Cardiothoracic Surgery: What to Expect
Pediatric cardiologists follow children with known heart defects and present them to the pediatric cardiothoracic surgeon at a time when surgery is the best recourse. Sometimes surgical timing depends upon age/weight/medical status of the child, and sometimes it is more urgent, dependent upon the life-threatening nature of some of these problems. Each situation is unique, but in general the cardiologist and cardiothoracic surgeon will talk to you about the nature of the surgery, and the staff will set up a surgery appointment.
At a pre-operative appointment, patients will come prior to the surgery to have laboratory tests, chest x-ray, and possibly an echocardiogram done in preparation for surgery. A history and physical exam will be performed, and surgical consent will be explained and obtained by the surgical team.
On the day of surgery, you will be asked to check in at Connecticut Children’s preadmission office. Once you and your child have been checked in, you will be directed to go to the 3rd floor preoperative area. Clothes are changed, the anesthesia and surgical teams speak with the patient and family, and often a pre-operative medication is given to the patient to help decrease anxiety. Usually patients are taken back to the operating room, breathe some inhaled anesthetic agents to go to sleep, and have all other procedures performed after they are asleep. The entire experience is kept as patient- and family-friendly as possible. Once children are finished with surgery, parents are encouraged to spend time with them in the pediatric ICU.
Following open-heart procedures, patients go directly to the Pediatric Intensive Care Unit (PICU). Patients will be taken care of by a team consists of special intensivists, as well as cardiologists, cardiothoracic surgeons, physician assistants, and nurses dedicated to children with heart disease. The Cardiology Service follows and cares for the patients on the floor with close involvement of surgical team prior to their discharge home.
Patients usually follow up with Cardiology and Cardiothoracic Surgery after about 1-2 weeks after discharge, and sometimes again 6 weeks thereafter. If families travel from a long distance, they may be followed in outreach clinics. The patients are then followed on an individual basis, usually at least annually by their cardiologist.
Will my child need blood?
The majority of open-heart surgeries require blood transfusion.Special measures are taken to save as much blood from the surgery as possible and give it back to the patient at the end of the surgery. Because the amount of blood loss can be large, or because the patient may be so small, it is important to anticipate the need for blood. If you have religious convictions against the transfusion of blood or blood products, please discuss this carefully with the team ahead of time.
Should I donate blood for my child’s surgery?
We generally discourage this practice, for a number of reasons. Parents will be very important caregivers during a child’s hospitalization, and should stay as healthy as possible themselves. For surgery, all blood is tested for compatibility with the child’s blood, as well as extensively tested for viruses or other diseases. If family members wish to donate blood to the hospital in general, that will increase the available supply. They will go through the same screening process as any other donor. This issue can be further discussed with the surgical team at the time surgical consultation.
Can I stay with my child in the hospital?
There will be a sleep room on the same floor at the PICU provided for you at the time of surgical admission. You have the option of visiting the bed side as often as you desire. Once your child gets transferred to the step down unit, you will be able to stay with your child throughout the rest of the hospital stay.
How long will our hospital stay be?
Most patients undergoing open-heart procedures will have to stay in the ICU for a few days or longer. Time on the surgical floor depends upon a number of factors such as feeding, heart rhythm abnormality, oxygen requirements, or anticoagulation with Coumadin. Ask the surgeon about length of stay, since the time could be longer or shorter, depending upon the complexity of the operation.
Will stitches have to be taken out?
Usually absorbable stitches are used on the chest scar. There are occasionally some stitches associated with tubes or drains which must be removed, but these are typically done in the hospital.
Should my child stay on aspirin or other anticoagulation drugs before surgery?
Please ask your surgical team about this. It varies, depending upon the type of procedure.
When can my child eat?
If your child has open-heart surgery, it causes some changes in fluid balances. They usually have some swelling of the body and the intestine after surgery which slows down digestion of food. They will be started on a source of nutrition either orally depending on bowel readiness, nasogastric feeding, or intravenous route depending on your child postoperative status.
Is there a chapel at Connecticut Children’s?
There is a chapel located on the third floor of the Connecticut Children’s. Please consult your bedside nurse for the availability of their support and services.
Please feel free to contact surgical team for any other questions and concerns you might have regarding your child’s surgical care.