) takeover the job of the radial artery. However, a small nerve that supplies the skin over your thumb usually gets disturbed causing some numbness in that area. Please do not worry, as this is not serious and is usually temporary (may last 6-8 weeks) .