How long does it take to heal from open heart surgery?

                                Valerie Johnson’s surgery was in 2013:  ©British Heart Foundation

by Carolyn Thomas       @HeartSisters

Heart patients are like all other patients in one major way: we have important quality-of-life questions for our doctors, like: “How long will it take after my _______  (insert name of  medical procedure) before I’m feeling well enough to _______  (insert whatever it is you want to get back to doing: drive, fly, golf, have sex, return to work, etc.)?” 

But what happens when different doctors offer different answers to that important question?       .         .            .  

Unless they’re undergoing minimally-invasive cardiac surgery, most heart patients facing open heart surgery may in fact hear a range of responses to “how long will it take?” because of the added complexity of getting their sternum (or breastbone, the long flat bone in the centre of the chest) cracked open right down the middle. 

This procedure is called a sternotomy.  As you can imagine, a cracked-open bone takes longer to heal afterwards than a simple soft tissue incision does.

But how long?  Cleveland Clinic cardiologists suggest this:

“You’ll do most of your healing – about 80 per cent – in the first 6-8 weeks after surgery”. Complete recovery can take about one full year.”

But when University of Toronto cardiac surgeon Dr. Bobby Yanagawa pondered the same question online recently, he received a surprisingly wide range of answers from other physicians in response to this post on Twitter (10/8/2020):

“As cardiac surgeons who see patients at a 6-week follow-up appointment, we don’t really have a good sense of how long it takes to recover from a sternotomy.

“I used to say three months, but now I say 3-6 months. I suspect a survey of patients will reveal that it takes much longer for complete recovery.

“Is a survey needed?”

Here’s just a sampling of dozens of responses from cardiac surgeons and other docs to Dr. Yanagawa’s Tweet:

1. “I tell patients they can do most things at three months, but for up to a year they will have some pain and remember they had surgery. It would be great to have the data, for sure.”

2. “Usually people take six months to recover. The more active and healthy at baseline, the sooner – but even then a minimum 6-8 weeks, it seems.”

3. “3-6 months needed to recover? Problem is this is a non-starter in 2020 post-COVID. No one can afford that much time off or not full work capacity when job losses are mounting. No wonder it’s hard to pitch surgery to our patients during pandemic times.”

4. “I think it’s all in the expectations we set as surgeons. I tell them six weeks, and most are pain-free and back to regular activity at that time. Cardiac surgery should be enabling, not disabling.”

5. “When patients follow up with me, I tell them they can do most things at three months, are mostly healed by six months, and may still have pain up to 1-2 years (mostly twinges of pain with certain movements).”

6. “Yesterday I saw a patient for chest pain one year after bypass surgery. Her pain was from keloid at the scar” (a raised overgrowth of scar tissue) – “the kind of things that are not recorded in studies.” (Another cardiologist recommended a referral to a plastic surgeon for treatment of  keloids).

7. “Maybe the definition of ‘recover’ varies. Patient expectations: pain-free, baseline function. Doctor expectations: good healing, improving function. Since people will heal variously, might be good to align expectations e.g. “At three months, we hope to see _____”

8. “Some bypass surgery patients complain of pump head (dizziness and fatigue) up to 10 weeks post-op. I agree we need a survey to see what’s going on with them.”

9. “It will also depend on the care provided after hospital discharge. If the patients are sent home straight after surgery, the recovery seems to take forever. If they go to recovery centres with physiotherapy, dietitians and an overall holistic recovery approach, then recovery is shorter!”

10. “There are so many variables in recovery after cardiac surgery. Cardiac rehabilitation enhances recovery. It’s imperative to get people moving and back to their baseline as soon as possible.” 

And even some responses from cardiac surgery patients themselves:

11.  “I had a mini-sternotomy with wires at age 52, and while I had minimal pain afterwards, I had complications at six months (pleural and pericardial effusion). I didn’t feel close to ‘normal’ for a solid year, then two years before I felt like myself. Depressing when they tell you it will take 6-8 weeks!”

12.  “I am nine months post-op; from the get-go I have been dealing with clicking, instability and pain. I found out it was a sternal non-union (a persistent fracture of the sternum after three months without signs of healing). “Now trying physiotherapy in hopes to avoid another sternotomy.  Long story short: yeah, I’d say it takes longer than three months to recover.”  NOTE: read more about how non-invasive pulsed ultrasound therapy has been successfully used in the U.K. to treat sternal non-union).

And these two comments from the When-Doctors-Become-Patients world, in which doctors have open heart surgery:

13.  “I followed up on a surgical colleague post-op – shocked at how long and difficult the recovery was.”

