Consider for a moment the scientific miracle that is open-heart surgery: A team of doctors and nurses crack your chest open, reroute your blood through a machine that substitutes for your heart and lungs, and then literally stop your heart for long enough to fix what's broken in it. If all goes to plan, you're back at home and back on your feet in a matter of days. 

But that miracle is not without cost. Slicing into any of the body’s organs is serious business, and slicing into the heart is particularly fraught. Even as arteries are unclogged and faulty valves repaired, a cascade of reactions can be set in motion that may usher forth a string of grim effects: irregular heartbeats, memory loss and other cognitive deficits, internal bleeding, and—perhaps ironically—heart attacks and strokes. In October, health officials added another risk to that list—a rare but deadly bacterial infection that can stem from a device used to cool patients' blood during open-heart procedures.

It can be tempting to shrink in the face of such awesome power and risk, especially given that chances of suffering any one of these surgical side effects depends on a host of factors (like age, gender, and whether you suffer from certain medical conditions) that are well beyond your control.

But don’t despair. There are many simple steps you can take to minimize your risk and maximize your recovery. We consulted several medical experts on the most important ones.

Prepare Yourself

Quit smoking and drinking at least two weeks before your open-heart procedure. Both can delay postsurgical healing, and drinking in particular can impair your immune system, liver function, and natural blood coagulation—all of which increase your risk for surgical complications. 

Start your deep breathing exercises early. Your care team will give you a device called an incentive spirometer (IS), which helps you take slow, deep breaths, before your surgery. Use it as much as possible (every few hours, even). Research shows that deep breathing exercises beginning a few weeks before surgery can reduce the risk of pneumonia and other lung problems after surgery.

See a dentist. Physicians and dentists often collaborate to manage dental issues—especially abscesses and infected teeth—because those conditions can trigger endocarditis (an infection of the heart's lining) in surgical patients. The debate over whether infected teeth should be extracted before open-heart surgery is a muddy one, but you should make sure your surgeon knows if you have any dental issues. 

Eat well and exercise. The better you take care of yourself before surgery, the better your recovery will be afterward.

Do your homework. During your your final presurgery appointment, your doctor should provide information describing what to bring to the hospital, what time to stop eating the night before your operation, and which medications to take and which to skip that morning.

It may also include instructions for how to wash yourself before surgery (many hospitals will provide you with antibacterial soap and ask you to use it the morning of your operation), and what to expect for your specific type of open-chest surgery (different operations carry different risks, and come with different postsurgical aches and pains).

Being aware of the basics will help relieve some of your uncertainty and anxiety.

Appoint a point person. It’s also a good idea to designate one family member to speak with the healthcare team and relay information back to other loved ones. You should talk with your immediate family before open-heart surgery and make sure your surgical team has your designee’s name and contact information.

Heal Your Body

Keep in mind that recovery will take months, not weeks. "You may not feel like yourself for up to six months," according to a patient handbook put out by the Veterans Affairs. "This is normal."

Mind your incisions. You should shower every day after your surgery. But don’t scrub; instead, let the soap and water trickle down over your incision. When you’re done, pat the area dry (as opposed to rubbing it). Those precautions will help keep the sutures intact.

Don’t panic if your surgical dressing peels off. Most surgeons will cover your incisions with a super-glue-like dressing, meant to keep them clean and dry; but that dressing is meant to peel off over time.

You should call your doctor immediately if you develop any of the following: a fever greater than 100.5 degrees F, chills, redness around your incision (especially if you had valve-replacement surgery), drainage or foul odor from the incision, painful urination, or a new inability to urinate. All of these are signs of a surgical infection and require immediate attention.

You should also see our guidelines on the risks of heater-cooler infections, and make sure your doctor knows that such infections, while rare, can emerge weeks to years after surgery.

Eating and sleeping. It’s normal to feel tired after surgery, so plan on extra rest and lots of naps. And while you should generally avoid stretching your arms over your head—especially in the first week after surgery—it's okay to sleep in that position if it's more comfortable for you.

Likewise, don’t be surprised if you lose your appetite. In the first week or so, focus more on foods that taste good and are easy to digest than on strict dieting. Of course, once your appetite improves, you should stick to a low-fat, low-sodium, low-cholesterol diet.

Movement do's and don'ts. Do walk as much as you can. Try walking when it's cool outside, and if you can, work up to a full mile in your first week or so after you return home. From there, slowly increase the distance as your health allows.

Don’t lift anything heavier than 5 pounds (roughly the equivalent of a gallon of milk) for the first six to eight weeks; heavy lifting can hurt your sternum, which will still be recovering from the cracking it received during surgery.

Don't push or pull anything with your arms if you can help it.

Do cross your arms and hold your elbows when you sneeze. 

 

Heal Your Mind

Expect some depression. Doctors aren't entirely sure why, but many people report feeling weepy and sad in the first few weeks after open-chest surgery. Those feelings should pass as your body heals, but in the short term, there are steps you can take to combat the post-surgery blues: keeping friends and loved ones close, making sure you rest as much as needed (see above), and exercising, though you should only do as much as feels good, especially in the first six weeks after surgery. If the depression persists, your doctor may prescribe antidepressants to help you through the rough patch. 

Watch for anxiety. Pain and anxiety often work in a feedback loop: pain might make you anxious (because, what does it mean? Is something not healing right?). And anxiety might in turn worsen your pain. The best thing is to manage both at the outset.

Yes, pain medication can be addictive and no, you don't want to take those pills for any longer than necessary. But you also don't want to be a pain-pill martyr. "You may slow recovery when you try to tough it out," according to the Mayo Clinic patient education brochure. So take the prescribed pain medications as needed—that is, follow your doctor's instructions carefully.

And if you’re feeling anxious or if you're prone to anxiety, try some relaxation and distraction techniques that have been shown to work

You may feel fuzzy. Patients who have traditional bypass surgery—where the blood is rerouted through a heart-lung machine while the operation is being performed—often suffer from cognitive aftershocks. Trouble concentrating, impaired motor skills, and delayed response times are among the chief complaints. These symptoms generally pass within the first six weeks after surgery. But in rare cases, and for reasons that doctors have yet to understand, they can linger or become permanent.

When they can, some surgeons will perform bypass surgeries "off-pump," that is, without rerouting the blood through a heart-lung machine. This approach (also known as "beating heart" surgery, because the heart is left to beat while surgeons operate on it), can reduce the risk of cognitive deficits.

But not every patient is a candidate, and doctors can't generally tell which patients are—or are not—until they've opened the chest and gotten a better look at the heart. Talk to your surgeon if you're concerned about the cognitive effects of traditional bypass surgery. 

When to Call Your Doctor

If you develop any signs of infection (described above), let your follow-up care team know as soon as possible. Also let them know if you experience any of the following:

  • Weight gain of 3 pounds or more in a two- to four-day period.
  • Leg swelling that gets worse or that doesn’t improve with elevation.
  • Shortness of breath, chest pain, nausea, vomiting, or dizziness that isn’t relieved by medication.

All of these symptoms can be signs of congestive heart failure and require immediate attention.