Frequently Asked Questions:

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Questions About Recovery After Surgery

It depends on many things but most patients do tend to have some incisional pain during this period. Most patients leave the intensive care unit (ICU) the day after surgery. Our focus will include making the patient comfortable with appropriate pain medications. With the robot approach, I have noticed most patient’s pain is reduced after the first two day (although not in everyone). We may remove drainage tubes or pacing wires (temporary pacing wires). We also use them time to manage any complications that may occur, such as bleeding.

Most patients can travel or fly within 1-2 weeks following endoscopic robotic mitral valve repair or similar procedures. Of course, everybody responds differently to surgery and some may not be able to. If a patient has complications from surgery this could delay the ability to travel significantly. But if all goes well, 1-2 weeks for travel is a reasonable expectation. To travel, the patient needs to be off narcotic pain medications for the most part, walking easily, and have an energy level that will allow for the travel. My personal view is that most patients know their bodies better than I do and can help make these judgments with me.

A typical patient will stay in the hospital for 2-3 days after surgery. Not all patients are discharged this early for a variety of reasons. Most patients are 80-90% within 1-2 weeks. Some patients take longer to recover. There are no special precautions after surgery (unlike standard heart surgery done through the breastplate) other than to avoid driving until off of narcotic pain medication. Patients have returned to full activity within 1-3 weeks but some take longer. I generally advise patients to tell their employer that they may need to be out of work for a month, but many of my motivated patients have returned much earlier.

The short answer is nothing. Scarring is different in different patients. Keeping the wounds clean with soap and water will help prevent infections which can lead to increased scarring. We recommend showering daily immediately after arriving home but no bath tub for a week.

Some patients develop excessive scarring known as keloids. If a patient is prone to this, steroid injections can be given to reduce the risk. However, keloids are less likely to occur in the locations of the incisions that we make so this may not be as helpful. The good news is the incisions are tiny compared to traditional open surgery done through the breastplate so even if there is scarring they will be small.

Additionally, the incisions are in a fairly hidden location (right arm pit area and the right or left groin area for robotic mitral repair for instance) so the cosmetic result of these procedures is dramatically superior to a traditional “zipper” wound down the middle of the breast plate. I don’t like to use cosmesis as an argument to do these robotic endoscopic procedures but it is a clear advantage.

It depends on your condition and the procedure you underwent. However, most patients with see me 2 weeks or so after discharge and then follow-up with their cardiologist long-term. Of course, any complications that occur may require additional visits. For mitral valve repair patients, I like to have the cardiologists perform an echocardiogram at 6 months, 1 year, and then yearly so that we can get direct feedback on the repair that we performed and alert your medical team if any problems arise that might require treatment.

This is difficult to predict. I can say that in patients who have an uncomplicated course, a return to work within 2 weeks is entirely possible depending on your job. Some have returned to work even early. However, some patients need up to 6 weeks to recover. It all depends on the patient, their age, whether they had complications, or other factors.

My general recommendation is to tell your employer that you could be out as long as 6 weeks but may be able to work as early as 2 weeks depending on how things turn out. One thing is for sure: endoscopic robotic heart surgery allows for an earlier return to work in most of my patients than would be possible with traditional large incision surgery. If your focus is to get back to work early, an operation such as robotic mitral valve repair is your best chance to do this.

This is a common question. The patient can take a shower as soon as they get home. I generally recommend waiting 1 week before getting into a bath tub, hot tub, or pool to give time for the incisions to “seal off”.

It is important to keep the wounds clean with soap and water (gently) to prevent infection.

The simple answer is yes. The pain should be much less than for patients who undergo a standard operation through the breast bone. Most of the pain seems to abate within a few days. We usually do a local anesthetic pain block the morning of surgery which seems to reduce the pain significantly. Most patients are off narcotic pain medication within a week or so although results vary.

One of the major potential benefits of robotic cardiac surgery is that restrictions after surgery are minimal compared to traditional sternotomy (breast plate division) surgery. I currently recommend no driving or working until off narcotic medication. This amount of time various greatly but is often between 1-2 weeks. After a standard sternotomy procedure, we usually advise patients no lifting, driving, or major physical activity for 6 weeks minimum to allow the bone that has been cut to heal.

It is very important to understand that the recovery period that patients need varies greatly depending on the patient, the procedure, whether complications occur, and the patient’s unique reaction to undergoing the procedure. However, in my experience, you best odds of a fast recovery after surgical mitral valve repair, would be a totally endoscopic robotic approach.

reat question! It depends. Any medications you were taken for conditions other than the one the surgery is treating may need to be continued. In the case of a robotic mitral valve operation, I usually recommend 3 months of adult strength aspirin and a blood thinner. After that, a baby aspirin for life is not mandatory and I recommend it. Your cardiologist will evaluate you after surgery and decide what needs to be continued. For coronary surgery, I recommend at least an aspirin a day, a beta blocker, and a statin (if tolerated) for life although every patient is different. Again, your cardiologist will have to review your medications and give you guidance on the specifics.

For the MAZE procedure, my goal is to get you off antiarrhythmic and blood thinner medications. It depends on the individual patient and whether the procedure was successful or not in eliminating atrial fibrillation.

You should have a detailed discussion with your cardiologist and your surgeon regarding this important question.

T. Sloane Guy, MD

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