14.  “I’m an interventional cardiologist who needed a sternotomy at a young age. After three months, I felt ‘okay’ enough to work.  But just barely. I couldn’t imagine true physical labor at that point.”

This small one-day snapshot of varying responses to a sternotomy healing question (with answers essentially ranging from six weeks to one year) may seem puzzling to some patients.

That’s an impossibly wide range of possibly correct answers.

And few if any of the answers even mentioned the psychosocial recuperation impact of being diagnosed with a heart condition serious enough to require profoundly invasive cardiac surgery.  See also:  When Are Cardiologists Going to Start Talking About Depression?

Given this reality, I commend Dr. Yanagawa’s open call for feedback, acknowledging that his own post-op advice to patients has dramatically changed from three months to now 3-6 months – and additionally suggesting a survey of patients.

But instead of asking other cardiac surgeons what they’re telling patients, how about instead asking patients what their lived experience has been like? 

As the University of Calgary’s Dr. Doreen Rabi answered that tweet:

It is so important to include patients in defining what ‘recovery’ really means. I have heard repeatedly when I speak with patients that they ‘don’t trust’ their body for two years after a cardiac event/surgery. Anecdotal for sure, but compellingly consistent.”

Last year, a systematic review of studies on patient-centred adult cardiac surgery recovery published in the Journal of the American Heart Association reported, in a remarkably under-stated conclusion, that “the evidence base for post-operative patient‐reported outcome measures needs to be strengthened.”(1)   TRANSLATION: The studies they found were small, mostly done in single centres, 71 per cent male and 88 per cent white.

So in answer to the original question: “Is a survey needed?”, we might be tempted to say, What took you so long?

The promising news is that such surveys do exist, and some heart patients themselves have already been asked.

In 2016, for example, Dr. Sari Holmes and her team at the University of Maryland in Baltimore published a study using a heart patient survey called C-SPEQ –“Cardiac Surgery Patient Expectations Questionnaire”.(2) Although prediction of poor outcomes or longer recovery time after open heart surgery is most often focused on physical and surgical factors, these researchers suggested that the wide variation in these predictions may also be affected by psychosocial aspects that are not typically even considered by cardiologists.

In this study, the higher the patients’ pre-surgery C-SPEQ survey scores, the greater their rate of depression and perceived stress, and the longer their recovery time.

The study’s conclusion:

“Negative pre-surgery expectations have a detrimental impact on both recovery and quality of life following that surgery. Pre-surgical education might better prepare patients, reduce negative expectations, and improve psychosocial outcomes after cardiac surgery.”

What else might help speed up sternotomy recovery?

♥  Cardiac rehabilitation for almost all heart patients is recommended in current practice guidelines of all cardiovascular societies worldwide as a Class I recommendation (which means that a procedure/treatment should be performed/administered). Studies have shown that completing a course of rehab classes can significantly lower your cardiac risk. Most cardiac rehab programs this year have had to move online due to COVID-19.  Ask your cardiologist about participating in a virtual rehab program like this series of exercises developed by Vancouver Coastal Health for their heart patients.

Keep Your Move In The Tubeis a recovery concept developed by a Texas-based team of physical therapists, occupational therapists and cardiac rehabilitation specialists to help prevent sternal wound complications.(3) They claim that the common “Don’t lift more than 5 pounds” hospital post-op warning to new heart surgery patients is the opposite of what they need to hear. Instead, this team teaches recovering hospital patients to safely move or lift (e.g. getting out of bed) that involves keeping elbows tucked into the sides (as if inside an imaginary “tube”) while lifting, pushing or pulling – with the goal of faster recovery. This concept is also expanding to other hospitals (including in Alberta, Canada).

♥  What you can do ahead of time:  You may assume that your recovery will start as soon as you’re safely out of surgery. But a key predictor of speedy healing is often how healthy you are before that day. So if your surgery is scheduled (i.e. not an emergency procedure), you  may have some time between now and your surgery date to work on issues like smoking or other steps you can take to become as healthy as possible.

And for cardiac surgeons who, like Dr. Yanagawa, are wondering how to answer that “how long does it take?” question from patients, consider surgeon Dr. Lisa Brown’s suggestion. Here’s how this researcher and Assistant Professor of Thoracic Surgery at the University of California-Davis responded to Dr. Yanagawa’s original Tweet:

“Start collecting patient-reported outcomes!”

Why didn’t somebody think of that?

