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Having Heart Surgery Booklet

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Having Heart Surgery Booklet Having heart surgery Your name: ____________________________________________________________ Your surgeon’s name: ___________________________________________________ Your cardiologist’s name: ________________________________________________ Your operation: _________________________________________________________ Your cardiologist (heart specialist) believes the best way to manage your condition is for you to have heart surgery. Your cardiologist should have talked to you about the alternatives to heart surgery and why we believe this is the best option for you. This booklet is not meant to replace these discussions, but we hope it will make you feel more comfortable with your decision to have this procedure. The aim of this booklet is to provide you and your family with information about what is involved in heart surgery. It explains the procedure, including risks and benefits, as well as what to expect when you come to hospital. If you have any questions or concerns, please speak to a doctor or nurse caring for you. Contents Types of heart operation page 2 Preparing for your operation page 4 While you are in hospital page 7 Before you leave page 14 Follow-up appointment with the surgeon’s team page 14 Cardiac rehabilitation programme page 14 Useful telephone numbers page 15 1 of 15 Types of heart operation Coronary artery bypass grafts, heart valve repair/replacement or a combination of the two, are the most frequent heart operations performed. They are described below. There are various other less common operations which your surgeon will explain to you if necessary. Most patients will have a vertical incision (cut) on the front of the chest and the breastbone will be divided to open the chest. A small number of patients may have incisions on the side of the chest, which may be less invasive and allow a more rapid recovery. Limited incision or ‘keyhole’ surgery may be offered to selected patients. Your surgeon will explain which approach is best for you but the general principles of recovery are similar for most types of heart surgery. Coronary artery bypass grafts This operation involves the grafting (surgical attachment) of a blood vessel to bypass a blocked or narrowed coronary artery. One end of the graft is stitched to the aorta (the main artery carrying blood from the heart to the body) and the other to the coronary artery beyond the narrowing or blockage. The artery running down behind the breastbone (the internal mammary artery) is the most commonly used graft, being used in 92% of cases of coronary artery surgery (see picture 1). Veins from the legs (such as the saphenous vein) or occasionally an artery from the forearm can also be removed and used as a graft (see picture 2). IMA (from chest) Aorta Saphenous vein (from leg) Blocked coronary artery Picture 1: Internal mammery artery Picture 2: Saphenous vein graft (IMA) graft 2 of 15 Heart valve replacement/repair The heart has four chambers, each with a valve at its outlet. These valves open and close with each heart beat. They can be affected by disease causing a leak (regurgitation), or a narrowing (stenosis), preventing the normal flow of blood through the heart. The two valves most commonly affected are called the mitral and aortic valves. Sometimes the surgeon is able to repair your own valve; this is only possible for the mitral and/or tricuspid valve. In other cases the valves are replaced with valves made of moving mechanical parts or of natural tissue. Mechanical valves are the hardest wearing and effectively last forever but patients must take anticoagulant drugs such as warfarin for life to reduce the risks of clots forming on the valve. The body readily accepts tissue valves. They are ‘inert’ and do not cause rejection. With tissue valves, patients need blood-thinning treatment much less often. However, tissue valves do not last indefinitely and may wear out after some years, in which case another operation may be necessary. The surgeon will discuss the most suitable choice of valve with you and help you towards the best decision for you. Aorta Pulmonary valve Tricuspid valve Mitral valve Aortic valve 3 of 15 Preparing for your operation While you are waiting The waiting list After your first appointment with the surgeon you will be placed directly on the waiting list according to your individual needs. Operation date Your surgeon will tell you roughly how long you will have to wait for your operation, and may give you a date whilst you are in the clinic. If not, the admissions coordinator (tel: 020 7188 3894) will contact you to discuss the operation date. If there is a date or period of time that is inconvenient for you to be admitted to hospital for your operation, please let the admissions coordinator know when discussing admission dates. What should I do if my symptoms change? If your condition worsens please see your GP. In the event of sudden deterioration, call an ambulance. Smoking Smoking is one of the most important factors contributing towards coronary heart disease. It is also an important cause of chest complications after cardiac surgery. We strongly encourage all smokers to quit so as to reduce the risk of postoperative complications and the risk of heart problems in the future. If you need advice on how to quit, we can refer you to someone in your local area or you can speak to the cardiac rehabilitation team. Details of groups and services can also be obtained from the NHS Smoking Helpline – 0800 169 0 169. Things to plan before admission There will be lots of things to plan for your operation and recovery period and it is useful to think about these things early on. Employment • If you are working, talk to your GP about working before the operation. • Speak to your employer about time off after the operation. You will need to take 8–12 weeks off work depending on your recovery and what job you do. Accommodation for your relatives while you are in hospital • There is limited accommodation available at our hospitals. If your relatives require accommodation, it should be arranged as soon as you know your admission date. Prices are available on request. For information about accommodation at St Thomas’ call 020 7188 0225. For information about accommodation at Guy’s call 020 7188 0474. Both lines are open Mon–Fri (9am– 5pm). 4 of 15 Travelling from hospital • It is important to plan how you will get home from hospital after your operation. You will be fit to travel as a passenger in a car. You may decide to travel home by train or coach but you must have someone to accompany you and to carry your bags. It is also advisable to use a taxi to get to the station. • If you feel that you need to use our patient transport service, a member of the transport team needs to assess whether you are eligible. This involves a brief telephone interview and is completely confidential. Assessments must be carried out at least 48 hours before your appointment. If you think you may be eligible for the transport service, please contact the patient transport assessment team on 020 7188 2888. • You will not be able to drive for six weeks after your operation. Holidays • If you are planning a holiday before your operation, it is a good idea to discuss this with your doctor. The British Heart Foundation has a list of travel insurance companies who offer services for heart patients. In general, air travel is discouraged before surgery. • After your operation you should not plan any holidays until after your follow-up appointment, which is normally six to eight weeks after your operation. Your recovery at home You will be given our leaflet Going home after your heart surgery, which gives advice on your recovery at home. If you do not have a copy, please ask your doctor or nurse for one. • Some patients like to go to a convalescent home after the operation, especially if they live alone. Convalescent homes provide a home-like environment for patients recovering from a long-term illness or operation, however, this service is not available on the NHS. If you feel you are able to afford convalescence, please discuss this option at your clinic appointment. Alternatively you may wish to make your own enquries at your GP surgery or with your local authority. • If you live alone and cannot afford to go to a convalescent home, please see your GP about getting some help in your own home. • If your profession has a benevolent society or if you are a member of a Friendly Society, they may own or be willing to fund your stay in a convalescent home. It is very important that you avoid any activity that will place a large force on the chest during the first six weeks, as this will hinder the healing of the breastbone and could lead to complications. This includes not lifting bags of shopping, not lifting children, not digging, mowing the lawn or hoovering, not riding a bike and not attending the gym. For this reason, you will need a family member or friend at home with you at all times to give general support for the first week after discharge. This may mean that they need to take some time off from work. Pre-admission clinic The pre-admission clinic aims to prepare you for your operation, both psychologically and physically. In the clinic you will meet members of the surgical team and have some important tests. You may be at the clinic for four to five hours, or possibly longer if special tests are required. 5 of 15 Tests All patients will have: • blood tests • an electrocardiogram (ECG), which records the electrical activity of the heart • a chest x-ray • swabs taken for methicillin resistant staphylococcus aureus (MRSA).
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