Coronary Artery Bypass Graft (CABG) and Heart Valve Surgery

Transcription

1 Networked Services Coronary Artery Bypass Graft (CABG) and Heart Valve Surgery Information for patients This booklet is for people having coronary artery bypass graft (CABG) surgery or heart valve surgery. It explains what happens before, during and after these operations, and the benefits, risks and alternatives. If you are having any other type of heart surgery, please ask for separate information. However, contact numbers and the recovery information in this booklet will be relevant to you. Confirming your identity Before you have a treatment or procedure, our staff will ask you your name and date of birth and check your ID band. If you don t have an ID band we will also ask you to confirm your address. If we don t ask these questions, then please ask us to check. Ensuring your safety is our primary concern.

2 Contents Page Number Introduction 2 Coronary artery bypass graft (CABG) surgery 2 Heart valve surgery 7 Consent 13 Before your surgery 13 Pre-assessment clinic 14 Coming in to hospital 16 What happens after CABG and heart valve surgery? 18 Visiting information 19 Recovery in hospital 20 Going home 23 At home after surgery advice and information 24 Cardiac Health and Rehabilitation Service 32 Outpatient appointments 32 Who can I contact with queries and concerns? 33 King s location map 36 2

3 CABG surgery What is Coronary Heart Disease (CHD)? Your heart is a muscle, and like all muscles in your body it needs to have a good blood supply in order to work properly. It gets blood from three main blood vessels called the coronary arteries. If you have CHD, one or more of these arteries narrow so not enough blood gets to your heart. These narrowings are caused by a build-up of a fatty substance in your artery walls. Angina is the term for the symptoms that you get when you have narrow arteries. Common symptoms include an ache, tightness or heaviness in the chest. You may also feel discomfort in your back, shoulders, arms and neck and be short of breath. What is Coronary Artery Bypass Graft (CABG) surgery? CABG surgery is an effective way of treating the severe narrowings of your coronary arteries. It improves the blood supply to your heart and relieves the symptoms of angina. We use veins or arteries to bypass the blocked coronary arteries. We may use the saphenous vein from your leg, the radial artery from your arm or the internal mammary artery from inside your chest wall for the bypass grafts. These are then sewn in place. You may wonder how your leg, arm or chest will cope with the loss of the artery/vein we use for the bypass. You have other blood vessels in those areas that will take over the work of the one that has been taken out. 3

4 After your operation the leg/arm from where we took the vein/artery may be swollen and you may have some discomfort and numbness. This will improve over time. After your CABG operation you will have a better blood supply to your heart muscle. This eases angina symptoms in the vast majority of patients. What happens during CABG surgery? You will have your operation in one of King s cardiac surgery theatres. Your surgeon will usually make a cut (incision) through your breast bone (sternum) and work on the arteries on the surface of your heart. They will take the blood vessels that they will use to bypass the narrowings in your coronary arteries from their original positions to use them as bypass grafts. Usually your heart is stopped and you are put onto a heart-lung (cardiopulmonary) bypass machine. This takes over the work of your heart while the surgeon is stitching into place your bypass grafts. You may have the operation while your heart is still beating. If your surgeon feels that this is possible in your case, they will discuss it with you before your operation. Once they have sewn in the grafts, your surgeon will restart your heart, take you off the heart-lung machine and close your wounds. Your breastbone will then be fixed back together with metal wires. These will stay in your chest for life. The rest of your wounds will be stitched using stitches that gradually dissolve, so you do not need to have them taken out at a later date. 4

5 Aorta Saphenous Vein (grafts from leg) Internal Mammary Artery (grafts from chest) Plaque blockage How long does CABG surgery take? It normally takes between three and five hours. What are the risks of CABG surgery? No operation is without risk. The estimates below are average figures for all patients as a whole. Your individual risk will vary according to specific factors such as your age, severity of disease or other medical conditions that you may have. Your surgeon will discuss your estimated risks with you. Our CABG surgery risks are: The risk of death is usually between 1 3%. The risk of serious stroke is between 1 2%, but may be higher if you have additional risk factors. The risk of an irregular heartbeat atrial fibrillation (AF) is 15%. This condition is common after heart surgery and can be put right by taking medication. 5

