Waikato Hospital as seen over lake Rotoroa

This information has been prepared by Australian and New Zealand College of Anaesthetists (ANZCA).  It is only a guide and should not replace information supplied by your anaesthetist. If you have any questions about your anaesthesia, please speak with your treating specialist.

By far the majority of adult heart surgery in Australia and New Zealand is performed for coronary artery disease and heart valve disease.

In most cases, patients are admitted the day before surgery and undergo relevant investigations, such as blood tests and x-rays.

On the morning of the operation, patients may be given a "pre-med", or medication to reduce anxiety, however they will be conscious when they arrive at the operating theatre complex.

All valve surgery and most coronary bypass surgery is performed on a non-beating heart.

Because the body requires oxygen, which is carried by circulating blood, a machine temporarily takes over the function of the lungs and the heart, pumping the blood around the body. This machine is called a heart-lung machine or cardiopulmonary bypass machine.

Some coronary artery bypass surgery can be carried out without cardiopulmonary bypass. This is known as off-pump coronary artery bypass surgery and reduces the complications that are possible with the use of cardiopulmonary bypass. Complications of cardiopulmonary bypass include stroke, reduced kidney function and an increased risk of bleeding.

Whether or not the coronary artery bypass surgery is performed on-pump or off-pump depends on the expertise of the surgeon, the number of arteries that need bypassing, which arteries they are and the degree of impairment of heart function.

After surgery, patients are often transferred while still anaesthetised to the intensive care unit for further monitoring and care. Patients are kept sedated and closely monitored. A breathing machine or ventilator supports and assists the breathing, which will have been suppressed by anaesthetic medications. Gradually patients are weaned off the ventilator and allowed to breathe with minimal breathing support. Provided the heart is functioning well, sedation and ventilation support will be stopped.

During heart surgery, patients have several plastic tubes inserted into their bodies, including their neck and chest, and also an "arterial line" in the wrist to measure blood pressure. The tubes are removed when patients are discharged from the intensive care unit.

The time that patients remain sedated after heart surgery depends upon the course of the surgery, whether there were any complications, the patient's underlying medical condition and the progress made after the operation. The intensive-care team will make all medical decisions in conjunction with the heart surgeons.

The usual stay in an intensive care unit after uncomplicated heart surgery is two to three days, after which a patient will be transferred to a ward. Pain relief will be administered in the form of oral analgesics and intravenous opioid drugs, such as morphine or fentanyl, for several days. Most patients find the chest and rib pain following surgery is not as severe as they expected.

Download the ANZCA information sheet here.