Is it necessary to dress the wounds after being discharged from the hospital?

Wounds do not need to be dressed after being discharged from the hospital, unless expressly indicated in the discharge note. If wound dressing is necessary, it is performed by medical staff. Using disinfectants, creams and ointments without consulting a competent surgeon is not recommendable.

When and where should sutures be removed from postoperative wounds?

The date when the suture removal from the wounds is recommended will be clearly indicated in the discharge note. Sutures are removed at the regional health center or at the Vascular Surgery Outpatient Unit within our Institute.

Is it necessary to follow a special diet after surgery?

During the postoperative course of recovery coming immediately after the intervention, the diet is controlled by the competent staff of the Institute. Taking food and drinks prepared outside the hospital is allowed with the prior permission of the staff. After being discharged from the hospital, it is necessary to adopt and follow a moderate diet, without heavy food and with predominantly boiled foods and plenty of fruits and vegetables.

What therapy should be taken during the period spent in the hospital?

Doctors prescribe adequate therapy during the patient’s stay in the hospital. All necessary medications will be administered to you by the medical staff. It is absolutely forbidden to take any medications and therapeutic agents on your own.

Are there any restrictions regarding physical activity after surgery?

After the operation, any form of hard physical work should be avoided. Moderate physical activity is recommendable after all types of operations, such as a relaxing walk in the period of 45 minutes. After certain time (depending on the type of surgical procedure), in consultation with the attending surgeon, the patient can return to his/her everyday physical and other activities.

When are visiting hours of the hospital?

The visiting hours at the Department are every day from 3 p.m. to 4 p.m. Children under the age of 12 and persons with infectious diseases are not allowed to access the Department. Visits to patients in the Intensive Care Unit are prohibited, except with the special permission of the medical doctor.

What are the possible ways to obtain information about the condition and course of treatment of patients?

Every weekday in the morning, it is possible to request a meeting with the patient’s doctor in order to obtain information about the current condition of the patient and about further course of treatment. It is necessary to be registered at the counter at the entrance to the hospital and wait for the doctor who will be at your disposal in accordance with his/her obligations.

When is the heart valve surgery performed?

Surgical intervention on the heart valves is performed when they have lost their function, or when they are significantly narrowed or leak blood at the stage when they should be closed.

When is the coronary artery bypass surgery performed?

When the stenosis of the large branches of the coronary arteries is significant, and when it prevents blood from reaching the heart muscle to bring oxygen and nutrients.

Are there any medications I should stop taking before being admitted for surgery?
The patient should not change the prescribed therapy on his own, but only after consulting his/her medical doctor. Medications such as Aspirin (Aspirin, Andol, Cardiopirin, Brufen, etc.) can cause excessive bleeding during surgery. Therefore, the patient should stop taking these medications at least 7 days before surgery. The same goes for drugs such as Plavix. If you are taking anticoagulant medications such as Sintrom, Farin, Coumadine, Sincum, etc. be sure to consult your medical doctor before any change in treatment regimen.

What examinations should I undergo before being admitted for surgery?
During the clinical examination in the cardiac outpatient unit, a list of additional examinations and necessary laboratory analyses required for the purpose of preoperative preparation will be provided to you at the cardiac surgery institution where you are going to receive your treatment. Most often, it is necessary to do an ECG, chest radiography, blood count with leukocytes differential count, biochemical analysis of blood and urine (urine and urine culture), blood type and blood test for communicable diseases, bleeding time and coagulation time. Nasal and throat swabs are sometimes required. Patients undergoing heart valve surgeries should have a settled dental status and should provide a certificate from their dentist. For patients suffering from other chronic concomitant diseases, other additional examinations will probably be required as well as the opinions of the attending medical specialist who treats the patient.

When should I quit smoking?
Smoking is extremely detrimental to the cardiovascular system and is one of the main risk factors for heart and blood vessel diseases. Therefore, you should quit immediately. Smoking also causes chronic lung diseases, which further increase the perioperative risk. Quit smoking now!

What types of physical preparations should be done before the operation?
Physical activity of cardiovascular patients depends primarily on the individual primary cardiovascular disease, but also on the general condition of the patient and his/her concomitant diseases. The level of physical activity should be determined in consultation with the attending cardiologist. No additional physical preparation is required or recommended for cardiac surgery.

