Technical Aspects of the Surgery

A month ago, I had open-heart surgery to replace the aortic valve.

Ever since being scheduled for surgery, I have been interested in the technical aspects of the procedure. I didn't want to watch the surgery, as I don't really like the sight of my own blood, but because of my work as a technical writer, I have been intrigued with the actual technical procedure. So, with all that said, the following is what I observed and learned from information received from interviews and questions to both the surgeon and the critical care nurses before and after the surgery.

On the day of the surgery, and in a separate room before the surgery, two technicians prepped me for surgery by cleaning and shaving my chest, and shaving my groin area and my right leg, in case the surgeon needed to go into my leg for a vein to make an unexpected repair, which fortunately he didn't need to do.

When they wheeled me into the operating room, I noticed a white board with my name and abbreviations of the symptoms I've been experiencing. I didn't recognize most of the abbreviations, but the last one caught my eye -- the abbreviation was "S.O.B.". As they were helping me onto the operating table, I mentioned to one of the nurses that the surgeon shouldn't have the perception that he was cutting into the chest of a guy he thought was an "S.O.B.". The nurse, somewhat amused, said that the abbreviation stood for "Shortness of Breath", but just before the anethesia took affect agreed with me that maybe an "S.O.B." was going under the knife.

According to Nana Pam, the operation lasted about 5 hours, during which time I understand the following occurred:

When I was completely anethetized, a tube was inserted down my throat and I began breathing with the assistance of a heart-lung machine.

The surgeon, using a scaple, cut a 10 inch long incision along my breast bone. Once the sternum was acccessible to him, he cut through it and spread open my split sternum and my ribs to reveal my beating heart.

I'm not sure which came first at this point, stopping the heart or connecting the flow of blood to the heart-lung machine. I think the surgeon would have connected me to the heart-lung machine first to continue blood flow before stopping the heart from beating.

After the heart-lung machine was connected and the proper tubes were in place to deliver the flow of blood to the rest of my body, the heart was stopped. After the heart beat was stopped, the surgeon clamped off the aorta about two inches away from the heart, and clamped off the main arteries into the heart itself. At this time, there now existed the possiblity of dislodging a piece of arterial plaque that could travel to my brain once all was complete and the heart beat was restarted. If I had been awake, now was the time I would have started to worry a bit.

At this point, the heart-lung machine was pumping my blood and doing my breathing for me, and the actually procedure was about to commence.

The aorta was separated from the heart to expose the faulty heart valve, which was removed using a combination of scaple cuts and a tool the surgeon told me was similar to a small-sized wire cutter. The artificial heart valve had been manufactured in about three sizes, and the surgeon had previously decided that I would need a "small" or "medium" size. However, he found that neither would fit properly - the "small" was too small, and the "medium" was too large. A large amount of calcified material had built up in the valve cavity and had to be cut away to make the "medium" artificial valve fit properly. This took extra time and I'm glad that the surgical team didn't really have any place they needed to be later that morning. What the surgeon had to do to make the new valve fit brought a whole new meaning to the term "wingin' it".

The artificial valve was sewn, or "jury rigged", back into place, the aorta was sewn back to attach it to the top of the heart, and the clamps were removed. A localized electric shock was given to my heart to "wake it up" and tell it start beating again, which I'm happy to say it did. Before closing the chest up, the surgical team tested the heart to ensure that all was well, that the artificial valve was working properly, that the heart was delivering proper blood flow, and that there were no leaks in areas that had been disturbed. I hope now that these guys did a FOD check and ensured all their tools were accounted for before closing me up.

Now, at some time during the surgery, wires were connected to my heart and fed through my chest, just to the right and below the heart. These were to be connected to an emergency defibrillator if needed during recovery. Also, three tubes used to drain fluid that accumulated during and after the surgery were insert through my skin just below the sternum at the center of the belly. And at some point, a thing called a "Foley catheter" was inserted through my urethra into my bladder to drain urine during recovery.

After the heart was put back together and it was confirmed to be working properly, the sternum was positioned back into place and "wired together" - that's the term used by the surgeon. I saw these "wires" later in an image of a chest xray - they actually are three large staples holding the sternum together during mending. I should be able to feel them, but to tell you the truth I don't want to just yet - it's too soon. After the sternum was put back together, the incision of the chest was sewn up using dissolvable stitches. The drainage tubes, defibrilating wires, catheter, and the heart-lung tube down my throat were left in place.

All this in five hours. Obviously, it took a lot longer to do it than to describe the procedure.

Afterwards, I was transported to the critical care unit for the first part of recovery.

