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Liverpool Heart and Chest Hospital, Thomas Drive, L14 3PE
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Pre-operative

Patients are referred to the surgeons typically from a cardiologist.

This is because the first line of management is usually medical. If your cardiologist feels that you should be considered for surgical treatments, they will ask for the surgeons to see you. 

Outpatient or Elective Treatment 

The majority of problems that require cardiac surgery can be dealt with on an outpatient basis. That means that once the diagnosis has been made, you will be able to go home and carry on as usual until your outpatient clinic appointment. 

Referral to our surgeons 

There are a number of ways of being referred to a surgical service. The quickest way is for the cardiologist to refer to the next available cardiac surgeon. This means that you will be allocated to the next appropriate surgeon who can deal with your case. 

Occasionally your cardiologist will seek out a particular surgeon to accept your case. This happens if the cardiologist feels that you require the specialist skills of that surgeon. In most cases you will then be seen at the next available opportunity of that surgeon. In some cases, if that surgeon has a particularly long 
waiting list and the surgery could be done by another surgeon, you might be seen by another consultant. This happens so that you are not waiting too long for your appointment. 

Some surgeons will ask for further information either from your cardiologist or GP or in the form of extra tests that are done by your local hospital or occasionally by LHCH. This is so that you are not seen in the outpatient clinic with incomplete information. 

Pre-operative Out-Patient Clinic Assessment 

The first time you see the consultant surgeon will be at the Outpatient Clinic. 

You are welcome to bring a friend or relative(s) to your appointment - most people do and it is often helpful for the information to be heard by several people as there is a lot to take in. This consultation serves several purposes: 

  • * to enable the surgeon to get to know you 
  • * for the surgeon to summarise what has been found so far 
  • * to discuss the options of treatment and what each of the benefits are 
  • * medical management
  • * cardiology options (e.g. stents)
  • * surgery
  • * for you to ask questions
  • * for you to make a decision as to how you would like to proceed

Most surgeons will allocate between 45 - 60 minutes to this first meeting. 

Although this can sometimes feel overwhelming or scary, all of our surgeons are very happy to go over things with you in detail, answer your questions or concerns and to discuss different options. Please feel free to discuss whatever thoughts, concerns or options you had in mind. The consultation is designed for the surgeon to give you all the information that you need in order to make the right decision for you. Quite often, the decision to proceed to surgery is clear-cut because surgery is the safest and most effective option for your disease. If there are any grey areas or your case is on the borderline between different treatment options, once the surgeon has met you, they may request a multidisciplinary team meeting to seek further opinions from other surgeons, cardiologists, anaesthetists and other health professionals.

At the end of the appointment, you should expect to have an idea of what will happen next. 

If more information is needed, you may be asked to come back to clinic to discuss those results. 

If you are being listed for surgery, you may get given a date at the time or sent one later on. 

This depends on what time of operation you need and how long the waiting lists are for those types of operation. Most routine operations are performed within a few weeks. Some specialist procedures may have waiting lists of months. If your surgery needs to be brought forward due to health concerns, your surgeon will arrange that. 

Pre-operative Anaesthetic Clinic 

In order to ensure that we are well prepared to give you a general anaesthetic, you may be invited back to meet an anaesthetist. This may or may not be the anaesthetist who will be present for your surgery. 

The pre-operative anaesthetic assessment clinic is run by Dr Jonathan Kendall. 

Pre-operative Clinical Nurse Practitioner Clinic

A large amount of information is required about you prior to setting out on your heart surgery journey. This includes:

  • * your previous medical history
  • * lists of medications
  • * allergies
  • * your smoking and alcohol history
  • * details of your home circumstances
  • * collation of all your test results
  • * a top-to-tail examination to make sure nothing is missed

Whilst most of this information is usually collected during your meeting with the consultant, that initial consultation is also used to give you information about the procedures and usually to seek your consent for the operation.

For patients who are planning to come in for a Day Of Surgery Admission (i.e. coming in on the morning of surgery rather than the night before), the Clinical Nurse Practitioners (CNPs) offer a clinic where all the final details are finalised in advance. 