6 The risk of your kidneys not working quite as well (renal impairment) is 5% with 1 2% of patients needing dialysis for a short time after surgery. Other risks include wound and chest infections and bleeding after the operation. What are the benefits of CABG surgery? CABG surgery should: relieve your angina and stop you from feeling breathless reduce the risk of you suffering from a heart attack improve your quality of life help you to live longer. Having this surgery does not cure coronary heart disease. But you can reduce the risk of your grafts becoming narrowed by: not smoking taking your prescribed medication exercising regularly eating a healthy diet staying a healthy weight attending a cardiac rehabilitation programme. If you live a healthy lifestyle and continue with your prescribed medication your surgery can relieve your symptoms for years or more. Most patients need this surgery only once, but if your angina symptoms come back you may need more treatment. Are there any alternatives? Your cardiac surgeon and the cardiologist who did your coronary angiogram will have already discussed with you any alternative treatments such as medication, angioplasty or having a stent inserted. 6

7 A CABG operation would have been decided as the best treatment for your condition. But please contact your surgeon if you would still like to discuss other options. Heart valve surgery What is heart valve disease? Your heart is a muscle, about the size of a clenched fist. It lies just behind and to the left of your breast bone (sternum). Its job is to pump blood and oxygen around your body. It has four chambers. The upper chambers, which receive blood from your lungs and body, are called the atria. The lower pumping chambers are called ventricles. Your heart has four valves that ensure blood flows in the right direction through the heart chambers. The valves act like one-way doors allowing blood to flow forward into the next chamber and then closing to stop it from flowing backwards. The symptoms of heart valve disease vary depending on which valve is affected and how severe it is. The extra strain placed on your heart may cause a range of symptoms including shortness of breath and chest discomfort, general tiredness, dizzy spells, palpitations and having excess fluid in the body which may cause swollen ankles. The heart valves which most often cause a problem are the ones on the left-hand side of your heart. These are called the aortic and the mitral valves. The left-hand side of your heart pumps to your whole body, so the blood is under greater pressure. This is why these valves are more 7

8 likely to fail. You may also need a new valve on the right-hand side of your heart usually the tricuspid valve. Your heart valves may not be working properly because of: stenosis: this is a narrowing of one of your heart valves (usually the aortic), which means it cannot open properly and restricts the flow of blood through your heart regurgitation: if you have a leaky valve, it does not close properly and allows blood to leak backwards. This can affect any of your valves. Both stenosis and regurgitation put your heart under extra strain. Why does heart valve disease happen? Congenital heart disease you may have been born with an abnormal heart valve. Some people never have any problems, but in others the condition gradually gets worse. Ageing can cause narrowing of the aortic valve. Infection (endocarditis) abnormal heart valves can become infected, which can cause them to leak. Rheumatic fever if you had this as a child your heart valve can become diseased in later life. Other heart conditions may also affect your heart valves. What happens during heart valve surgery? You will have your operation in one of King s cardiac surgery theatres. Your heart is stopped and you are put on a heart-lung (cardiopulmonary) bypass machine so your surgeon can operate. This machine takes over the work of your heart during your surgery. 8

9 Your surgeon will then find and open the part of your heart that has the diseased valve. They will either repair your valve or replace it by sewing in place an artificial valve. They will then start your heart again, take you off the heart-lung machine and close your wounds. Your breastbone will be fixed back together with metal wires. These will stay in your chest for life. The rest of your wounds are usually stitched with stitches that gradually dissolve, so you do not need to have them taken out at a later date. How long does heart valve surgery take? It normally takes between three and five hours. What type of heart valve will be used? Tissue heart valve These are commonly made from pig heart valves. They are very similar to human ones and are treated so your body will not reject them. You may need to take warfarin for a short time after the operation and you may also be given aspirin. The lifespan of a tissue valve can be reduced in certain circumstances, particularly in young patients. But most patients with heart valve disease are over 70, so the replacement valve should last them a lifetime and not need to be replaced again. Mechanical heart valve These are made of metal and carbon. They should last a lifetime, but sometimes you need another operation. If you have a mechanical heart valve you may be aware of the valve clicking, which is perfectly normal. They are much quieter than they used to be and you will find that over time you will no longer notice the clicking and those around you are not likely to hear it, either. 9