How long does heart surgery take?
Heart surgery is one of the most complex surgical interventions. The duration of the operation depends on the complexity of the findings, but also on other non-medical factors such as the preparation of the operating theatre, changes in the patient’s condition, etc. Due to all this, it is difficult to predict the duration of the operation. The average time required for heart bypass is between 4 and 5 hours.

When will I wake up after surgery?
Patients should wake up a few hours after the operation, but most patients will be fully aware and able to breathe on their own the morning after the surgery.

How long will I remain in the intensive care?
The stay in intensive care unit lasts from 24 to 48 hours. In more complex cases, the stay in the intensive care is extended, until the general condition stabilizes, and the ability to reach the next stages of recovery is achieved.

How long will I stay in the hospital after surgery?
The patient usually goes home 7 to 10 days after heart surgery, but the length of hospitalization is generally individual, and can be extended in some cases.

When can I bathe after surgery?
Maintaining personal hygiene is important at all times after surgical treatment and is performed immediately after surgery by medical staff, while the patient is in the hospital. After being discharged from the hospital, personal hygiene should be maintained at home, without allowing water to come into direct contact with surgical wounds, by rubbing the body with a sponge and a mild soap solution. After removing the sutures, i.e. 10 to 14 days after the intervention, showering and/or bathing is allowed without any restrictions, unless the surgeon or cardiologist indicate otherwise.

Why do I have to sleep only on my back after surgery?
In order to access the heart, it is necessary to cut the sternum, and it takes 4-6 weeks for it to heal. During that time, regardless of the steel wires that fasten it, you should avoid sleeping on the side. If you happen to turn on your side during the night, you should not panic about the possible consequences. During this period of sternum healing, it is necessary to avoid carrying heavier loads in your hands, as well as all activities that additionally burden the pectoral muscles and shoulder muscles. During the early rehabilitation, which is performed in the hospital after the operation, physiotherapists will inform and educate you about everything listed here.

What kind of physical activity can I have after leaving the hospital?
During the first month after the intervention, physical activity is recommended in accordance with individual abilities, up to the fatigue limit. The patient should behave in accordance with his/her abilities, but should not test his/her strength and exhaust him/herself over the fatigue limit. Over time, the strength and general fitness should be restored, and accordingly your physical abilities. Relaxing walks and distances that do not cause exceeding the fatigue limit are recommended. It is necessary to avoid extreme temperature changes, i.e. before leaving the house environment, it is necessary to adapt to the outside temperature. Always adapt clothes and footwear to external weather conditions. During the rehabilitation in one of the specialized centers, an exercise stress test will be performed, after which the doctors will advise you on the regime of further physical activity.

What diet should I follow after the operation?
What diet should I follow after the operation? Immediately after the operation there are no dietary restrictions, except for concentrated sweets and foods rich in trans fatty acids (industrially processed foods), or if the specific condition and/or the presence of other diseases (diabetes, kidney diseases, gout…) requires a special diet. General recommendations regarding quality nutrition also apply. Consuming nutritious food will lead to faster and better recovery after surgery. The future diet must be customized, which means tailored to your personal characteristics (age, sex, underlying cardiovascular disease, concomitant diseases, lifestyle and work, current therapy…). Therefore it is best to consult with the medical doctors who specialize in this field, i.e. with a nutritionist.

Can I consume alcohol?
Alcohol consumption can significantly modify the effect of medications you use, i.e. it can weaken the effect of some medications and strengthen the effect of others. Alcohol consumption is absolutely forbidden during the first two months, and it is recommendable to abstain even after that period of time, since most patients will have lifelong chronic therapy. Social drinking (occasionally on special occasions) is allowed, but it is necessary to discuss this with the attending doctor, who will explain how alcohol affects the medications you use and what effects you can expect.

Can I have tea and coffee?
Consumption of coffee, as well as hot beverages made of tea plant (white, green, black tea) is not recommended during the first month after surgery, due to active substances they contain, which may affect your cardiovascular characteristics. If you cannot completely refrain from consuming them, prepared solutions should be of milder concentrations. After the first month of recovery after surgery, it is recommended to consult your doctor regarding further consumption of these beverages, and to limit your daily intake to 1-2 cups.

