Patient’s guide and agreement to consent form Cardiac surgery Patient’s guide to surgery and enhancing your recovery Agreement to consent form Important Please bring this booklet into hospital on admission 1 This document contains a consent form which your surgeon will go through with you and ask you to sign if you are willing to proceed. You will be given this booklet which will include a copy of the consent form. This information booklet has been prepared to help you and your relatives understand more about your cardiac surgery. It also gives you general information about what to expect from the time of your admission to your discharge from Royal Papworth Hospital, and some practical advice on what to do when you get discharged. Contents Your heart and how it works .............................................................................................................1 Reasons for needing cardiac surgery .................................................................................................1 Aneurysms ...........................................................................................................................................3 What are the risks? .............................................................................................................................3 Live well ...............................................................................................................................................4 Be prepared .........................................................................................................................................5 Flexibility exercises ..............................................................................................................................6 Strengthening exercises ......................................................................................................................7 Lower limb exercises ...........................................................................................................................8 Exercise diary .......................................................................................................................................9 Preparation for your operation..........................................................................................................10 Cancellations .......................................................................................................................................10 Blood transfusion ................................................................................................................................10 X-rays and other images .....................................................................................................................11 On admission to hospital ....................................................................................................................11 Who does the operation? ...................................................................................................................11 Just before the operation ...................................................................................................................11 After your operation...........................................................................................................................12 Visiting/contact ....................................................................................................................................12 Post-operative stay in the CCA ...........................................................................................................12 Post-operative care on the ward ........................................................................................................12 After-effects of the surgery ................................................................................................................13 What happens when I go home? .......................................................................................................14 Medication ...........................................................................................................................................14 Wounds ................................................................................................................................................14 Consent form .......................................................................................................................................16 Resuming activity ................................................................................................................................19 Flexibility exercises (post-surgery) ......................................................................................................21 Exercise diary .......................................................................................................................................22 Cardiac rehabilitation .........................................................................................................................23 Health promotion ...............................................................................................................................24 Monitoring results (audit) ..................................................................................................................24 British Cardiac Patients Association ...................................................................................................24 Guidance for health professionals .....................................................................................................25 Discharge advice ..................................................................................................................................27 Diary .....................................................................................................................................................30 Contacts ...............................................................................................................................................35 Patient’s guide and agreement to consent form Your heart and how it works at the site of the narrowing, a heart attack (myocardial infarction) occurs. The heart is a muscular pump. The right side of the heart receives blood from the body and What is used to create the graft? pumps it to the lungs. There the blood picks The coronary artery bypass graft operation up the oxygen that you have breathed in (all (CABG) uses extra blood vessels, sewn to your living tissues need oxygen to survive and they narrowed coronary arteries, to ‘bypass’ the receive it from a network of blood vessels that narrowed area and bring blood to the heart lie within the lung). muscle. There are spare arteries inside the chest wall and the forearm and spare veins The left side of the heart receives this oxygen- in the legs which can be removed safely. All rich blood from the lungs and pumps it to all these can be used to construct excellent bypass parts of the body. This is a continuous process. grafts. The valves of the heart The arteries in the chest (the internal mammary arteries) are the most common Pulmonary bypass grafts, as they have been shown to valve Mitral valve have the best long-term results and can be accessed through the main incision for the cardiac surgery. In most cases, these arteries can be kept intact at their origin since they have their own oxygen-rich blood supply. During the procedure, the arteries are sewn to the coronary artery below the site of blockage. There are two arteries in the lower part of the arm, the ulnar and radial arteries. Most people receive adequate blood flow to their arm from the ulnar artery alone and will not have any side effects if the radial artery is removed Tricuspid valve Aortic valve and used as a graft. Careful preoperative and intraoperative tests determine if the radial artery can be used. If you have certain Reasons for needing cardiac surgery conditions (such as Raynaud’s syndrome, Coronary artery disease carpal tunnel syndrome or painful fingers The heart muscle (myocardium) receives its in cold air) you may not be a candidate for blood supply from the coronary arteries. this type of bypass graft. Some people report Sometimes these arteries can become numbness in the wrist and hand after surgery, narrowed by a disease process known as however, long-term sensory loss or numbness atherosclerosis. This is when fatty deposits are is uncommon. gradually laid down inside the vessel causing Veins from the legs - the saphenous veins, may the artery to become narrowed. This is shown be harvested (removed) using one of the three up by the coronary angiogram investigation techniques described below: performed by your cardiologist. 1. Open vein harvest (OVH) - a continuous The heart and coronary arteries incision (cut) is made from the ankle As the coronary artery becomes narrowed, upwards towards the knee or groin the blood supply to the heart muscle (depending on the length of vein that (myocardium) is decreased. When the demand is required). The vein is then surgically for oxygen-rich blood is greater than the removed. supply, angina pain arises from the muscle. 2. Bridging vein harvest (BH) - the vein is If the coronary artery becomes completely surgically removed through multiple small blocked, usually by a blood clot occurring incisions along the leg. 1 Patient’s guide and agreement to consent form 3. Endoscopic vein harvest (EVH) - a small