10 You will also need to take warfarin for the rest of your life. This makes your blood thinner to prevent blood clots forming around your new heart valve. Because you are on warfarin you will need to have regular blood tests to make sure your blood is not too thin or that it does not clot too easily. You can have your blood tested at your GP surgery or local hospital haematology clinic; this will be arranged by your ward nurse before you are discharged from King s. Valve repair Your surgeon may be able to repair your valve by using a ring to strengthen it. This is more likely if you have a leaking mitral valve. We have surgeons who specialise in repairing mitral valves who achieve a repair in about 90% of patients. Occasionally, they may be able to repair your aortic valve, although this is less common. Mechanical aortic valve Bovine (cow) tissue valve Pictures courtesy of SORIN What are the risks of heart valve surgery? No operation is without risk. The estimates below are average figures for all patients as a whole. Your individual risk will vary according to specific factors such as your age, severity of disease or other medical conditions that you may have. Your surgeon will discuss your estimated risks with you. Our heart valve surgery risks are: The risk of death if you are having an aortic valve replaced is 1 3% and for a mitral valve it is 3 5%. But for some patients it may 10

11 be10 15% because the risk rises with age and if you have other medical conditions. Your surgeon will discuss this with you. The risk of serious stroke is 1 2% but may be higher if you have other risk factors as well. The risk of an irregular heartbeat atrial fibrillation (AF) is 24%. This condition is particularly common after valve surgery and can be corrected with medication. The risk of your kidneys not working quite as well (renal impairment) is 3% with 2% of patients needing dialysis for a short time after surgery. Other risks include wound and chest infections, bleeding after surgery, and needing a temporary or a permanent pacemaker. What are the benefits of heart valve surgery? After surgery you will notice that your symptoms will gradually improve. Even patients without the symptoms of valve disease may benefit from surgery, because it will improve how long they can expect to live. Are there any alternatives? We can sometimes do minimally invasive (keyhole) heart valve and coronary bypass surgery. This involves making a number of smaller cuts and using an endoscope. If your surgeon thinks this type of operation is suitable for you, they will discuss your options with you before surgery. The only alternative to heart valve surgery is medication to control your symptoms. This can help to ease your symptoms but may not be a long-term solution. Depending on how severe your valve disease is, the valve itself can gradually work less well and the only way of treating this is with surgery. It is also safer to have the valve either repaired or replaced before your symptoms get worse. 11

12 Guarding against infection If you have valve disease you are at greater risk of developing endocarditis, which is an infection of the lining of your heart and valves. It usually attacks only valves that are already abnormal or hearts with other abnormalities from birth (congenital). It is important that you take special care to avoid this serious infection, because if you develop it you will need to be treated in hospital with antibiotics through a vein (intravenously). It often starts in your mouth, so take extra care of your teeth and gums and visit your dentist regularly for check-ups. Please let your dentist know when you have had a new valve fitted. Recent guidance given to dentists no longer requires them to give antibiotics to patients with a valve condition. But our cardiac surgeons would like all of their valve surgery patients to have antibiotics before any dental work. If you or your dentist has any concerns or queries about this, please contact your surgeon. You may also need to take antibiotics before other surgical procedures or investigations. So please check with the doctors. 12

13 Consent We must by law obtain your written consent for any operation and some other procedures beforehand. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of the treatment proposed, please do not hesitate to ask to speak with a senior member of staff again. Before surgery your surgeon will explain the specific risks that apply to you and tell you if the expected complication rate will be different based on these factors. They will also discuss with you the risks of not having the surgery. Before your surgery On the waiting list Your cardiologist will refer you to one of our cardiothoracic (heart) surgeons who will assess you to see if surgery will improve your condition. During your consultation, they will discuss with you the risks of surgery and how long you may have to wait for your operation. You will then be placed on the waiting list. If you would like more information about our current waiting times, please contact the Cardiothoracic Admissions Manager on or ask your surgeon. Once you are on the waiting list, the Cardiothoracic Admissions Manager will be able to give you information about your admission plan. This includes arranging your pre-assessment clinic appointment, booking the tests you need and booking a date for you to come into hospital for your operation. 13

14 How can I prepare for heart surgery? Stop smoking if you stop smoking before your surgery you will reduce your risk of getting a chest infection and improve your long-term recovery. If you need help to stop smoking, please discuss this with your GP or practice nurse. Lose weight if your surgeon has advised you to lose weight before your surgery and you need help, please discuss this with your GP or practice nurse. Are you a carer? If you look after someone else, please think about who will care for them while you are in hospital and during your recovery. You may need more support or have to make other arrangements before you come in for surgery. Pre-assessment clinic You will have a pre-assessment clinic appointment at King s before you come into hospital for your surgery. This is to prepare you for your operation and to help to ease any concerns you may have about it. You will be given information and advice about your surgery, what happens when you come in to hospital and your recovery. You will also be able to ask us questions. One of the pre-assessment team will review your medical history and do a physical check. You will have a number of tests, including a chest x-ray, blood tests and a heart tracing (ECG). You will also be screened for MRSA by having swabs taken (see page 15). You may need other tests/investigations; we will tell you which ones on the day. 14

