Preparing for cardiac surgery

Understanding why cardiac surgery is recommended

Cardiac surgery is recommended when a heart problem is better treated by directly repairing or bypassing the affected structure than by medicine or a catheter-based procedure alone. The three most common reasons are severely narrowed coronary arteries not suited to angioplasty, a heart valve that is leaking or narrowed beyond what repair by catheter can achieve, and, less commonly, a structural problem such as an aneurysm or congenital defect. The decision is rarely made by one clinician alone.

Preparation is not a single event but a structured process: confirming the diagnosis, reviewing whether a less invasive alternative is suitable, checking how well your other organs will tolerate surgery, planning your medicines around the operation, assessing anaesthetic risk, and preparing you and your family for what hospital recovery will involve. Good preparation is one of the most effective ways to reduce avoidable risk.

Common operations

• ●Coronary artery bypass grafting (CABG) — creates new routes for blood to reach the heart muscle beyond blocked arteries
• ●Heart valve repair or replacement — treats a valve that leaks or has narrowed significantly
• ●Combined procedures — some patients need more than one operation addressed in the same surgery

The pre-operative pathway

The exact pathway depends on your diagnosis, examination, previous results and overall health. It typically includes some or all of the following, over the days to weeks before surgery:

• 01
  Heart-team review. Your surgeon, cardiologist and anaesthetist review your case together and confirm surgery is the right option.
• 02
  Blood tests and imaging. A full blood count, kidney and liver function, blood group and cross-match, and imaging such as echocardiography or coronary angiography.
• 03
  Infection screening. Checking for and treating any active infection before surgery, including dental assessment where indicated, since untreated dental infection can affect surgical safety.
• 04
  Medicine and blood-thinner planning. Deciding which medicines to pause, continue or adjust in the days before admission, particularly antiplatelets and anticoagulants.
• 05
  Anaesthetic assessment. Reviewing your fitness for general anaesthesia and planning pain control for after surgery.
• 06
  Consent and individual risk discussion. A detailed conversation about your specific operation, its risks and expected benefit, before you sign consent.

What you can do to prepare

• ✓Follow medicine and fasting instructions exactly as given
• ✓Tell the team about every medicine, supplement and herbal product you take
• ✓Arrange family, work and home support for the weeks after discharge
• ✓Bring your current medicines and any previous reports to your pre-operative visit
• ✓Stop smoking as far in advance as possible — it measurably improves healing and lung recovery
• ✓Ask questions before signing consent — it is your decision to make with full information

What happens on the day of surgery

On the day, you are admitted, final checks are completed, and you are taken to theatre once the team confirms everything is ready. Cardiac surgery is performed under general anaesthesia, so you are fully asleep and unaware during the operation itself. Depending on the procedure, the operation may take several hours; your family is kept updated by the team during this time.

Immediately after surgery

You wake in the intensive care unit (ICU) or high-dependency unit (HDU), typically with a breathing tube still in place at first, monitoring leads, an intravenous line and a wound dressing. This can feel disorientating, but it is expected and closely monitored. The breathing tube is usually removed once you are breathing adequately on your own, often within hours. Pain is actively managed, and you are encouraged to report discomfort rather than endure it.

How recovery in hospital unfolds

Recovery is a gradual, staged process rather than a single milestone.

• ●A period of monitored recovery in ICU or HDU before transfer to the ward
• ●Breathing exercises and physiotherapy to reduce chest infection risk and rebuild strength
• ●Gradual mobilisation, often starting with sitting up and short walks within days
• ●Wound checks and pain control adjusted as you recover
• ●A discharge plan agreed with you and your family before you go home

Getting your results

Your surgeon explains how the operation went before you leave hospital, and any imaging or tests done during your stay are reviewed with you. A formal follow-up review after discharge checks your wound, medicines and overall recovery, and is the right time to raise anything that has changed or worried you since you went home.

Recovering at home: everyday self-care

• ✓Care for your wound as instructed, and watch for redness, discharge or increasing pain
• ✓Build up walking and activity gradually, following your team's guidance rather than a fixed schedule
• ✓Attend cardiac rehabilitation if offered — a structured, supervised programme to rebuild fitness and confidence safely
• ✓Take all medicines exactly as prescribed, including any new ones started after surgery
• ✓Expect some emotional adjustment — low mood or anxiety after major surgery is common and worth mentioning at follow-up
• ✓Ask your team specifically about driving, lifting and returning to work — timing is individual to your operation and recovery

Preparing for your pre-operative appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous ECGs, scans, blood test results or hospital letters
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

Your full medical history, current medicines, allergies, previous surgeries, and who will support you at home during recovery.

Questions worth asking us

• ●What exactly will be done, and why is this the recommended operation for me?
• ●What are the specific risks for my situation?
• ●How long is the expected hospital stay and recovery?
• ●Which of my medicines should I stop, continue or adjust before surgery?