 

  1. Makoto Mori et al. “Characterizing Patient‐Centered Postoperative Recovery After Adult Cardiac Surgery: A Systematic Review” Journal of the American Heart Association. 2019;816 Oct 2019
  2. Holmes SD et al. “Development of the Cardiac Surgery Patient Expectations Questionnaire (C-SPEQ).” Qual Life Res. 2016 Aug;25(8):2077-86. 
  3. Adams J et al. “An alternative approach to prescribing sternal precautions after median sternotomy, “Keep Your Move in the Tube”. Proc (Bayl Univ Med Cent). 2016;29(1):97-100. doi:10.1080/08998280.2016.11929379

Q: What was the difference between the time estimated to heal from your cardiac surgery vs. the actual time required?

.

NOTE from CAROLYN:  I wrote much more about what you can learn if you ask patients about their lived experience in my book A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017).  You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).

See also:

– Recuperation and a red leather chair

Learning to love your open heart surgery scar

Convalescence: the forgotten phase of illness recovery

Learning to live with heart disease: the fourth stage of heart attack recovery

16 thoughts on “How long does it take to heal from open heart surgery?

  1. Hello Carolyn, thanks for this topic.

    My open heart surgery was in 2015 in Vancouver, at St Paul’s. Part of the getting-ready-for-discharge procedures was showing the nurses the ability to do that tucked elbow push to get from a prone position. Works like a hot-damn and I still use it.
    I would say my physical recovery took about 3-5 months but more interestingly, I had a hard time in a way I can only describe as spiritual.

    I get acupuncture regularly and after the surgery I was trying to explain to my acupuncturist what this odd feeling of just not being right was. I could only explain it as it felt like something had escaped when my chest was opened.

    He said, your chest was cut open and your heart was manipulated…your heart chakra was disturbed. So, that was something he focused on for treatment.

    A realization I had as I rummaged around looking at accounts of other OHS patients and their post-surgical lives was so much of the language used to describe near and long-term effects of surgery so closely fit with descriptions of near-death experiences.

    I think the medical community misses the profound spiritual effect of open heart surgery as a near-death experience.

    Liked by 1 person

    1. Hello Alane and thanks so much for sharing that perspective on your open heart surgery. I believe that this focus on physical recovery only is, not surprisingly, pervasive throughout the practice of surgery. Studies point out that surgeons’ communication focus with the patient is on PAR (the Procedure, the Alternatives, the Risks) and NOT on the profound psychosocial or spiritual aspects of what’s about to happen to those patients.

      That odd feeling you describe of ‘just not being right’ after surgery (or what researchers like Dr. Kathy Charmaz call the “loss of self“) is common – yet also commonly ignored on hospital wards. Discharge planning rarely includes even a mention of the psychosocial or spiritual fallout from having just had your chest cracked open, your heart stopped and then cut open.

      I’m glad that you and your acupuncturist found a way to help address that effect.

      Take care, stay safe! ♥

      Like

  2. Hi Carolyn —

    When I read the opening question about how long it takes to heal after open heart surgery, my first response was “Two years.”

    Much of the initial material is focused on the physical recovery from open heart surgery, and then  you quote Dr. Rabi: 

    “I have heard repeatedly when I speak with patients that they ‘don’t trust’ their body for two years after a cardiac event/surgery. Anecdotal for sure, but compellingly consistent.”  

    This makes psychological sense; my experience as a psychologist and heart patient  is that it generally takes two years to get over a trauma  —  and open heart surgery easily qualifies as a trauma.   

    In the first year after a trauma each season/holiday of the year can set off anniversary reactions of what life was like before at the time; in the second year, one is rebuilding and creating a new sense of normal.

    This does not mean that for two years one will be always depressed or anxious or struggling to feel normal.  There are positive things that come out of trauma — learning to take care of one’s self and body, learning to live with vulnerability, connecting with caring others, even perhaps developing a spiritual attitude about the specialness of being alive and breathing and having a beating heart. 
     
    It has been my experience that most cardiologists and physicians underestimate and discount the psychological aspects of recovery after major surgery; I would hope that pre-surgical education include dealing with the psychological as well as the physical recovery.

    As usual, thanks for your posts…  You are providing a wonderful service..

    Liked by 1 person

    1. Hi, Dr. Steve – thanks so much for your kind words, and especially for sharing your informed perspective as both a psychologist and (more importantly, I think) as a heart attack survivor who has survived a number of cardiac events.

      When you say “most cardiologists and physicians underestimate and discount the psychological aspects of recovery after major surgery”, I believe you are 100% correct. As cardiologist Dr. Sharonne Hayes (founder of the Mayo Women’s Heart Clinic) described:

      “Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues…”

      I’d like to think this reality is changing, and that med school training is now focusing more on the psychosocial fallout after a serious diagnosis. It simply makes no sense to “underestimate and discount” psychological aspects of recovery, or to ignore what you once called the swirling emotions that surround a cardiac diagnosis.