15 Coming to this clinic makes it less likely that your operation will be delayed. By having all of your tests in advance, we can check you are well enough to have surgery and find out if there is anything that we need to deal with before you come into hospital. If you cannot come to your pre-assessment clinic appointment, please tell the cardiothoracic surgeon at your consultation. If you have any queries or concerns about your surgery, even after attending the pre-assessment clinic, please contact the cardiothoracic admissions manager on Dental check-up If you are having heart valve surgery it is important that you have had a dental check-up within six months of your operation. Preventing infection Meticillin-Resistant Staphylococcus Aureus (MRSA) is a type of bacteria (germ) that has become resistant to most antibiotics. About 30% of the population carries Staphylococcus Aureus (Staph Aureus/SA) in their noses, throats or on their skin. This is called colonisation, and is very different from being infected with MRSA. At King s, we screen all patients having elective (planned) and emergency operations and procedures by taking swabs. This is simple, painless and takes only a few seconds. Many people have the MRSA germ without showing any symptoms. By screening we can find out if someone is carrying it. If so, they can be treated by their GP before they come into hospital for surgery. 15

16 During your stay on the ward you will be asked to shower and wash using a special antiseptic lotion that will reduce your chance of developing wound infections. To prevent the spread of infection at King s we also ask visitors to the ward to take the following precautions: do not visit if you are unwell avoid sitting on the patient s bed. wash your hands before entering and leaving the ward do not bring flowers and pot plants in as they are an infection risk. If you have any concerns about infection control, please do not hesitate to speak to a member of staff. Coming into hospital What do I need to bring with me? Please bring only one bag to the ward. You will need: slippers/footwear that you can adjust as your feet may swell after surgery nightwear and a dressing gown that have buttons at the front and do not need to be pulled over your head because you will find them easier to put on after surgery underwear and toiletries but no shower gel or soap a set of day clothes for when you are up and walking about the ward and to wear when you go home. 16

17 Valuables It is very important that you do not bring any item of sentimental or monetary value into hospital with you. If these items do go missing it is very upsetting for you and we cannot accept liability for their loss. Your admission date The Cardiothoracic Admissions Manager will arrange your admission date with you. You are normally admitted the day before your surgery, usually in the afternoon or the evening. If you become unwell before your admission date for example, you develop a cough, flu, diarrhoea, vomiting, or are put on antibiotics please tell the Cardiothoracic Admissions Manager as soon as possible, because you may not be well enough to come in for your surgery. Please do not leave home without being told by the hospital that your bed is available. Day of surgery You will not be able to eat or drink before your surgery. The nurses will let you know when you will be nil by mouth. On the morning of your operation they will give you your usual medication with a small amount of water. The nurses will use clippers to remove any hair from your chest and other areas that need to be clear for the operation. You will be asked to shower twice in a special antiseptic lotion before your surgery. Once you are ready you will be taken on a trolley to the operating 17

18 theatre. A small plastic tube (cannula) will be put into your hand so we can give you a general anaesthetic. Everything else happens while you are asleep. What happens after CABG and heart valve surgery? Cardiac Recovery Unit (CRU) You will be taken to the CRU while you are still asleep. You stay there until you are awake enough to breathe without the help of a breathing machine (ventilator). You will have various tubes and drips attached to you so we can monitor your progress. If you need more care after your surgery, you will be taken to the Surgical Intensive Care Unit (SICU). A dedicated nurse will look after you while you are in the CRU. Most patients wake from the anaesthetic within one to three hours. But it is a big operation and the painkillers you are given will make you feel drowsy. You will stay in the CRU until you are fully awake and ready to move to the High Dependency Unit (HDU), which is on the Victoria & Albert (V&A) ward. High Dependency Unit (HDU)/Victoria & Albert ward The HDU is similar to the CRU, although you will no longer need to be on a ventilator and the nurses will use monitors to keep a close eye on your progress over the next few days. You will stay on the HDU until most of the tubes have been removed and you are moving around. Usually, after one three days, you will be moved onto the main ward area. Please note that we do not have separate male and female areas on the HDU and CRU. 18

