In typical fashion the surgeon will bring the breast bone back together using wire. This helps the stability of the bone during the recovery process. Around 6-8 weeks are expected for the bone to heal properly (without any complications), while recovery from an open heart is variable from person to person.
Following surgery, your physician may ask to you complete a cardiac rehab program and/or implement sternal precautions, both can vary from physician to physician, as well as facility to facility.
You may encounter many faces during your hospitalization. All are working together to get you back to your normal daily activities as soon as possible. The team can consist of physical and occupational therapy, dietary, social work, cardiac rehab specialist, pharmacists, and respiratory therapists. While it may seem overwhelming, they are all there to benefit you.
Following your surgery, you will be admitted to the ICU. Here you will be given time to awaken from anesthesia, and have the breathing tube from surgery removed. Here your vital signs will be closely monitored, and family can have short visits. When you are deemed stable from the doctor’s standpoint, you will be moved to the step-down or general surgery unit to begin your recovery. Currently, research has shown getting out of bed and becoming mobile while adhering to sternal precautions sooner, can significantly decrease postoperative complications. Some of these would include sternal wound infections, pulmonary complications, and persistent (chronic) pain.
What are sternal precautions you may ask?
Sternal precautions are designed to help prevent separation of the breast bone during the healing process. While these can vary from doctor to doctor, most common can be found in the list below.
- No lifting anything weighing more than 8-10 pounds
- No Raising arms or reaching over your head
- No Reaching behind your back with arms
- Stopping the activity if you hear any clicking/popping in your chest
- Avoid pushing or pulling with your arms
- Minimizing stair rail use
Immediately after surgery, you may often find it painful to sit up from a lying position or to stand up from a chair. Your physical therapist may show you alternative methods to assist you with this to minimize pain and protect your incision. It may be recommended to use an external chest support device to ease pain associated with movement, coughing, and sneezing.
A system that provides both a constant circumferential chest support, and additional on-demand chest surrounding support, can help minimize the risk of the complications as described above. In the diagram below you can see a variety of ways to move safely using the latest research philosophy of “Keeping it in the tube”.
The left side of the Keep, Your Move in the Tube graphic contains visual tips for staying “in the tube” while performing commonly recommended techniques for getting out of bed. Examples are: side-lying and placing one or both hands in front of the body, leaning forward, and pushing up to a sitting position; leg rolling; and/or the elbow method (leg rolling and counterweighting).
As you can see on the right side of the graphics upper arms and elbows are kept close to the body while performing activities, as to not put a strain on your incision area. You will find you begin to use more of your leg muscles than arm muscles, you may even experience soreness in your legs from this.
By learning and practicing these techniques, they can be applied to progress your recovery. You may have set goals of walking, activities of daily living (dressing, grooming, etc) to be considered for discharge from the hospital.
Discharge from the hospital will be dictated by many factors determined by your doctor. Examples of criteria for hospital discharge may include: normal heart rhythm, absence of wound infection, normal routine blood tests, satisfactory chest X-ray, and full mobility. Toward the end of your hospital stay, the therapy team's assessment of mobility status is a major determinant of whether a patient needs rehabilitative care after being discharged. Instead of going home with a doctor’s referral for outpatient cardiac rehabilitation, they may suggest you for an inpatient rehabilitation facility for a short time.
Although it may be difficult to start a cardiac rehabilitation program when you're not feeling well, it can benefit you in the long run. Cardiac rehabilitation can guide you through fear and anxiety as you return to an active lifestyle with more motivation and energy to do the things you enjoy. Here you will continue to build strength and endurance to prepare to go back home. It will also guide you when you are ready to resume such household responsibilities such as laundry, washing dishes, cooking, light cleaning, and even driving yourself.
Remember during your recovery to using common sense is the best way to keep yourself from overdoing it. Cardiac rehab is very beneficial to restore your health and guide you on how to change lifestyle habits to help prevent future heart problems or conditions.
“According to studies, people who go to cardiac rehab have up to 30 percent fewer fatal heart events, and are 25 percent less likely to die compared to people getting standard therapy alone.”
After around 6-8 weeks following your surgery, your breast bone and incision should be well healed and your activity has probably progressed well. Your doctor may release you to start driving, completing household cleaning, resuming sexual activity, and even light cardio exercises. Activity levels and healing times may vary for each patient, always listen to your body, stopping an activity if needed. Common post-surgery activity is walking (start with 5-10 minutes at a time, and increase every few days by 5 minutes), recumbent bike (no resistance, easy pace for 10 minutes increasing time as tolerated).
- lifting weights -- hand weights, free weights, or weight machines
- using a wall pulley
- using elastic bands or body weight
Generally, these activities are recommended 2-4 times a week, with each session lasting from 30-45 minutes as tolerated. Always discuss with your doctor prior to starting an exercise program following heart surgery.
Depression and anxiety are common among people with heart disease or who’ve had a heart attack or heart surgery. There many resources available to help prevent feelings of depression and anxiety located both in the communities and online. As responsibilities may have shifted at home, staying in communication with those closest to you, and verbalizing feelings can alleviate symptoms. Many people find that keeping some sort of routine is very helpful for staying positive during recovery, too. Routines can include whatever keeps your spirits up, provided you have your healthcare providers’ okay.
Sample daily routine:
- Try to get at least 8 hours of sleep each night. Go to bed at the same time each night.
- Wake up and shower each morning at approximately the same time.
- Weigh yourself daily.
- Get dressed in regular daytime clothes. This will make you feel more like being active.
- Eat breakfast.
- Take your medication.
- Plan your day during breakfast to help you from getting too tired.
- Follow the walking plan provided by your physical therapist.
- Avoid prolonged naps in the daytime—they may prevent you from sleeping at night.
Great support groups with those who have had similar procedures can be found, here are a few links to reach out.
Incorporating social and exercise activities can also help alleviate symptoms of depression. If you feel you are not able to control the feelings of depression or anxiety, it is recommended to talk to your doctor for options such as medications or behavioral therapy counseling.
As you make great strides in your recovery, take time to celebrate little victories. Maybe you walked for 30 minutes and didn’t get short of breath or stopped to take a break, congratulate yourself. Maybe your heart doctor gave you praise for how well you have done during your recovery, treat yourself or pamper yourself with something you enjoy. Heart surgery can fix immediate concerns of the heart, however, long term recovery involves fighting any potential risk factors (i.e. family history, dietary and exercise habits) in an ongoing fashion. Healthy lifestyle changes make a big impact on your future health and preventing complications down the road. If you stick with what you learn in your cardiac rehab program, you may soon find you are feeling even better than before you had a heart condition or had heart surgery.
- Cahalin, L et al. Sternal precautions: is it time for change? Precautions versus restrictions - a review of literature and recommendations for revision. Cardiopulm Phys Ther J; 22(1): 2011: 5-15.
- Balachandran S, Lee A, Royse A, Denehy L, El-Ansary D. Upper limb exercise prescription following cardiac surgery via median sternotomy: a web survey. J Cardiopulm Rehabil Prev. 2014;34(6):390–5.
- Baylor Heart and Vascular Hospital (Adams, J et al. An Alternative Approach to prescribing sternal precautions after median sternotomy. Proc (Bayl Univ Med Cent). 2016 Jan;29(1):97-100.