The CNPs are also well positioned to give you information on logistics, provide emotional and psychological support, and furnish you with additional information where required. 

The week before elective surgery 

Medications

In the days leading up to your operation, you may have been asked to stop certain medications by your consultant in order to ready yourself for surgery. This may vary according to the type of disease you have and the operation that is being planned for you. If you are on any of the following medications, please ask your consultant’s secretary when you should stop taking them: 

  • * antiplatelet medications: aspirin, clopidogrel, prasugrel, ticagrelor 
  • * blood thinning tablets: warfarin, sinthrome, apixaban, dabigatran, edoxaban, rivaroxaban 
  • * ACE inhibitors: ramipril, perindopril, lisinopril, other medications ending in -pril 
  • * Angiotensin II blockers: valsartan, candesartan, olmesartan, other medications ending in -sartan 

Illness

If you have been unwell in the days leading up to surgery, including needing any changes to your medications, any changes to your symptoms and especially if you have been given antibiotics for a chest infection, you MUST let the hospital know as soon as possible. Although it can be disappointing having your operation cancelled due to a minor illness, the risks if you undergo cardiac surgery whilst your body is recovering from another illness can be life-threatening.

Coming in for elective surgery 

Once a date has been set for your surgery, you can normally stay at home until the day before (or the day of) surgery.

Day Of Surgery Admission

In order to increase the amount of time that patients can spend at home and out of hospital, LHCH now offers patient the opportunity to come in on the same day as their operation. This means seeing anaesthetists and nurse practitioners in advance in a clinic.

Inpatient or Urgent Treatment

If you have been brought in to hospital with an urgent problem (for example a myocardial infarction or heart attack) or if a serious problem is found during a routine scan (for example a worryingly tight narrowing on one of the coronary arteries during angiography) then you may be asked to stay in hospital until the
date of surgery. You will be prioritised according to the disease - so if you need to have surgery more urgently than someone who came in after you, you will taken an earlier slot. 

Referral to our surgeons

The cardiologists at your hospital have an online referral system to contact surgeons for inpatient surgery. If they feel that you need your operation brought forwards or prioritised, they will contact us directly via the on-call surgeon who will make the assessments required to decide who, what, when and how your surgery will be performed.

There is an on-call surgeon available 24 hours a day and 365 days a year to discuss emergencies.

All other urgent referrals will be dealt with on a daily basis. 

The in-house waiting list for urgent surgery is typically under three weeks. 

Transfer to our hospital

If you were brought in to your local hospital and had all the necessary investigations performed there to decide that you need to have cardiac surgery, you will normally be cared for there until 1-2 days before your operation. 

If any changes in your clinical condition require additional support that cannot be offered at your local hospital, or if you need tests that can only be done at LHCH, we will transfer you across to us sooner. Normally this is under the care of the cardiologists who are performing the additional tests; but may also be under the surgeons. 

Your consultant surgeon will see you in the days preceding your surgery and explain to you everything that is planned for you. However, during this meeting, new information may come to light which may change the plan that was initially made during your case being reviewed. 

Although most of the time, people who have been referred for urgent surgery have a clear idea in their mind as to why they need surgery, please use this meeting: 

  • * to enable the surgeon to get to know you
  • * for the surgeon to summarise what has been found so far 
  • * to discuss the options of treatment and what each of the benefits are 
  • * medical management 
  • * cardiology options (e.g. stents) 
  • * surgery
  • * for you to ask questions
  • * for you to make a decision as to how you would like to proceed 

Pre-operative anaesthetic assessment 

In-patients are normally seen by the consultant anaesthetist who will be performing their surgery the day before surgery. They will have had the opportunity to review your records prior to meeting you in person. 

Your in-patient stay until surgery 

While you are waiting in hospital for your operation, you will normally be looked after by the cardiologists who admitted you. During this time, any tests required prior to your cardiac surgery will be performed and conveyed to the cardiac surgery team. You may need to have your medications adjusted and in  the seven days prior to your operation, some of your cardiac medications will be stopped in preparation for the operation.