I have an artificial valve and I take Farin (Sintrom 4, Sincum…) – can I eat salad and other leafy, green vegetables?
Consumption of leafy green vegetables, as well as other green and red vegetables, rich in vitamin K, may require higher doses of medication used as oral anticoagulant therapy, in order to maintain INR values within the recommended therapeutic range. The intake of these vegetables is not prohibited, but you must be aware that when consuming these foods, it is necessary to control your INR values more often, since your stable regimen of Farin administration or administration of other medications from this group will probably change, i.e. higher doses will be required.

I have an artificial valve, and I have heard that there are new anticoagulant medications with do not require the control of INR values. Can I take them and avoid frequent blood tests?
The use of new anticoagulant medications, the so-called NOAK (Pradaha, Heralto, Eliquius) currently is not allowed in patients who have artificial mechanical valves. Consult your cardiologist regarding this matter, who will inform you if the indications for their use expand.

I am overweight, when after surgery can I start a restriction diet to reduce weight?
The restriction diet and additional measures plan to reduce body weight must be implemented under the supervision of a team of doctors of various specialties (cardiologist, nutritionist, endocrinologist, physiatrist) who deal with eating disorders and/or metabolism disorders. Two months after surgery, you can start with the recommended diet and physical activity plan to regulate body weight.

Why does my leg which the vein was removed from become swollen?
When a vein section is removed from a leg to provide a bypass piece, the venous blood flow from that leg becomes more difficult, thus causing swelling until the secondary circulatory system is established. It is necessary to wear elastic bandages or elastic compression stockings during that period of time. The method of applying elastic bandages or stockings will be explained to you during your stay in the hospital.

Why do my legs become swollen even though my vein has not been removed?
The reasons for swelling after surgery can be different. You need to consult your doctor to determine the true cause and receive timely therapy.

When could I resume sexual activity after surgery?
The ability of being sexually activity is individual and directly dependent on the individual ability to cope with physical effort as well as general condition. It is generally recommended to resume sexual activities 6-8 weeks after the operation, but it is best to consult your doctor.

Can I use Viagra or other erectile dysfunction medications?
The use of erectile dysfunction medications can jeopardize your health. Therefore, it is necessary that the decision is made by your doctor, and in accordance with your general condition and the medications you use regularly. Never use these medications on your own!

When could I start driving after heart surgery?
Driving is not recommended until absolute stabilization of your medical condition and sternum healing, i.e. no sooner than 6 to 8 weeks after the intervention.

Am I entitled to spa treatment after heart surgery?
After heart surgery, you have the right to rehabilitation in one of the specialized centers, which will be indicated on the discharge note, which will be given to you upon being discharged from the hospital. The request for exercising this right should be submitted within one month after being discharged from the hospital where you were admitted for cardiac surgery. Your selected doctor in the primary health care institution, i.e. community health center, should provide detailed information about the application procedure before or after the operation.

I had heart surgery, and I would like to retire on disability pension, what should I do?
The heart surgery is not performed so that patients could retire, but so that they could have a normal life and so that they could work normally, i.e. so as to improve their quality of life and prevent cardiovascular events. Most patients can resume work soon after surgery. Sometimes it is necessary to change the type of work performed by the patient at his/her workplace. If there is severe impairment of cardiac function or general health, caused by previous cardiovascular events and/or after surgery, the patient’s ability to work should be assessed. Special medical services in the field of occupational medicine deal with these matters, all in accordance with the procedures prescribed by the Ministry of Health and the Government of the Republic of Serbia. Relevant information about this will be provided at the primary health care institutions.

When I turn in my bed I feel like something shifts at the place of my chest wound?
The sternum is probably unstable. Make an appointment with your cardiac surgeon. The feeling like something is moving or squeaking when breathing may also indicate the same condition.

I have a fever. Something is draining from my chest wound?
Fever, wound redness and secretion from the wound can be a sign of wound infection. Any suspected wound infection should be reported immediately to the appropriate cardiac surgery institution.

I had heart surgery two weeks ago, and I feel weak?
Different patients handle heart surgery differently. This depends on the age, the overall health condition and the severity of the operation. Weakness after surgery is most often a matter of slower recovery. If you do not experience any improvement or your condition starts getting worse, contact your doctor.

