CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A R FRO CARDIAC SURGERY PATIENT INFORMATION BOOKLET

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1 CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A R FRO CARDIAC SURGERY PATIENT INFORMATION BOOKLET

2 Welcome / Croeso Welcome to the Cardiothoracic Department unit at the University Hospital of Wales. This booklet has been designed to give you information about your forthcoming surgery. It contains helpful advice on what to expect before, during and after your heart operation. Within the Cardiothoracic surgery department we believe that it is very important for patients and their relatives to have a clear understanding as to why the operation is to be carried out, what is involved and what you the patient can expect during your stay. Any member of the nursing or medical team will be more than happy to answer your questions or deal with any issues that may be worrying you. PLEASE DON T BE AFRAID TO ASK

3 Why Surgery? There are various reasons for undergoing heart surgery; the two main reasons are usually disease of the coronary arteries and disease of the heart valves. You can however be certain that the decision in each individual case to undergo heart surgery is considered the best and safest treatment by your Cardiologist and Cardiac Surgeon. Coronary Artery Surgery Coronary arteries are the blood vessels which supply the heart muscle with energy and oxygen. These arteries can become narrowed or blocked due to the build up of fatty substances in the wall of the coronary artery.

4 Valve Surgery. Within the heart there are four valves which ensure that the blood flows in one direction and is unrestricted. The valves can become damaged or diseased and their normal function disturbed, they may obstruct the blood flow or become leaky. These abnormalities place an increasing strain on the heart, which the patient may recognise as tiredness or breathlessness. The damaged heart valve may be detected by a doctor in the form of a heart murmur however damage may be present even though the patient has no symptoms. In some patients only one of the four valves is affected, in other patients surgery may be required for two or even three affected valves. The names of the heart valves most commonly affected are the mitral valve and the aortic valve. Valve replacements can be either mechanical or come from natural tissue. Both types of valves function very well; your surgeon will

5 suggest which type of valve is best in your individual case, but please discuss this with them if you have any concerns. Mechanical Valves These are made of artificial substances, usually carbon or plastic. This type of valve requires you to take anticoagulant pills for the rest of your life (usually warfarin). This is to prevent blood clots forming on the artificial surfaces of the valve. Tissue Valves These valves are constructed from natural biological tissue. The tissue is often animal tissue treated with a substance, which preserves the tissue. If you have a tissue valve you may only have to take warfarin for up to three months. If you are having your valve replaced you must visit the dentist prior to your operation. This is because any infection in the teeth or gums can spread to the new valve and cause

6 complications. It is also important for you to see your dentist regularly for a check up after your operation.

7 Staff involved in your care The following team members will visit you during your stay: - The Case Managers will visit you before your operation to discuss what will happen before your operation and afterwards. They will also inform you of the name of the surgeon who will be operating. You will be given relevant booklets and information about your operation. The surgeon will visit you before the operation to discuss what he plans to do. He will give you the opportunity to ask any questions about your operation. The anaesthetist will visit you to assess your breathing and to tell you about the drugs you will be given in the anaesthetic room. He or she will want to know if you have had an anaesthetic in the past and ask if you are allergic to any drugs. The anaesthetist will ensure your pain is controlled after the operation

8 The Physiotherapist will show you techniques of breathing and coughing which will be very important after your operation. All heart surgery patients need to learn these techniques and they are especially important if you have been a smoker. A physiotherapy information booklet will be given to you before your operation with specific advice for your recovery. The nursing staff will be introduced to you on your admission day to ward C5. They will look after you before you go for your operation and when you return from the high dependency unit. They have a lot of experience dealing with heart surgery patients and will be able to answer any of your questions. The cardiac rehabilitation team will visit the ward to discuss your rehabilitation following surgery and what it involves. The aim is to ensure that you recover as quickly as possible after your operation and to take action to help prevent further heart problems.

9 The pharmacist visits the ward on a daily basis and will be happy to discuss any questions you may have regarding your medication.

10 Getting ready for surgery Shaving Part of the preparation for surgery involves shaving those parts of the body where the surgeons are likely to make an incision. This normally means shaving the chest, abdomen, arms and groins, if you are having coronary bypass surgery your legs will have to be shaved also. One of the nurses will do this for you with special clippers the evening before your operation. Bath or Shower It is important for any patient having surgery that the skin is as clean as possible to reduce the risk of postoperative infection. The ward staff will advise you to have a bath or shower and wash your hair the evening before and the morning of surgery. The ward nurse will also give you antibacterial soap to use.

11 Eating Before Surgery If your operation is scheduled for the morning, you will not be allowed to eat or drink any thing from midnight prior to your operation day. If your operation is to be carried out after midday you may be allowed a light breakfast at 6am and nothing after that. The ward nurse will keep you informed as to when they will be keeping you Nil by Mouth. The Pre-med. Normally one to two hours before your operation you will be given a pre-med.. This is a drug prescribed by the anesthetist to relax you before the full anaesthetic is given. It is normally either given in tablet form, injection or both. It is important that you stay in bed once it is given, as you will feel quite sleepy, if you need any thing call the nurse with your bell.

12 Going To The Operating Theatre When the theatre staff are ready you will be taken to the operating theatre on a trolley. A porter and a ward nurse will accompany you and you will be given oxygen via a facemask to breathe on your way. Once in the anaesthetic room you will be given an injection of anaesthetic drug and will be asleep for the whole operation. You will be in the operating theatre for at least 3-5 hours, some patients are in theatre longer depending on the type of operation you are having performed. Following your operation you will be transferred to the cardiac intensive care unit. Visiting There are no set visiting hours on the intensive care unit (open visiting). Immediate family and close friends will be welcome but visiting is restricted to two per bed. You will either be asleep or very drowsy for most of the time in the intensive care unit so visitors will not be able to speak to you very much.

13 If your relatives prefer not to visit on the day you have your operation then they are very welcome to telephone the unit to see how you are progressing day or night. Intensive Care Telephone number: C5 You will be transferred to C5 from Intensive Care. Ward C5 has 37 beds and patients on the ward are either waiting or recovering from surgery. The ward is divided into North and South but is run as one area; the division is made to simplify bed management, nursing care arrangements and to make it easier for visitors to find you. A map and telephone numbers can be found at the back of the booklet. Visiting hours on C5 are between 3pm-8pm daily.