Well before the surgery, a painless echocardiogram will be performed to assess the functioning of the heart and valves. A cardiac catheterization may also be performed, particularly if the patient is over 40, to rule out the possibility of coronary artery disease or other forms of cardiovascular disease that could complicate surgery. As the date of open-heart surgery approaches, patients should prepare for a hospital stay of at least 10 to 12 days.

The patient is usually admitted on the day of the surgery. Once in the hospital, the patient will undergo a battery of tests. Even if these tests were already performed days or weeks before surgery, they may be done again just before surgery to be sure that the patient’s medical condition has not changed. They include:

• Chest x-ray. A radiation-based imaging test that offers the physician a picture of the general size, shape and structure of the heart and lungs.

Eight hours before surgery, all patients are placed on NPO (non per os; nothing by mouth) status. That means they are not permitted to eat, drink or take anything by mouth until after their surgery. Smokers will have been instructed to completely avoid smoking for at least two weeks before their surgery to prevent problems in blood flow, clotting or breathing. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their cardiologist before surgery.

Immediately before surgery, the patient will be given specific pre–operative medications and then “prepped” for surgery. First, the chest area is shaved if necessary. Next, the surgical team creates a sterile environment by swabbing the patient’s chest with an antiseptic solution and covering the area with sterile surgical drapes. An intravenous (I.V.) line will also be started, usually in the forearm or back of the hand.

The patient is then given a sleep-inducing medication (general anesthesia) through the I.V. line. The patient will continue to breathe a mixture of oxygen and anesthetic gas to make sure that he or she remains asleep throughout the entire surgery.