Frequently Asked Questions

Every operation is slightly different and it depends on what you are having done. Ideally you should have the opportunity to speak to your consultant surgeon about the surgery at the outpatient clinic or before your surgery if you are an inpatient. Some of the different types of operation are described in Types of Surgery. 

The average stay is described in Patient Journey. 

Your surgery is prioritised according to the clinical need. Most operations can be performed within a few weeks of deciding that surgery is required, but more complex procedures may require further planning and preparation. If tests are still outstanding, these must be undertaken first which can sometimes rely on other departments or hospitals that are out of our control. 

No patient who requires surgery urgently will be held in a standard waiting list - if your condition deteriorates, please advise us so that we can prioritise accordingly. This may involve admitting you to hospital to ensure your safety until the next available slot. 

The operation will always be done by a suitably trained surgeon. Every consultant takes direct responsibility for the patients under their name, so even if a surgical trainee is performing parts of your procedure, it will be under the guidance of the named consultant. Our trainees are meticulous, dedicated and undertake parts of procedures that they have been trained to perform. 

As a teaching hospital, we are proud of our reputation of training the next generation of consultants. Many of our current consultants were trained themselves at LHCH and relied on structured, supervised training in order to reach the levels of expertise that they are able to offer now. 

As further reassurance to you, it is worth noting that the outcomes following surgery performed by trainees has been shown to be exactly the same as that performed by consultants. 

All cardiac surgery referred to surgeons at the Liverpool Heart and Chest Hospital is done on site. 

There are many different operations offered at LHCH. 

Most are performed through a median sternotomy, although there are also minimally invasive options available that utilise partial sternotomy, video assisted  thoracoscopic surgery, port-access and robotics. 

When you meet your surgeon to discuss your operation, you should have an opportunity to discuss what all the options available to you are. Typically, you will have been referred for surgery as other options will have been considered, but you can always discuss what alternatives are available. 

Options sometimes include: 

• Medical treatment alone
   
• Stents for coronary artery disease
   
• TAVI for aortic stenosis
   
• Minimally invasive surgery
   
• Repairs vs replacements for valves
   
• Tissue vs mechanical valves for replacements

Cardiac surgery is major surgery and carries significant risks, some of which can profoundly affect your quality or length of life. The risk to your life on average of different types is listed below: 

• Emergency appendicectomy 0.08% 8 in 10,000 patients 
   
• Gall bladder removal 0.15% 15 in 10,000 patients 
   
• Aortic valve replacement 1-2% 100-200 in 10,000 patients 
   
• Removal of large bowel 5% 500 in 10,000 patients 
   
• Perforated peptic ulcer 7% 700 in 10,00 patients 

It is possible to get a more detailed, personalised risk profile for you based on your medical records and the operation you require. This is normally calculated using a well-established tool called the EuroSCORE (www.euroscore.org) Your surgeon will be able to give you more information on this.  In addition to the risk of death, cardiac surgery carries risks of other complications including: 

• stroke 
   
• kidney failure
   
• heart attack 
   
• abdominal complications (including those requiring urgent surgery) 
   
• bleeding requiring further surgery 
   
• blood clots 
   
• breathing problems requiring additional time on a ventilator or a tracheostomy
   
• irregular heart rhythms
   
• infections (wound, chest, urine)
   
• failure of the operation
   
• need for pacemaker

If you are an inpatient, you may have to stay in hospital whilst you are made fit for surgery. This is normally achieved within 2-3 weeks, but may take longer in some cases. The average stay in hospital after surgery is around 5-7 days. 

It is possible to be released as quickly as 3 days after your operation.

Everyone is slightly different and some people will recover very quickly and others will need some time to recover from their operation. A rough guide to recovery would be: 

For surgery that involves opening the breastbone, it is usually the time taken for the bone to heal that delays recovery rather than any problems with the heart. 

For most patients, there is only one outpatient appointment with the surgeon where the wound is checked and it is made sure that you are back to expected activities. This normally happens at 6-8 weeks and may or may not include a chest x-ray, ECG or echocardiogram. At this appointment you meet either the consultant surgeon or one of the registrars.

If you are given the all clear from the surgical team at this time, you are discharged from surgical follow up. Your medications will be adjusted and instructions sent to your GP for them to manage you from there onwards. You will also probably start your cardiac rehabilitation program around the same time. If you have an artificial valve, you will need to continue to have this checked by your cardiologist at regular intervals. 

If you are having your surgery performed by a surgeon from Liverpool Heart and Chest Hospital, your surgery will always be done on site. We do not perform operations at the other hospitals where you may have seen your referring cardiologist. This is because all the equipment, expert personnel and operating theatre setup we have are specialised and best utilised where the teams who know how to use them are based. 

If you would like to discuss the option to have your surgery at another cardiac centre, please raise this with your consultant.

Doctors are not allowed to do anything to patients against their will. If we offer you surgery, this is a recommendation only, based on scientific evidence and an assessment of your clinical condition. If, after you have heard all the options available to you, you would prefer not to have surgery, this is entirely your right. In order to make a decision to proceed on with a treatment - or to refuse it - you must be competent to make that decision. This is a legal requirement which  means, broadly, that you must fulfil the following criteria:

1. You must understand what has been said about your surgery
    
2. You must be able to remember what was said (in general - you will not be asked to remember specific details, but you must recall the crux of the discussion) 
    
3. You must be able to “weigh in balance” the options presented to you 

If your doctor has any concerns that these requirements have not been met, they may require legal assistance or a second opinion in order to check that you are in fact able to make those decisions.