I got a fever after coming home?
Fever immediately after surgery is not uncommon. However, patients are discharged only when their temperature becomes normal. If you develop a fever at home, contact your doctor and do not start self-medication with antibiotics. Your attending doctor will decide on further treatment and possible re-referral to the cardiac surgery institution where you were operated on.

I experienced hoarseness after heart surgery, why?
Hoarseness after heart surgery is a consequence of the presence of one tube that allowed you to breathe freely while you were under anesthesia. It should pass spontaneously. If it does not disappear in two weeks, contact your doctor.

I have a burning sensation when urinating after surgery?
It is probably either irritation of the urinary tract after the presence of a catheter or it is an infection. You need to contact your doctor.

After the operation I have diarrhea, what should I do?
Due to the use of antibiotics after the operation, the normal intestinal bacterial flora is often disturbed. This often causes diarrhea, which can mostly be treated with probiotic bacterial cultures (Bulardi, Linex, Probiotic…), which can be administered even before consulting your doctor. If the number of liquid, loose stools is significant and if this condition continues for a long period of time and if it causes significant general weakening, medical assistance and further microbiological examination is necessary to determine adequate therapy.

My heart is beating fast and it has irregular rhythm, my blood pressure is low, I don’t feel well?
These may be signs of anemia, dehydration and other easily correctable causes; but also of more serious heart problems and/or other concomitant disorders. Contact a doctor!

What are minimally invasive cardiac surgery procedures?
Minimally invasive cardiac surgery involves interventions which cause minor operative trauma – smaller incision.

What are the conditions in the domain of cardiac surgery that can be treated with minimally invasive methods?
Isolated heart valve diseases and bypasses can be operated on following these methods.

What is a minimal-access sternotomy?
A minimal-access sternotomy or J-sternotomy is an approach to the heart with only a partial incision of the sternum. Only a small incision remains in the middle of the sternum. In this way, the heart valves can be accessed.

What is endoscopic heart surgery?
Endoscopic heart surgery is a minimally invasive cardiac surgical procedure where the heart is operated on according to the principles of endoscopic surgery, but due to the implantation of a ring or valve, it is necessary to make a small incision in the fold underneath the right breast. This is why these procedures are called “port-access” surgery or “keyhole” surgery.

What are the advantages of endoscopic – “port-access” heart surgery?
These are interventions where the trauma is significantly reduced with a significant aesthetic effect. The heart intervention itself must be performed in the same way as in case of normal incision. These patients experience less postoperative pain, faster recovery, they are able to return to their everyday activities earlier, and can sleep on their side.

What heart parts can be operated on endosopically?
Endoscopic surgery is mainly applied to operate on, reconstruct or replace the mitral valve. It can be applied to address minor congenital defects as well as in case of interventions on the tricuspid valve. Proper selection and stimulation of patients is of crucial importance for the success of the intervention.

Can any vascular problem be treated endovascularly?

No, despite the development and improvement of endovascular treatment, open vascular surgery remains the only adequate treatment for certain pathological conditions.

How long does a hospital stay last after an endovascular procedure?

Usually, the patient is discharged from the hospital one day after the procedure, with adequate postoperative recovery. In case of complex procedures such as endovascular repair of thoracic or abdominal aneurysms, the hospital stay lasts for 2 – 5 days.

Should I take my regular therapy before having an endovascular procedure?

Yes, make sure to take your regular therapy with a little water before having the procedure, unless otherwise indicated by the medical staff.

I’m allergic to iodine. Does that mean that I am not a candidate for endovascular treatment?

No. It is necessary to report an allergy to your doctor, and with adequate preoperative preparation with appropriate medications, it is possible to perform endovascular procedures.

How soon after the procedure can I return to my regular activities?

It is necessary to refrain from heavy effort and lifting loads for at least 24 hours after the procedure, after which you can return to your regular activities.

Can I use Metformin before scheduled endovascular intervention?

Metformin-based medications should be excluded 48 hours before and after the procedure.

I have a chronic kidney disease. Does that mean I cannot undergo endovascular treatment?

No, chronic kidney disease does not exclude endovascular treatment, but it is necessary to consult a nephrologist before undergoing the procedure.