19 Sleeping on the ward at night We do our best to keep the ward quiet at night, but you may be disturbed by the noise of patients buzzers and monitors or emergency admissions. Although we dim the lighting, our nurses need enough light to be able to see patients, so your room may not be as dark as your bedroom at home. If you have any concerns or suggestions about your hospital stay, please ask to speak to one of our Ward Managers or the Cardiac Matron. Visiting Please check with the nurses about visiting times for the CRU, the HDU and the Victoria & Albert ward. We ask that you have only two visitors at your bedside at any one time. There is also a protected meal time and rest period between 12pm and 2pm when no visitors are allowed. Phone calls Please nominate one person from your family to phone with enquiries. This person can then update everyone. While you are on the main ward you will have a bedside phone on which you can receive incoming calls; you can buy a phone card to make outgoing calls. You can also use a mobile on the main ward and in the corridors but not in any of the high risk/high dependency areas. 19

20 Recovery in hospital Aftercare and recovery The nurses will usually help you to sit in your chair beside your bed on the first day after your operation. This will help you to breathe better and keep your lungs clear of infection. By the second day you may be able to take short walks and go to the bathroom. Getting up and about You will find that moving around gets easier each day. Walking is a key part of your recovery and it is important that you manage to walk around the ward and go up and down the stairs before going home. If there are any concerns about your breathing or mobility, we may refer you to a physiotherapist for advice and more treatment. Pain control During the first few days you are likely to have some pain and discomfort. Many people who have had heart surgery say afterwards that the pain is not as bad as they had expected. Your nurses will give you painkillers regularly, but please let them know if these do not seem to be helping you. You may be able to try different tablets. It is very important to let your nurses know if you are in a lot of pain because this can affect your recovery and your breathing as well as making you feel low. Wound care After your surgery we will give you a special wash to use. This helps reduce your risk of developing a wound infection. Stitches The stitches in your wounds will dissolve on their own. Any other 20

21 stitches, such as those for your chest drains, will be taken out before you go home. You may also notice you have a blue wire below your chest wound; this is called a pacing wire and it will also be taken out before you go home. Sternal wires If you have had a cut made through your breast bone (sternum), your surgeon will put metal wires in place to hold it together and help it to heal. These are not taken out. Eating and drinking After your operation you may lose your appetite and feel sick. You will be given medication to ease these symptoms. Start by having sips of water and then gradually start eating, because this can help to settle your stomach. Things you may notice People who have had heart surgery have said they have had some of the following symptoms or problems afterwards. They are usually temporary and settle over the next few days or weeks: Confusion/disorientation/hallucinations: you may sometimes have these in the very early days after your surgery but they should go away fairly quickly. Altered sense of smell/strange taste in your mouth: this is caused by the anaesthetic and it is common to lose your appetite. Try to eat small meals, often. Blurred vision/dots in front of your eyes: we recommended you do not have an eye test within the first three months after your surgery to allow your sight to settle. Nightmares/ difficulty sleeping: disturbed sleep is common after any operation and will usually settle once you are at home 21

22 and you get back to your normal routine. You may find it more comfortable to sleep on your back at first because of your chest wound. Muffled hearing/greater awareness of your heart beat: you may be particularly aware of these if you lie on your side at night. They are normal but you might find them worrying. Try a different sleeping position to see if it helps. Alternating between feeling hot and cold: you may also feel hot and sweaty after your surgery. Hoarse voice/voice sounds different: this is caused by the breathing tube that was used during your operation. These will improve over time. Sore or numb bottom: it is important to be as active as you can after your surgery and not sit in one position for long periods. Constipation: this can be caused by painkillers and not moving about. We can give you a laxative to help ease this. Please tell the nurse if you have not had opened your bowels before you go home. Loss of concentration/memory problems: many people find they cannot concentrate on things like reading a book or newspaper. This should improve over time, but be patient. Your concentration levels will return to normal as you get over your operation. Arm, shoulder or wrist pain/numbness: this temporary problem can be caused by the surgery. The position of you arm during the operation can also sometimes cause this condition. 22