Unfortunately, even if you are only coming to help your friend or relative, the law states that the decision to proceed to surgery must be made, in the first instance, by the patient. If they are unable to make the decision themselves, the responsibility lies with the surgeon to determine their best interests - and they would have to seek a second opinion before proceeding. 

If the patient is unwilling to decide - but has the capacity to do so - then they will need to come to a final decision as to what they want as only they can consent to have the procedure. It is sometimes helpful for patients to discuss their choice with family or friends, but this must never be under duress - it’s a  big decision but must be made by them.

Cardiac surgery is major surgery and carries significant risks, some of which can profoundly affect your quality or length of life. The risk to your life on average of different types is listed below:

• Emergency appendicectomy 0.08% 8 in 10,000 patients
   
• Gall bladder removal 0.15% 15 in 10,000 patients 
   
• Aortic valve replacement 1-2% 100-200 in 10,000 patients 
   
• Removal of large bowel 5% 500 in 10,000 patients 
   
• Perforated peptic ulcer 7% 700 in 10,00 patients

It is possible to get a more detailed, personalised risk profile for you based on your medical records and the operation you require. This is normally calculated using a well-established tool called the EuroSCORE (www.euroscore.org) Your surgeon will be able to give you more information on this. 

In addition to the risk of death, cardiac surgery carries risks of other complications including: 

• stroke 
   
• kidney failure
   
• heart attack
   
• abdominal complications (including those requiring urgent surgery)
   
• bleeding requiring further surgery
   
• blood clots
   
• breathing problems requiring additional time on a ventilator or a tracheostomy
   
• irregular heart rhythms
   
• infections (wound, chest, urine)
   
• failure of the operation
   
• need for pacemaker

You would be surprised at how old some of our patients are! The oldest patient to have surgery at LHCH was 92 years old and did very well.  However, your age and your suitability for surgery are assessed by your surgeon when they meet you to discuss surgery and the options for your treatment. They will only offer surgery if they think it is in your best interests and will tell you whether they think you are putting yourself at undue risk. No surgeon would offer an operation to someone who they didn’t think would benefit from it more likely than be harmed by it.

You can postpone any treatments you like for as long as you like. You can even refuse surgery altogether if you don’t feel it’s the right choice for you. If you choose not to have surgery when it is offered, you may be taken off the waiting list in order to allow someone else to take your slot. This is not a penalty - it is to make sure that every opportunity to give someone life-saving heart surgery is used efficiently.

Keeping fit and healthy increases your chances of having a successful operation and recovery. Things you can do to improve your health before surgery include: 

• Stop smoking completely (ideally for at least 2 weeks, but as long as possible is best)
• Exercise as much as your heart disease will allow
• Lose weight by eating a healthy diet with plenty of fruit and vegetables, less fat and refined sugar, and lean meat where possible
• Take all your regular medications
• Have your teeth checked if you are having a valve operation
• Keep away from people with coughs and colds immediately before your operation
• Try to reduce stress

Most cardiac surgery has underlying heart disease that still needs to be managed after the mechanical problem has been fixed. If you have coronary artery disease you are likely to stay on lifelong:

• aspirin 

• beta-blocker
• statins
• ACE inhbitors

If you have a mechanical valve, you will need:

• warfarin or sinthrome

If you have a valve repair, you may need

• aspirin or warfarin temporarily

If you have heart failure you will likely be placed on:

• water tablets or diuretics
• ACE inhibitors
• spironolactone or eplerenone

If you have long-standing atrial fibrillation you may be on: 

• beta blockers
• digoxin
• blood thinners (warfarin or newer medications like apixaban, edoxaban, rivoraxaban etc)

If you had a median sternotomy, this usually needs to heal fully before stressing your upper body. This normally takes around 2-3 months to reach about half-strength and a further 2-3 months to get to maximum strength. You can drive once you have been seen in clinic at 6-8 weeks.

You can fly short distances (e.g. Isle of Man patients fly home) immediately. Long haul flights should be discussed with your surgeon at clinic. 

You can start an exercise program immediately after surgery, but should not do upper body weight bearing workouts for at least 3-4 months after the breastbone has been closed, and then should gradually build up. Treadmill, swimming and cycling are normally all fine. If you have had a minimally invasive operation, these limits may be reduced. Please speak with your surgeon.

Depending on which ward you are on, the visiting hours are set from 2-4pm and 6-8pm. This allows your care to be delivered and all the activities you need to participate in to be done without distraction. On the POCCU, visiting hours are from 8am - 8pm.

Please see the individual pages for the wards for more details.

You should raise any concerns you have with any member of staff you see. If they are unable to help you themselves, they should be able to find someone who can help you. Your consultant (or the consultant on the daily ward round) or the senior surgical doctor in the hospital should normally be able to address any issues you have with clinical matters. 

If at any time you feel that your concerns have not been heard or responded to adequately, you can ask to speak to the hospital manager at any time of day or night.

Many factors determine what operation you will receive.

Angiograms provide a useful roadmap of the disease, but they are only two-dimensional photographs of three-dimensional structures. Your surgeon may have found that your blood vessels were too small or diseased to take a bypass graft and may therefore modify your surgery. 

If you have any concerns, please discuss this with your surgeon.