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Heart surgery and transplant
Cardiac operations can be either corrective or palliative. Examples of corrective procedures include repairing or replacing heart valves, relocating the major blood vessels of the heart to their correct position, or patching a septal defect. Palliative procedures are generally performed to improve circulation. For instance, a surgeon may reroute, or shunt, an artery that normally supplies blood to the arm to the lungs instead, as in the Blalock-Taussig procedure. This procedure allows the blood to pick up more oxygen before circulating to the rest of the body. Another example of a palliative surgery is placing a constricting band on the pulmonary artery to decrease blood flow to the lungs.
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In most heart operations, the surgeon makes an incision in the center of the chest to operate on the heart. Less-invasive incisions can also be made on the side of the chest when appropriate. A cardiopulmonary bypass machine is usually needed to take over the functions of the heart and lungs during the procedure on the heart. Once the procedure is completed and the surgical team is satisfied that the heart is beating strongly, the cardiopulmonary bypass machine is disconnected and the chest incisions are sutured closed. Heart operations usually last two to four hours, but complex procedures may last longer. After heart surgery, all patients are moved to a surgical intensive care unit (ICU) to begin the recovery process.
Recovering from heart surgery usually takes six to eight weeks before patients can return to their daily routine. The first five to seven days are spent in the hospital, starting in the intensive care unit. In the ICU, the patient's condition is constantly monitored using several surgically inserted tubes and drains to record fluid uptake and loss as well as assist with breathing. Sleeping in the ICU can be difficult for patients; visitors may find this environment distracting. It's not uncommon for patients to appear pale or swollen, or even become temporarily confused during this stage of recovery. Once the patient's condition has improved, most of the tubes and drains will be removed and the patient will be moved out of the ICU to complete the hospital stay in a bed equipped for continuous cardiac monitoring.
Before discharge from the hospital, members of the healthcare team will discuss the at-home recovery plan with the patient. Written instructions for diet, pain management, incision care, physical therapy, medications, and followup appointments will be provided. Activity restrictions including driving, heavy lifting, and showering will also be covered. Pain management is an important aspect of recovery, allowing patients to perform simple functions such as coughing, breathing deeply, and walking that are important steps to recovery.
Emotional responses to heart surgery vary widely due to the stress of operation and medication. These events may trigger feelings of denial, distress, fear, anger, and even depression. For most people, these feelings are temporary; however, if they persist, discuss them with a member of the healthcare team.
Heart transplants are occasionally needed for babies born with multiple defects that are too complex to repair or for older children and adults whose hearts have experienced irreparable damage. Although the procedure itself is straightforward for an experienced surgeon, recovering from a heart transplant involves significant medical monitoring and followup care. Heart transplants require a lifelong commitment from the patient to daily medications, regular medical visits, and a healthy lifestyle.
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