They left me intubated during the first part of recovery. My first memory after surgery is of being partially awake and feeling the tube in my mouth and fighting against it. It was soon removed and I fell back to sleep.

I have few memories of first waking up during recovery. I know my family members were allowed to visit me in the recovery room, but I have no memory of when this actually happened, and no memory of what was said. Right now, the first visit almost seems days after the surgery, but I know it was only hours.

In fact, my memory during the first two weeks is rather fuzzy, and I remember very little during these first two weeks. Nana Pam told me I had some visitors while in the hospital, and I vaguely remember them. She said that a lady from work visited once and stayed and talked with me for a couple of hours - I'm sorry that I don't remember the conversation, and in my mind that couple of hours seemed like only a few minutes. According to Nana Pam, I was coherent and talkative, but I sure don't remember any of the conversation. And she said that the program manager, my boss, visited twice on different days while I was in the hospital - and again I don't remember any of the conversations, and I would swear that the two visits were actually one visit.

At some point early in recovery I was given a teddy bear, the intended use of which was to hug it tightly against my chest whenever I had to cough or sneeze. Coughing was severely painful in the middle of my chest at first and the teddy bear helped keep my sternum from popping open - at least it felt like it was going pop open. But I never sneezed while in the hospital. The first time I sneezed was at home during the second or third week of home recovery - and I thought the world was coming to an end. The pain was so great it brought tears to my eyes and I began weeping and I didn't want to do anything for pretty much the rest of the day. After week five of recovery, the pain from coughing is tolerable. But, sneezing still ain't a favorite thing on my list.

The teddy bear was a constant companion while in the hospital. When not hugged during coughing/sneezing, I kept the silly thing between my legs covering up what the hospital gown readily exposed. The teddy bear was not only my constant companion to guard by sternum when I coughed, it also served as a kind of "crotch guard" during visitations (if you know what I mean).

So, at this point, I had two wires coming out of my chest, three drainage tubes protruding from my belly which were hooked up to a collection device, and a "Foley catheter" in my . . . you know . . . (don't make me say it). These stayed in for at least two days after the surgery. Although I don't remember the exact day, these were all removed while I was still in the critical care unit. And even though I don't remember the exact day, I DO remember quite clearly the removal process. Not much pain was involved, but I most certainly remember the event. The process was quite simple: a nurse pulled the tubes and wires out one at a time. The wires came out easily, but the tubes required aggressive pulling. Like I said, not much pain was involved, just a weird feeling of discomfort. One of the drainage tubes didn't come out at first, and the nurse told me that if it continued to be a problem, a surgeon would have to "go back in" to surgically remove it. Well, I didn't want to be cut open again, so I told her to try again and if necessary to have Nurse Burley to come in and help. After about the fifth time and with even more aggressiveness, the tube finally came out.

Now, as for the "Foley" catheter, that was last to come out, and it was the weirdest of them all. I won't explain the details of the removal, let's just say that all sexual thoughts were completely absent from my mind. I'm just glad I wasn't awake when they inserted the thing.

There are some things I do remember about my stay in the hospital, things like the room service type meals, that were absolutely fabulous. And I remember sleeping a lot. And I remember needing a shower after five days without one. And I do remember being discharged from the hospital and getting home exactly seven days after the surgery. One week. When I was a kid, any body who was admitted into a hospital for a surgery of any kind was admitted for at least a month, or so it seemed. It's remarkable just how much things have improved over the years. Maybe it is just good living on my part, but it seems I left the hospital sooner than expected. According to the nurses taking care of me, most patients having open-heart surgery are carried into the hospital on a gurney and are bed-ridden during their entire stay of two or three weeks, and then have to be wheeled out of the hospital to undergo hired home health care for a few months more. In my case, I walked into the hospital, had surgery, stayed a week, then walked back out. Except for the occassional trip when Nana Pam had to drive me to followup reviews and procedures during the first four weeks, I have been able to take care of myself at home. And according to Nana Pam, the recovery at home has been easier on her than originally expected - she originally thought I would need a lot more care and attention.

As I said, I can pretty much take care of myself at this point. The doctor told me earlier in the week that although I can now drive, I still need to limit any rigorous exertion, and that I'm still limited to 5 pounds lifting, pushing, or pulling for at least two more weeks. And I'm real careful about that - I'm not too bashful about letting Nana Pam open doors for me. The last thing I want is for the sternum to not mend properly. I have found that although I have muscle aches in the upper chest and back (due to the rib cage being spread open during the surgery), I feel much better and the blood flow is much better.

Hey, an open-heart procedure ain't elective surgery, but if you need a new ticker or a valve job, I highly recommend the Oklahoma Heart Hospital to do the job.