23 Going home Make sure you are given our Discharge Information leaflet before you go home. If you go home without it, call the King s Cardiac Health and Rehabilitation nurses (see page 33 for the number) and we will send you one in the post. We can also offer advice, support and information over the phone. Getting ready to go home On the fourth or fifth day after your operation you will have a blood test, a chest x-ray and a heart tracing (ECG). One of our nurses will check that you can walk up and down a flight of stairs. If these tests are fine and you are recovering well, you will be ready to go home. If you live alone or are a carer for someone, please discuss with the ward nurses how you will manage once you go home. Before you go home, please fill in one of our How are we doing surveys to let us know what you think of your care at King s. You can also use it to make suggestions or comments. The day you go home We will usually tell you in the morning that you will be discharged in the afternoon. We recommend that relatives or friends drive you home. By law you must wear a seatbelt so you may find it more comfortable to put a flat pillow or soft blanket between your chest and the seat belt. Please note: organising your discharge and waiting for your medications usually means that you go home after 4pm. 23

24 Hospital transport Our patient transport service is available only for patients who cannot travel to or from the hospital by any other type of transport because of their medical condition. Please talk to the nurses on your ward if you have any concerns about how you will get home. At home after-surgery advice and information It is important to remember that it takes time to recover from heart surgery. It can take several weeks to get your normal energy back and to stop feeling weak and tired. Many people find that they are able to be quite active one day but feel washed out the next. This is normal and will improve. Over the next few weeks you will find that you will start to feel better physically and mentally. You will gradually be able to increase what you do every day. This can take anything from 6 12 weeks. We advise you to have someone with you at home for your first week. But it is safe for you to be on your own for part of the day. Activity and exercise Keeping active is important after heart surgery and walking is the best way to be more active each day. You may find that the amount you can manage varies from day to day. 24

25 It is best to exercise little and often for the first one two weeks after your surgery. Begin by walking around your home and taking short walks outside. Once you are comfortable on flat ground, try walking up hills slowly, resting when you need to. Build up slowly over four weeks to a 30-minute walk each day. You can split this into two 15-minute walks each day if you prefer. You may find this hard if you have mobility problems, so do what you can manage because it is important to be as active as possible. Always wait for at least one hour after eating before you exercise, and plan your exercise into your day so you do not do too much and tire yourself out. As you improve, try and walk more briskly, taking care not to overexert yourself. Walking at a pace that gets you slightly out of breath is fine, but you should still be able to talk while walking. As soon as you are walking comfortably around your home you can start doing light housework such as washing up, dusting, laundry, small amounts of ironing (while sitting down) and light weeding in the garden. Remember, none of these activities should make you feel very breathless. If they do, you are working too hard and need to slow down. You may feel a little short of breath when you first start walking. But if you have any of the following symptoms, please contact your GP or NHS 111 immediately, or go to your nearest Emergency Department (A&E): 25

26 severe chest pain extreme shortness of breath (you find it hard to speak) palpitations which make you feel dizzy or faint excessive sweating feeling generally very unwell bleeding problems if you are taking warfarin. If you have any general concerns you can contact the V&A ward 24 hours a day, or the King s Cardiac Health and Rehabilitation team on , 9am 5pm, Monday to Friday. Activities to avoid Because of the type of surgery you have had, you need to avoid certain activities to allow your breastbone to heal. If you have any concerns about which activities you can do, or you want to take up strenuous activities, please talk to your cardiac rehabilitation nurse, GP or surgeon. Returning to normal activities is different for each person. The following advice is a general guide: For a minimum of six weeks after getting home, do not: get in and out of a bath drive carry heavy shopping vacuum dig the garden mow the lawn swim dance fish cycle do any activity which places a strain on your breastbone or requires you to take weight through your arms and may cause a strain on your chest wall. 26

27 For a minimum of three months do not play: golf squash tennis badminton team games. Pain You usually get discomfort around your wounds, but you may also feel it around your neck, shoulders or back. At first your chest may feel numb to the touch, but as the nerve endings around your wound begin to knit back together you may feel tingling or pins and needles. You may also notice sharp stabbing pains where you had your chest drains. These will improve over time and painkillers will help. Pain relief We will give you a two-week supply of painkillers to take home with you, but you may need them for up to six weeks after your operation. You can get a repeat prescription from your GP. Take the painkillers until the pain begins to ease and then slowly cut down on the dose. It is normal to be taking painkillers now and again after six weeks. Caring for your wound If your wound is dry you do not need to cover it at home. Do not rub anything directly onto your wound until it is fully healed or use talcum powder. Once a scar has formed you can use products that may help to improve what it looks like. You may notice a slight lump at the top of your chest wound. This is normal and will quickly flatten down. 27