      The patient struggling psychologically is also the person who is unable to follow recommendations – like take your meds, exercise, quit smoking – or any other doctor’s orders. Physicians then simply call these people non-compliant“…

      Take care, and stay safe!

      Liked by 1 person

      1. Carolyn: At this point, I am almost proud of the number of “Non-compliant” notations in my medical records. I even got a “non-compliant” when I sought a second opinion that said I needed immediate intervention.

        One needs to find one’s individual path to healing, and I suppose one of the lessons from trauma is that doctor’s don’t know very well what is right for you individually….

        So important to become one’s own advocate and have a collaborative relationship with physicians.

        Thanks, I had almost forgotten I was non-compliant.

        Like

  3. Thanks for this post. I had open heart surgery in an emergency situation because my heart had been punctured, so I had zero expectations. And because my situation going in was different, I would assume recovery was different as well.

    But even in a “standard” open heart surgery, there are lots of different variables. All of these attendant circumstances play a role… my chest was black from CPR bruising for several weeks, so there was soreness from that and then of course from my sternum being sawed open.

    I was in decent shape before the event and I’m sure that helped, but my body was essentially jump-started a couple of times and my cardiologist suspected the effects from that went on quite a while.

    I’d say that I felt much better after 6 months. It’s important for people to realize (especially docs) that every patient is different- their status going in is different, their support post procedure is different, and I really believe a person’s own approach – state of mind- is very important.

    For me, my dominant emotion was exhiliaration at being alive and well… and that took me through quite a bit of pain. I was fortunate that many people sent messages of encouragement and support. I know that helped.

    But I don’t think there’s one pat answer. It is like asking how long does it take someone to cook dinner. It depends. There are lots of factors.

    Liked by 2 people

    1. Hi Helen – oh, I agree! Your own remarkable experience with open heart surgery was indeed a serious emergency – starting with an accidentally punctured heart muscle during a cardiac ablation procedure, acute cardiac tamponade, two cardiac arrests, and emergency open heart surgery to repair the tear! No time for any discussion about recuperation predictions… I can’t imagine that any of your doctors could have possibly predicted much about your future recuperation on that day.

      The physical after-effects of being resuscitated during your cardiac arrests must have taken a toll all by themselves – even without the added effects of open heart surgery. No wonder you felt exhilarated afterwards because you’d survived not one but two cardiac arrests!

      Every patient IS different, and every path to recovery, as we can see from patient comments, is unique as well. Thanks for sharing your own unique recovery experience here!

      Take care, stay safe… ♥

      Like

  4. Hi Carolyn…
    I had 2 open heart surgeries 15 months apart. I won’t go into details of the procedures but will address recovery as I experienced it.

    Both times the only markers I remember were:
    1) in 6 weeks you can drive a car
    2) Cardiac Rehab is the best bet to improve recovery

    I realized as I was recovering much more slowly than anyone in my online support group … I was totally unprepared for my recovery.

    And I had worked for years in the cardiac surgery ICU!

    So many things I experienced: fatigue, post-pump brain fog, sternal Non-Union due to diabetes, depression and muscle weakness from new medications … on and on. I never expected.

    It seemed the only recovery markers they talked about were driving, going back to work and sex. Of which only driving applied to me. I was so fatigued I couldn’t even get to rehab after going for a couple of weeks.

    Do the surgeons have knowledge of this and just don’t tell us because they think we will not have the surgery???

    My point is that you are correct. More accurate and specific information about recovery needs to be gathered so that INDIVIDUALIZED pre- surgical and Post-surgical education and SUPPORT can take place.

    I felt very alone post-op and not understood because “I should have been better by now” according to all the research.🙄

    Open Heart surgery is a Big Deal and a very personal experience. Nothing I’ve experienced truly accounts for that…except possibly the online support of others who have gone through the experience.

    Surgeons tend to feel they did their job with expert cutting and the recovery process belongs to someone else. I saw it when I worked in their ICU and I experienced it personally.

    My saving grace was a cardiologist who took over after surgery and partnered with me through the minefield of my recovery.

    Ignorance is not Bliss!

    Blessings to ALL of our Heart Sisters!

    Liked by 2 people

    1. Oh Jill – thank you for such a comprehensive description of your complex recuperation. As an experienced cardiac surgery intensive care nurse, you must have felt blind-sided that, despite your background, you still felt unprepared for what was about to happen.

