All patients are seen in a pre-operative clinic before the surgical date to ensure all the necessary investigations have been performed. These include a Full Blood Count, a Urea and Electrolytes Test, Liver Function Tests, a Transthoracic Echocardiogram and a Coronary Angiogram. Further investigations, such as Pulmonary Function Tests (PFT’s), a Computed Tomography (CT), and a Carotid Doppler, might be required depending on individual requirements. For NHS patients, all these tests are performed at Manchester Heart Centre. For private patients, most of these tests are performed at BMI Alexandra Hospital in Cheadle. All investigations are reviewed in the clinic by your surgeon, appointed senior nurse or doctor.
All patients are asked to see a dentist, before any valvular surgery. These dentist checkups are absolutely mandatory.
Admission Before Surgery
Patients are admitted to the ward the night before surgery. All NHS patients are admitted to Ward 3 and Ward 4 at Manchester Royal Infirmary on the first floor in the purple zone. All private patients are admitted to the Chester Ward at BMI Alexandra Hospital in Cheadle.
On the evening before surgery, patients will be visited by the anaesthetic team, surgeon and physiotherapist. They will be asked to sign the consent form stating that you understand the risks involved if they have not signed it already. The nurses will then explain the pre-operative checks. You will be asked to take a shower and to shave your chest, groin and legs.
It is natural to be anxious the night before a surgery. Our team of expert nurses and doctors will answer any questions you or the family might have. If required, a mild sedative will be prescribed. You will be advised not to eat or drink anything from midnight on the day before surgery.
For all patients, all the necessary medications will be prescribed and administered by the staff. All patients would be advised to stop taking Clopidogrel 3 days before surgery, Ticagrelor 5 days before surgery and Aspirin 3 days before surgery. Patients are also advised to stop taking blood thinners, such as Warfarin, 3 days before surgery. If you have previous mechanical valves you will be put on alternative medications such as Intravenous Heparin. You might be asked to continue some or all medications depending on your individual needs.
Day of Surgery
On the day of surgery, the nurses will perform a preoperative check confirming your name, date of birth and the procedures which will be performed. If you are not comfortable speaking or understanding English, an interpreter can be arranged. Patients will be transferred to the theatre check in-area by a porter and a nurse. Family members are not allowed beyond the ward and are not allowed in theatre under any circumstances.
Before going to the anaesthetic room, theatre staff will welcome you, confirm your identity and transfer you to the operating table while you are still lying down. You will be transferred to the anaesthetic room next to the operating theatre. Consultant anaesthetists and other anaesthetic doctors will then insert a venflon into your arm. You will be asked to take a few deep breaths and relax while anaesthetic medications are administered.
Once you are asleep, a Central Venous Line will be inserted into your neck, an Arterial Line into your arm, an Endotracheal Tube or Breathing Support and Transesophageal Probe or Food Pipe into your throat for echocardiographic assessment during surgery. A small tube or urinary catheter is inserted into your urethra to monitor your urine output and kidney function. During this time you should not feel any pain or discomfort as deep sleep is established via anaesthetic medications.
Once all the monitoring equipment is in place the patient is transferred to the operating room where surgery is performed. Most of the procedures are performed through a midline sternotomy during which an incision is made in the chest and the breastbone is sawed through. Most of the procedures take anywhere between 3 to 5 hours. Some complex aortic and congenital procedures could take between 8 to 12 hours.
Intensive Care Unit
After surgery patients are transferred to the intensive care unit for 24 to 48 hours. They are usually woken up 3 to 4 hours after surgery. Once awake you will notice pipes coming out of your chest. These are known as chest drains and they will be removed the 1st or 2nd day after surgery. Any pain will be very well controlled with painkillers and anaesthetic medications. Midline sternotomy results in a relatively painless scar, however, you might experience some discomfort in the first few days. Families can visit patients during the ICU visiting hours and no more than 2 people are allowed to visit at one time. Children are not allowed in the ward or ICU.
Ward and Length of Stay
Most patients are transferred to the ward on the 1st or 2nd day after surgery. Once on the ward, physiotherapists and expert nursing staff will assist the patient to mobilise and get gradually get back to their preoperative state of mobility. Social and occupational therapist can visit the patient if required.
Most patients are discharged by 5th or 7th day after surgery, depending on their recovery. Once discharged you will be given a discharge note (TTO) that can be sent to your GP and referring cardiologist. This will serve as your sick note. If you require a longer-term sick note, the doctors on the ward can arrange this for you. Nurses and pharmacists talk you through the medication you should take and when you should take them, before your discharge.
NHS patients are seen at a follow-up clinic at the Manchester Royal Infirmary and private patients at the BMI Alexandra. If you are an NHS patient, you will most likely be seen by one of the registrars. If you have any specific concerns or questions that cannot be answered by the registrar, you can ask to speak to a consultant. All private patients are seen by their respective consultant at the BMI Alexandra hospital.