Preparing for CHD Surgery

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Apr 23, 2019 | Ethan McConkey, Moderator | @ethanmcconkey

Surgery is a common outcome for congenital heart disease patients. According to the Center for Disease Control, 25 percent of the roughly 40,000 infants born with congenital heart defects, have defects serious enough that surgery or another procedure is necessary.  Over the past few years, Mayo Clinic has averaged 450 surgical procedures per year for congenital heart disease patients.

Lucinda Stroetz, a physician’s assistant who has been assisting surgical congenital heart disease patients for the past 40-plus years, says there are several ways patients can prepare themselves prior to their surgery.

Throughout the lives of all congenital heart disease patients they undergo a series of tests, such as echocardiograms, ultrasounds, or catherization procedures to check the heart’s rhythm, structure, and function.

If surgery is a possibility, a CHD patient’s cardiologist, may refer their patient to another cardiologist who has more experience with that defect. An example would be a patient being referred to Mayo Clinic for a rare defect such as Ebstein’s Anomaly, as Mayo has a large history and clinic that works with this congenital heart defect. Having an experienced team review your case is of the utmost importance to the timing of your surgery. Per Stroetz, “the group of adult congenital cardiologist’s here, are very savvy and know when is the right time for surgery and who can wait.”

Before your visit to determine the need and timing of surgery, it is important to send your most recent echocardiogram and additional images (such as CT or MRI scans) to the cardiologist and surgeon, along with any other pertinent studies if not already in the surgeon’s possession. In addition, if the patient has had heart surgery before, a copy of the operative report is important to send ahead.

Once surgery is deemed the best treatment, a cardiac surgeon is brought on to review the case and discuss the proper timing of surgery, whether in the next few weeks or months, or in some cases, year-by-year check-ups watching for certain symptoms.

When the surgery date is scheduled, one of the most important things to do is see a dentist. This is done to ensure there are no sources of infection in the patient’s mouth.

“They (patients) can get an infection in their heart or on a new valve from dental issues, this is a very serious problem that can be life threatening” Stroetz said.

A second way for patients to prepare, is arranging for work leave, that is covered by FMLA (Family Medical Leave Act), or short-term disability. Patient’s should collect any forms necessary and send them to the surgeon’s secretary to help file the forms. The typical time away from work after surgery is six weeks, four weeks when minimally invasive, and 8-12 weeks when the patient’s job requires heavy lifting. Six weeks allows the patients’ sternum bone to heal properly and gives them enough time to get plenty of exercise, specifically walking, as a part of their active recovery.

A third item to prepare prior to surgery is to arrange for care after surgery. If the patient lives alone, they should find someone or multiple people to check in on them a couple times a day when they get home after their surgery, helping them prepare meals, get laundry done and do simple cleaning such as vacuuming. This person or group can also help the patient with transportation to and from appointments  for follow-up as the patient is not allowed to drive for a month after surgery.

24-hours before the surgery, the patient will meet with someone from the cardiac surgery team to discuss the procedure and give some typical pre-surgery instructions. The patient must not eat anything after midnight and only drink clear liquids from that point on. Two hours before the surgery they can have nothing to eat or drink.

In addition, a patient will have to take a shower with a hospital provided antibacterial solution both the night before and the morning of surgery, as well as apply a prescribed antibacterial ointment in their nose. The night prior to the surgery the patient will also call the surgical department to find out what time they should arrive at the hospital. This is important as they will need to make sure they will have transportation at that time as the earliest time slot is 5:45 in the morning.

Once the patient arrives at the hospital, they will check in at admissions, then will be escorted to a small room where they can prepare for their surgery with their family. As the surgery gets closer, a member of the anesthesia team will come and look things over one last time, the IV is started, and the relaxant medications are administered. Shortly thereafter, the patient is brought to the operating room.

During surgery, the family is updated about the progress, including when the patient enters the operating room, what time the operation starts, and finishes. If feasible, the surgeon will visit with the family after the operation has been completed.

After surgery the patient is brought to the ICU where they typically stay for at least one day. While in the ICU, a patient’s family can come and visit. When intensive care is no longer required, the patient is brought to a single room outside the ICU to complete their hospital stay.

The biggest impact a family member can have on a patient prior to the surgery is by providing encouragement. Stroetz explained, “with nearly every patient, the family needs to remind them, that the overwhelming odds are in their favor. The most important thing, is the frame of mind when people come in.” She added that calling to ask questions is very important “When they are going to have surgery, they’ll hear all sorts of stories, from people here and there that may not even apply to their situation.. If there is something they’re really concerned about, they should call and ask.”