On the day of surgery, your congenital heart surgery team’s top priority is the health and wellbeing of your child. There are several steps along the way to ensure the best possible outcome for each surgery.
The hours before surgery
Your child is not allowed to eat or drink (this includes gum and hard candy) after midnight the night before surgery. This is called NPO (nothing by mouth) status. Clear liquids may be allowed only with the specific instructions of the anesthesiologist. If your child is admitted to the hospital the night before surgery, an intravenous (IV) catheter may be used to provide IV fluids once the patient is no longer eating or drinking.
On the morning of surgery, your family will check in at the 3rd floor of the West Tower in the Day Surgery waiting area and then go to the 17th floor waiting area.
About an hour before surgery, your child and up to 2 visitors will be taken to the 18th floor holding area. Your child will be dressed in a hospital gown, wiped with a special medicated wipe that decreases the risk of infection and placed in a crib or bed. The anesthesiologist will order medications either by mouth or IV that reduce anxiety and will help your child relax.
During surgery
The type of surgery your child will have depends on your child’s heart condition. Before surgery, the surgeon will have a detailed consultation with the family to explain the specific surgical procedure, discuss risks and benefits and answer any questions.
Throughout the child’s procedure, a surgical nurse clinician will update you about every hour and a half. These updates will be given in the private waiting room assigned by the receptionist.
What happens in surgery
Preparation
Preparation for surgery may take 60 to 90 minutes.
The anesthesiologist and operating room nurses will take your child into the operating room. A nurse will attach a heart monitor to your child that shows the operating room team a continuous reading of your child’s heart rate and rhythm throughout the surgery. Anesthesiology then applies a mask that disperses a gas that brings on a deep sleep.
Once your child is asleep, the anesthesiologist inserts a breathing tube so that your child’s breathing is supported throughout surgery. Next, the anesthesiologist places IV catheters in your child’s veins, often in the neck or the groin. IV fluids and medication are given through them during the surgery.
An arterial line is placed in an artery to monitor blood pressure during and after surgery. This special catheter is used to draw samples of blood to obtain various laboratory values and usually enters the body through the wrist or the groin.
A nasogastric (NG) tube is placed in the nose and gently guided down to the stomach after the arterial line is in place. An empty stomach will continue to produce juices, which can lead to nausea and vomiting. The NG tube empties the stomach and prevents vomiting. Finally, a Foley catheter is placed in the urinary opening and through to the bladder. This catheter is attached to a device that drains and measures the urine produced during surgery.
Once all the lines and tubes are in place, a transesophageal echocardiogram (TEE) is performed. A cardiologist places an ultrasound probe through the mouth and gently guides the probe down the esophagus. The TEE probe rests behind the heart and provides the surgeon with a continuous picture of the structures of the heart during the operation. When the TEE is completed, the surgeon will begin the procedure.
Incision and operation
The type of surgical incision is based on the specific surgical repair.
Open heart surgery
In the case of open-heart surgery, the incision is made through the chest and sternum to better access the heart. In this case, your child’s circulation will be assisted by a heart–lung bypass machine, which allows the surgeon to open the heart and operate on the structures inside.
When surgery is completed, your child is weaned off the heart–lung bypass machine until the newly repaired heart is managing all the blood flow. Between one to three chest tubes are positioned at the base of the incision to drain any blood or fluid that may collect in the chest after surgery. Temporary pacing wires may be positioned on one or both sides of the incision that may be used to help the heart maintain a regular heartbeat pattern after surgery.
Intracardiac monitoring lines may be placed depending on the type of surgical repair. These special catheters are placed in the chambers and vessels of the heart to provide the surgeon and the postoperative team with valuable information about the pressures within the heart and lungs.
A postoperative TEE is performed that provides the surgeon with valuable information after the surgical repair. Once the TEE is completed, the surgeon closes the incision with steel wires to secure the sternum in place. The skin is then closed with clear stitches, adhesive strips, surgical glue and/or surgical staples.
Closed-heart surgery
If surgery does not need to occur on the inside of the heart, an incision is made on the side of the chest under the arm, extending up toward the shoulder blade. The ribs are separated to expose the heart or blood vessels. Since the procedure is performed on structures outside the heart, the heart–lung bypass machine is not used.
When the surgical procedure is complete, the ribs are brought back together, and a chest tube is placed to drain the surgical area. Temporary pacing wires and intracardiac lines are not used with closed-heart procedures. The skin is closed with clear stitches and adhesive strips.
Completion and transfer to recovery room
If adhesive strips or staples are used, a dressing will cover the incision for 24 hours. The anesthesiologist and operating room nurses then secure all the tubes and lines and transport your child from the operating room to the Cardiac Intensive Care Unit.
