Heart Surgery

August, 2006

Definition of the Problem
Cardiac surgery can best be divided into five major classifications: cardiovascular operations, bypass surgeries, valve repair, repair of congenital defects, and other miscellaneous procedures.

Scope and Cost of the Problem
The American Heart Association reports that for the year 2000, there were a total of 5,939,000 in-patient cardiac surgeries, 686,000 of which were open heart procedures. This number includes 87,000 valve replacements, 561,000 Percutaneous Transluminal Coronary Angioplasties (PTCA’s), 1,318,000 in-patient cardiac catheterizations, 34,000 implantable defibrillator procedures; 152,000 pacemaker procedures; 124,000 endarterectomies, and 519,000 bypass procedures (American Heart Association, 2003).

An American Heart Association report lists the average cost of an in-patient cardiac catheterization at $16,838 (AHA, 2003). The cost for Bypass (CABG) surgery is approximately $27,000, with an average stay of 5-6 days (9 days for Medicare patients); most bypass patients are not able to return to work for 4-6 weeks (and, in some cases, 6-12 weeks) (Coronary Heart Disease Treatment, undated).

Mind-Body Approaches to Coping with Surgery
Since pharmacologic sedation often increases the risk of low blood pressure and lack of oxygen, doctors have looked at other ways to reduce pre-surgical anxiety. Even the outwardly simple act of listing to relaxing music can have significant positive effect on cardiac surgery patients’ anxiety and pain (Voss, Good, et al, 2004).

Most effective have been relaxation with guided imagery (self-hypnosis) and pre-procedure provision of information (Ashton, Whitworth, et al, 1997; Faymonville, Fissette, et al, 1995; Lang and Hamilton, 1994; Lang, Joyce, et al, 1996; Ludwick-Rosenthal and Neufeld, 1993).

Self-hypnosis, or relaxation with guided imagery used before and during surgery has resulted in shorter procedures (Lang, Benotsch, et al, 2000; Tusek, Church, et al, 1997). These techniques can also significantly reduce post-surgical pain and the need for post-operative pain medication (Ashton, Whitworth, et al, 1997; Faymonville, Fissette, et al, 1995; Halpin, Speir, et al, 2002; Lang, Benotsch, et al, 2000; Lang and Hamilton, 2004; Lang, Joyce, et al, 1996; Manyande, Berg, et al, 1995; Rensi, Peticca, et al, 2000; Syrjala, Donaldson, et al, 1995; Tusek, Church, et al, 1997; Weinstein and Au, 1991), anxiety (Hattan, King, et al., 2002), shorten the time it for the return of normal intestinal motility (Disbrow, Bennett & Owings, 1993; Tusek, Church, et al, 1997), and reduce the length of hospital stay (Bennett, 1996; Cowan, Buffington, et al, 2001; Disbrow, Bennett & Owings; Meurisse, Faymonville, et al, 1996; Rapkin, Straubing & Holroyd, 1991; Tusek, Church, et al.).

There is also some evidence that mind body therapies like hypnosis and imagery can reduce blood loss (Bennett; Bennett, Benson & Kuiken, 1986; Dreher, 1998; Enqvist, von Konow & Bystedt, 1995; Lucas, 1975; Meurisse, Faymonville, et al) and speed wound healing (Ginandes, Brooks et al, 2003; Holden-Lund, 1988).

Hypnosis and guided imagery have been used effectively in cardiac bypass to reduce length of stay, decrease use of pain medications, and lower pharmacy costs (Ashton, Whitworth, et al, 1997; Halpin, Speir, et al, 2002). These techniques and similar techniques such as autogenic training also help to alleviate anxiety (Ashton, Whitworth, et al; Kanji, White, and Ernst, 2004). In one study, bypass patients using these techniques were more relaxed pre-operatively and had lower levels of post-operative depression, fatigue, and anger (Ashton, Whitworth, et al).

Tension and pain in open heart patients were significantly reduced in a group of patients who used a combination of complementary therapies consisting of guided imagery, bodywork (light massage/gentle touch), and music (Kshettry, Carole, et al, 2006). Solid organ transplant recipients who used mindfulness meditation experienced significant improvements in sleep (Gross, Kreitzer, et al, 2005; Kreitzer, Gross, et al, 2005) and anxiety (Gross, Kreitzer, et al). Use of music prior to cardiac catheterization reduced patient anxiety, especially in women (Hamel, 2001).

Anger can be particularly problematic for cardiac patients, since anger has been associated with cardiac events including heart attacks. High levels of anger are also associated with re-narrowing of heart arteries and the need for coronary artery bypass grafting (Appels, Bar, et al, 1997). A simple mind-body technique like breathing therapy, similar to the breathing technique taught in this program, has been shown to reduce anger scores, and cut by 50% the risk of post-PTCA cardiac events (Appels, Bar, et al). Male CABG patients who used hypnosis experienced decreases in both anger and depression, with the improvements being maintained at follow-up (de Klerk, de Plessis, et al, 2004).

Acceptance of Mind-Body Approaches
In a recent survey of middle-aged and older cardiac patients, over 80% of those responding said that they used Complementary and Alternative Medicine, including imagery and relaxation techniques (Ai & Bolling, 2002).

High patient satisfaction with guided imagery tapes have been reported by several sources, including Blue Shield of California and Cedars Sinai Medical Center (Los Angeles) (Bodaken, 2000; Fontana, 2000). World-renowned cardiac surgeon Mehmet Oz and his colleagues have stated: “Mind-body techniques and complementary care may assist people who are undergoing surgery and those recovering from cardiac surgery to cope with the event, the process of recovery, and accompanying lifestyle changes.

These approaches can provide cardiac patients with nonpharmacologic tools that may prevent further coronary artery disease and the development of dysrhythmias” (Whitworth, Burkhardt, and Oz, 1998).

A low-cost guided imagery program can help to lower pre-surgical anxiety, reduce pain and the need for post-operative medication, shorten procedure time and hospital stay, and possibly reduce surgical bleeding, and speed recovery.

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