Before your surgery

Maintain your regular exercise routine as advised by your doctor. Exercise will help relax your body and tone the muscles. Stop exercises that bring on signs of your heart problems. Don't start any new exercise programs before surgery.

Good nutrition can help prepare your body for surgery and help with recovery after your surgery. If you have diabetes, making heart healthy food choices can also help to optimize your blood sugar control before surgery.

Cardiovascular surgeons

Our highly skilled, multi-disciplinary team delivers a full spectrum of cardiovascular care for some of the most complex cases of heart disease in Ontario. World-renowned researchers and clinical teams work together to develop methods for earlier detection of heart disease and better, less invasive diagnosis and treatment to significantly improve the quality of life for our patients.

Cardiovascular coordinators

The cardiovascular coordinators are links to the surgeons during the waiting period before hospitalization. During an office visit and/or telephone follow-up, these nurses help you understand your symptoms, monitor any changes in your condition, and assess your risk factors through education, support, and referral to other health care team members.

Nursing staff

With knowledge and skill in cardiovascular care, nurses assist and support patients and families during all phases of hospitalization. Recognizing that each patient and their family has special needs, nurses play a key role in preoperative and postoperative education and discharge planning.

Nurse practitioners

After your surgery a nurse practioner (NP), a Masters degree prepared RN specialized in cardiovascular care who works with your doctor, will see you regularly. The NP will help direct your daily care and discharge planning. The NP is also a resource for nurses, other staff members, patients and their families, in areas of clinical management, education, family support and planning from the hospital. In addition, they will assist you and your family in communicating with the other members of your health care team.

Anaesthetist

Before surgery you will be visited by a member of the anaesthesia department. This may occur in either the readmission clinic or in the hall outside the operating room just prior to your surgery. This doctor will put you to sleep in the operating room and take care of you until your operation is finished. When you leave the operating room, you will go to the Cardiovascular Intensive Care Unit (CVICU) where your care will be supervised by a physician of the Department of Critical Care Medicine.

Cardiologist

A member of Sunnybrook's cardiology staff will also follow patients undergoing heart surgery during their stay. The cardiologist does not participate in your operation itself, but will pay particular attention to what heart medications you receive after surgery. They will be available to help treat any post-operative problems such as heart rhythm disturbances. These are common, usually short lived and resolve before you go home. Your own cardiologist will receive information about the care and medications you required from the Sunnybrook cardiologist.

Physiotherapist

Before your surgery, you will be taught deep breathing exercises and how to cough properly by a physiotherapist. He/she will also explain why deep breathing and coughing are important to your recovery and what to expect when moving around. After surgery, the physiotherapist assesses your progress daily, reviews your breathing exercises and assists you with your walking activities until you are able to do them on your own. Before leaving the hospital, you will attend a class where the physiotherapist will review your home exercise program and give recommendations concerning activities at home. Information about cardiac rehabilitation programs will be discussed with you by your physiotherapist during your hospital stay.

Dietitian

Good nutrition is very important during the recovery period after surgery. The dietitian is available to help optimize your nutritional intake after surgery, and also make sure that your in-hospital meals are tailored to any dietary restrictions or food allergies. The dietitian teaches group nutrition classes on heart healthy eating after surgery, and can provide individual teaching at your bedside (upon your request).

Heartpals

"Heartpals" are a team of volunteers who have undergone cardiovascular surgery and who may visit patients before and/or after surgery. Having been through the experience, they are able to help you understand the emotions and feelings that accompany cardiovascular surgery. The volunteers can provide a compassionate "listening ear" when necessary or answer simple questions that are not of a medical nature. "Heartpals" are living proof of the success of the cardiovascular surgery.

Pharmacist

The pharmacist is available to discuss your medications at anytime during your stay. Things that will be discussed about your medications include:

• The names of your medications
• Reason(s) why you are taking it
• The dose, amount, and side effects
• Any changes to your pre-operative medications

You may be provided with a personal medication schedule and medication information sheets. If you have had a heart valve replacement and will be taking a blood thinner called warfarin (Coumadin®), you will be given special information about this medication.