28 If your wounds are still oozing before you go home, the ward nurses will arrange with your GP surgery for a district nurse to visit you at home or you will need to see your practice nurse at the surgery to dress the wounds. If your wound was dry but later starts oozing or becomes inflamed, please see your GP as soon as possible. This is to find out if you have an infection and treat it. You will have metal wires in your chest to help your breastbone mend. These should not cause any problems. They will not rust and they will not set off the alarms at airports. Some patients find that certain movements such as raising their arms to get something off a shelf or picking something up off the floor causes a clicking feeling in their breastbone. This should stop about two weeks after surgery. If it does not, please tell your GP or contact King s pre-assessment nurse/cardiac health and rehabilitation team for advice. We advise women to start wearing a bra as soon as possible after surgery because this will reduce the strain on their chest wound. Washing and bathing You can shower or wash but do not rub any soap, shower gel, body lotion or talcum powder directly onto the healing wound. Pat it dry with a clean towel. It is important not to have a bath in the first six weeks at home. This is because pushing up with your arms to get out of the bath puts too much pressure on your healing breastbone and it is also better not to soak the wound. Resting and sleeping Although it is very important to do more when you get home, it is equally important for you to rest and get some sleep. It is a good 28

29 idea to rest in the middle of the day for the first week or two. You may feel more tired when you first go home; this is normal and will improve over time. You may also find it hard to get a good night s sleep at first because of discomfort. It is important that you take your painkillers before going to bed so you can sleep well. You may also find for a while that you are comfortable only when sleeping on your back and you may need more pillows or a back rest to help when sitting up. Medication We will discharge you home with a two-week supply of tablets, so you will need to see your GP to renew your prescription. We will give you a letter listing your tablets and also send a copy to your GP. If you are taking warfarin you will need to have regular blood tests as an outpatient. Before you leave hospital we will give you the date and time of your first appointment. Driving and insurance You should not drive for six weeks after surgery. You do not need to tell the DVLA about your heart surgery, but we advise you to tell your insurance company. This will avoid problems with any claims you may make in the future. If you have problems with your insurance the British Heart Foundation (BHF) will be able to give you details of insurance companies which may be able to help you. If you hold a commercial licence the DVLA will need to know about your surgery and can advise you what you need to do. You must have a medical and exercise test before getting your licence back. You usually have this after 12 weeks. 29

30 Flying It is safe to fly as a passenger two weeks after your surgery, as long as you do not have any complications. But it may be best not to fly for at least four to six weeks because it is unlikely you will get the best out of your time away. If you want to fly within three months of you heart surgery, check with your doctor and airline as each has its own procedure. Also remember to make sure that you have valid travel insurance. Contact the British Heart Foundation (BHF) for advice. Going back to work Please discuss this with your surgeon, the Cardiac Health and Rehabilitation nurses or your GP as there are many things which may affect when you can start working again, including the type of work you do. We usually advise patients to take about three months off to recover. Remember that going back to work can be very tiring, It is often best to ease yourself back in gently by doing part-time work for the first few weeks or by going back only when you feel ready. Resuming your sex life It is safe to have sex after heart surgery. You and your partner may be worried that it will put your heart under a great deal of strain or that it will damage your chest wound. These fears are understandable but research has shown that the physical effort of having sex from start to finish, including orgasm, is no more than climbing about 20 steps. So, once you are walking and managing simple everyday activities, you can resume your sex life. Begin slowly as you would with any other activity and build back up to your normal level. You may find that you are held back at first by discomfort from your chest wound, so changing your position may help. 30

31 Your partner may be more anxious than you are about having sex again, fearing that you will have a heart attack or be in pain. To overcome any problems it is important to discuss how you are both feeling. If you are having sexual problems because of impotence, please discuss this with your GP. Your emotions after heart surgery Having heart surgery can be very traumatic and affect you emotionally as well as physically. Your moods and feelings may swing from one extreme to another. People who have had surgery often say that they find themselves being snappy and short with those around them. You may feel depressed, tearful or irritable one minute and on top of the world the next. This is a normal part of getting over surgery and these feelings will pass. Talking to your family and friends about how you are feeling can help. If your emotions feel very intense or last for longer than six weeks you may find it helps to have some psychological support. If you are local to King s, you may be able to be referred to the Clinical Psychologist who is part of our Cardiac Health and Rehabilitation team. If you do not live locally, there will be other psychological support available to you. Your GP should be able to advise you. You should also be given a copy of our Psychological Issues Following Heart Surgery booklet. If you do not have one, please ask one of our nurses for a copy. Reading this may put your mind at ease and give you some useful information about coping better after surgery. The British Heart Foundation website also has useful information and you can read about other patients experiences or contact their helpline on