      The part of your comment today that both broke my heart and made me furious was this:

      “Surgeons tend to feel they did their job with expert cutting, and the recovery process belongs to someone else. I saw it when I worked in their ICU, and I experienced it personally.”

      I observed that kind of attitude in the online responses to Dr. Bobby’s original comment on Twitter – one specifically that stuck in my craw:

      “It’s all in the expectations we set as surgeons. I tell them six weeks, and most are pain-free and back to regular activity at that time. Cardiac surgery should be enabling, not disabling.”

      The implication is clear: my surgery patients should NOT feel disabled after what I’ve done for them, and if they do, it’s about their unreasonable expectations… Pity his poor patients who might be “recovering much more slowly” – as you describe your own recuperation.

      Thank you again for this – take care, stay safe… ♥

      Like

  5. I had a very difficult (painful) postoperative recovery, but I believe it was a normal experience for most patients.

    My physicians told me I would be back to normal in 6 weeks. I am 9 years out and still experience pain where the sternotomy wires were knotted.

    And no, no one goes back in my chest if I can help it.

    Liked by 2 people

    1. Hello Dr. Anne – NINE YEARS! Your comment on wires reminds me of another cardiac surgeon’s response to Dr. Bobby’s original Tweet; an Edmonton cardiac surgeon wrote:

      “We’re the only surgical specialty that fixes bones with steel wires. All other specialties that deal with bones (orthopedics, plastic surgery, oral/maxillofacial) moved away from wire to rigid fixation with plates and screws. Bones heal better and faster with rigid fixation as shown in multiple trials.”

      That comment prompted a discussion among the surgeons on wires vs. plates (there are of course pros and cons to each choice). Still, when considering heart patients like you, nine years out, still experiencing pain where the sternotomy wires were knotted…. 😦

      Do you think your colleagues are aware of these examples of longterm pain?

      Please take care, stay safe…♥

      Like

    2. To Dr. Stohrer –

      Much to my dismay…I had to let someone back into my chest to redo the surgery that was not done properly the first time. So I never say never, and I cringe every time I have a cardiac cath because I’m well aware that untoward complications could mean a trip to the OR 😱

      Like

  6. It’s been over 3 years now. I was told 6 weeks to 3 months, but it was made clear to me that everyone’s recovery rate is different.

    I was fairly physically fit – aerobics and weight training 3 times/ week – pre-surgery. My only post-surgical pain was at the spot where the heart and lung machine tube was inserted near my shoulder and that went away after a couple of weeks.

    When I described the pain to my doc as a really horrible muscle ache, he explained that the tube had to be squeezed between muscles and that’s what it was! However I developed post-op atrial fibrillation which required an extended hospital stay and angina which comes back to bite me about once a month.

    One of the nurses, who got my sense of humour and quirky imagination, told me the A-fib was a sign my heart was pissed off at me for fooling around with it! Had a good laugh at that.

    Back to work in 3 months. Back to the fitness class in 4 months, never at the same level of intensity but steadily increasing. Fatigue is ongoing and not crippling. I allow myself to rest now.

    Between years one and two I wouldn’t give myself a break, thinking “I must be better by now!”. Scar keloid is pretty severe – still red and lumpy at the top – and very itchy at times.

    Don’t care about it enough to get plastic surgery. I’ve never done this kind of overview before. It felt good to write it down.

    Thanks, Carolyn!

    Liked by 2 people

    1. Hello Deborah – thank you for this overview (not only felt good for you, but I’m sure that your experience will resonate with other women reading this!)

      I loved your nurse’s quirky explanation of your atrial fibrillation diagnosis. In a way, she’s very correct – a number of studies have found that acute or new-onset post-op atrial fibrillation (POAF) is in fact a common complication following cardiac surgery, affecting around 35% of cases – sometimes blamed on local or systemic inflammation?

      A 2017 paper published in the European Journal of Cardio-Thoracic Surgery, for example, reported in typically understated research-speak: “Clinical efforts to prevent and manage POAF following cardiac surgery have thus far presented a major challenge and results have been less than optimal.”

      In so many ways, you were an ideal cardiac surgery candidate – and who knows? Had it not been for your AFib diagnosis, that 6-week recovery prediction may well have been correct for you!

      Take care, stay safe… ♥

      Like

    2. Hello Debra,
      My keloid scar was painful and looked bad and I happened to mention to my dermatologist when I went in for my yearly skin scan. He injected something into the area and it improved markedly.

      It might be worth checking with a dermatologist, as it made a big difference for me.

      Like

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