Other Support Services

Before, during, and after your hospital stay, a number of additional support services are available to your and your family:

Social worker

A social worker works with the cardiovascular team in assisting patients and families to identify and manage possible social circumstances that might act as a barrier to hospitalization and recovery. The social worker assists patients and families with the impact that change in health status might have on the social situation of patient and family. Some interventions might include:

• Consulting with patients and families in planning an appropriate plan of discharge.
• Providing counseling to patients and caregivers to help them manage different anxieties, worries and emotions experienced through hospitalization and recovery.
• Assist patients and caregivers with practical concerns such as finances, transportation, housing, and food, via referral to appropriate community resources.

Occupational therapist

An occupational therapist is available upon request to assist you in returning to your normal activities and routines. This involves showing you ways to practice energy conservation techniques and recommending special equipment as necessary. Your surgeon or nursing staff can refer you to the team member best suited to meet your needs at any time.

Chaplain

There is pastoral or chaplaincy staff available for you. If ministry of a specific denomination is desired(Christian or non-Christian), pastoral services staff will arrange this. A chaplain is available 24 hours a day to assist patients and their family members. They are available for support and not just religious needs. Please ask any staff member if you would like to contact the chaplain.

Family support

The support of family and or friends cannot be overestimated. Caregivers are an invaluable element of your recovery. There are many important tasks that they can help with that will be challenging for you independently. Caregivers include friends as well. Do not be afraid to ask for help. Often friends and family
want to help. If you are living independently and do not have resources available, please contact the social worker 416-480-6100 ext. 63913. The social worker will assist you in planning an appropriate discharge plan.

All patients require preparation prior to surgery. This preadmission information session will take 2-3 hours to complete. This visit consists of a pre admission assessment with a nurse and an anesthetist. The anesthetist completes a medical exam and reviews your medications. The nurse will review skin preparation & fasting with you, and address any concerns you may have.

Preoperative testing consists of blood testing, a chest x-ray, an electrocardiogram, and any other testing your surgeon may request.

You will need to bring your health card and a hospital card, if you have one. Remember to bring all your medications in their original containers, including all prescription, over-the-counter, and herbal medications. Please bring the name and number of your regular pharmacy or family physician with you to the pre-admission class.

The class is offered for patients having heart surgery one week before your admission. The date of your class is provided by the surgeon's office. Family members are encouraged to attend and participate in the class, as they play a key role in your recovery. The cardiovascular coordinators and other members of the health care team will be available to answer any questions you may have about your upcoming surgery, as well as any discharge concerns. The physiotherapist will be demonstrating some deep breathing exercises for you to practice at home.

By the time you attend pre-admission class, your discharge plan should be in place. Most patients are well enough to return home in 4- 5 days after surgery with a family member or friend. Someone is required to be available for the first 1-2 weeks to offer you assistance with grocery shopping, meal preparation and cleaning. Most people do not require a nurse to visit them at home. If the need arises, the necessary care will be arranged prior to your discharge.

Clipping of the hair will be done with special clippers prior to your surgery by one of the staff. Please do not shave the hair on your chest or legs yourself. Clipping the hairs on your skin decreases the chance of infection following your surgery. The area and time of the clipping will depend on the kind of surgery and your doctor's orders.

A suppository may be given to help you have a bowel movement the night before your surgery.

If you can not sleep the night before surgery, ask your nurse if a sleeping pill is ordered. Sometimes just talking to your nurse helps reassure you.

You must not eat or drink anything on your own after midnight before your surgery. This will prevent you from vomiting during your surgery. You may be given some of your medications with a sip of water. You may rinse your mouth with water, or brush your teeth, if it becomes too dry but don't swallow it.

Often some patients and or caregivers experience fear and or anxiety. Some common questions patients ask are:

• How will I manage?
• How will my life change?

Do not be afraid to express these feelings, as these concerns are natural prior to surgery. Often talking to someone helps in decreasing your worry.