Following a review of your health history, films, and x-rays, you will have a brief clinical exam by the surgeon or a member of his team, such as a physician assistant (PA). Your surgeon will then discuss with you whether surgery is deemed appropriate, and if so, he will discuss with you the type of surgery recommended, the specific risks and benefits, and the recuperation process.
Once your questions and concerns have been addressed and surgery has been agreed upon, you will schedule the date and time of your surgery (for approximately 1-2 weeks later). You will also be asked to sign an "Informed Consent for Surgical Operation" form that provides permission for treatment.
The Cardiac Education Coordinator will meet with you and your family. She will provide you with useful information regarding the logistics of your hospitalization and answer any remaining questions that you may have. If cardiac rehabilitation is anticipated after your heart surgery, you can meet with a social worker.
If your cardiologist is not affiliated with NewYork-Presbyterian/Columbia University Medical Center (NewYork-Presbyterian/Columbia) a cardiologist will be chosen by your surgeon to provide your care during your stay at the hospital. The NewYork-Presbyterian/Columbia surgeon will be in contact with your referring cardiologist.
Your surgeon's office will obtain pre-certification for the surgical procedure only. It is your responsibility to verify coverage for all other aspects of your hospital stay.
Pre-Admission Testing (PAT)
At this point, you have been scheduled for surgery. PAT is located on lower level 1 of the Vivian and Seymour Milstein Family Heart Center (Heart Center) at 173 Fort Washington Avenue (between 165th and 168th Street in Manhattan).
The following consults/tests are needed in order to form a clinical baseline assessment before surgery and to help your doctors decide the best treatment for you during and after your operation.
- Cardiac Anesthesiologist—During your preoperative testing, you will meet a member of the cardiac anesthesiology team who will review your procedure, discuss the intravenous and monitoring lines, and answer any questions about the anesthetic care you will receive. You will be asked to sign another consent form regarding your anesthetic care.
- Electrocardiogram (EKG)—a diagnostic test to measure the heart's electrical conduction system
- Chest X-ray
- Blood work and urine analysis
Depending on whether you have had a cardiac catheterization or angiogram prior to your pre-operative visit, you may be admitted a day prior to your surgery to have this test. A catheterization measures pressures in your heart and assesses your coronary arteries to determine blockages.
In the time leading up to surgery, there are a few simple steps you can take to enhance your successful and speedy recovery. These suggestions can help you feel better and heal faster.
If you smoke, quit. Smoking makes you more prone to developing pneumonia and pulmonary complications after surgery. It also makes your heart work harder, and accelerates the atherosclerotic process. You must quit smoking at least 3 weeks prior to surgery.
Dr. Emile Bacha – Do I need to quit smoking before heart surgery?
It is advisable to discontinue blood-thinning medications—such as aspirin, Coumadin®, Plavix®, Motrin®, Vitamin E, and Fish Oils—4-5 days prior to surgery. Consult with your physician before stopping any medication. Medications for diabetes (such as glyburide, metformin, insulin, etc.) should not be taken on the day of surgery.
- If you take medications in the morning, you may do so with a minimal amount of water the day of your surgery.
- Please bring a list of all medications you are currently taking, and the dosage, on the day of admission.
Please check with your cardiologist regarding continuing aspirin usage prior to surgery. Aspirin should also not be used as an over-the-counter medication in the week prior to surgery. Many over-the-counter medicines, such as Anacin, Bufferin, NSAID'S (non-steroidal anti-inflammatory drugs) and products containing salicylates also contain aspirin. Tylenol® is okay.
You will be provided with an antibacterial soap (chlorhexidine gluconate) to shower with the night before and the morning of surgery from the neck down. Inpatients will be given chlorhexidine gluconate cloth wipes in place of a shower.
Do not eat or drink past midnight the night before your surgery.
Nutrition is essential to good health and is especially important prior to your hospitalization for surgery. Maintaining healthy nutritional habits may help with a quick recovery. A balanced diet, adequate in calories, proteins, vitamins and minerals, should be consumed. A balanced diet is one that contains a wide variety of foods from the Four Food Groups—grains, fruits and vegetables, dairy products, and meat. If you have been following a therapeutic diet as part of your medical treatment, continue to do so and inform your physician.
Arrive at the hospital as rested and relaxed as possible.
Stop drinking alcohol–liquor, beer and wine–2 days prior to surgery.
Fever or cold
If you develop a fever or cold, contact your physician prior to coming to the hospital.
Plan to have someone accompany you to the hospital the morning of your surgery.
It is beneficial to designate one family member or friend to maintain communication with your surgeon and the healthcare team. This will enhance the flow of information and decrease the chance for miscommunication.
All patients are scheduled for a semi-private room. Private rooms are subject to availability, and by request, and are not covered by insurance. For patients seeking deluxe accommodations, the Milstein's McKeen Pavilion offers attractive, modern rooms, a concierge and room service for patients and visitors.
What Should I Bring?
- Prepare a small bag with a robe, slippers and toiletry items. You will not need these items until you leave the Intensive Care unit, so you do not need to bring them the day of surgery. Ask a family member or friend to bring them for you.
- Storage case for dentures or other dental work, hearing aids, glasses or contact lenses.
- Insurance card and personal identification.
- A copy of your health care proxy and/or living will, if you have one.
- Do not bring anything valuable (jewelry, watches, rings, credit cards, cash, etc.)
- A list of medications you are currently taking.
Most insurance companies require pre-certification for hospitalization. Your surgeon's office will obtain pre-certification for the surgical procedure only. Any questions regarding finances may be handled in advance by calling the Admitting Office at 212.305.7091.