32 King s Cardiac Health and Rehabilitation Service Advice line: The Kings Cardiac Health and Rehabilitation team will endeavour to see patients before their surgery if they have not attended the pre assessment clinic. After surgery they can offer advice and support about recovery and give a discharge advice and information sheet to take home. Cardiac rehabilitation helps you to keep your heart healthy and to return to a full and active life after your surgery. If King s is not your local hospital, you will be referred to your local cardiac rehabilitation team when you are discharged home. The rehabilitation team usually has cardiac health nurses, an exercise specialist, a physiotherapist and a psychologist who all provide support and advice during your recovery. You may get a home visit or clinic appointment and also be invited to join the cardiac rehabilitation programme. This offers exercise and relaxation sessions, as well as health education advice and the chance to talk to other patients who have had similar surgery. You will find the cardiac rehabilitation sessions and the support of the team very helpful to your recovery. Follow-up outpatient appointment Your follow-up appointment will be at King s College Hospital, Denmark Hill, about eight weeks after your operation. If you do not receive an appointment, please contact the ward receptionist on V&A ward. If it is very difficult for you to travel to King s for this appointment, please tell your surgeon because you may be able to be seen locally by your cardiologist. 32

33 Who can I contact with queries or concerns? Monday to Friday 9am 5pm: Cardiothoracic Admissions Manager Inga Salter Cardiac Health and Rehabilitation Team Advice line and voic Consultant Cardiothoracic Surgeons Mr Jatin Desai Professor Olaf Wendler Mr Lindsay John Mr Ranjit Deshpande Mr Donald Whitaker Mr Max Baghai Other useful numbers Outpatient appointment queries Tel: and select cardiac Victoria and Albert Ward available 24 hours Tel: Victoria & Albert High Dependency Unit (HDU) available 24 hours Tel: Cardiac Recovery Unit (CRU) available 24 hours, except weekends Tel:

34 More information British Heart Foundation (BHF) Tel: DVLA Medical enquiries, Tel: Go to and search for medical Your GP: Temporary accommodation Please contact the PALS team for a list of temporary accommodation close to the hospital. Chaplaincy service The Chaplaincy team offers support to people of all faiths as well as those who do not have particular beliefs but would like someone to talk to. There is a member of the chaplaincy team who regularly visits patients on the V&A ward and you can ask the nurses if you wish to be seen by one of their team. Tel: or dial extension 3522 if calling from within the hospital. kch-tr.chaplains@nhs.net 34

35 Patient Advice and Liaison Service (PALS) The PALS team offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road staff will be happy to direct you. Tel: kch-tr.pals@nhs.net You can also contact them by using their online form at If you would like the information in this booklet in a different language or format, please contact PALS on Sharing your information We have teamed up with Guy s and St Thomas Hospitals in a partnership known as King s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy s or St Thomas. To make sure everyone you meet always has the most up-todate information about your health, we may share information about you between the hospitals. Care provided by students We provide clinical training where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. Acknowledgments King s Cardiac Health and Rehabilitation team 35

36 D Location of King s College Hospital CAMBERWELL RD FLOODEN ROAD CAMBERWELL NEW ROAD CAMBERWELL CHURCH STREET PAULET ROAD CAREW LILFORD R O A D F L A X M A N STREET EASTLAKE ROAD LUXOR ST D E N M A PADFIELD R A R ROAD 2 2 C A M B R CAMBERWELL K R O A D WARNER ROAD 1 7 C O L D H A Loughborough Junction Station R B O U R WEC CUTCOMBE RD A L BAVENT RD N E D E N M C ALDEC OT ROAD VENETIAN RD A R K H I L L BESSEMER ROAD KING'S COLLEGE HOSPITAL DANEVILLE ROAD Denmark Hill Station GROVE LANE DE CRESPIGNY PARK MAUDSLEY HOSPITAL D E N LOVE WALK M A MAPOTHER HOUSE WINDSOR WK CHAMPION PK R K HERNE HILL ROAD I A R O A D RUSKIN PARK H I L L H I N T O N R O A D Corporate Comms: 0347 PL208.5 December 2015 Review date December 2018