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Your Child’s Heart Surgery

Stollery Congenital Heart Program

Before Surgery | Pre-Admission Clinics | Day of Surgery | Discharge | At Home

Your child needs heart surgery. Now what? Coming to the Stollery Children’s Hospital for surgery is a big event for you, your child, and your family. Getting ready and thinking clearly can seem almost impossible at this time. Take the time to talk together before coming. Knowing what to expect and how to prepare ahead of time will help to decrease anxiety for both you and your child.

If your child is coming to the Stollery for any other surgery, visit Your Child’s General Surgery, Surgery and Operative Services.

Before Surgery

While you wait for your child’s heart surgery date, there are some important things to do to prepare and information you will need to know.

Visit Your Dentist

To help prevent infection after heart surgery, babies and children with teeth must see their dentist before heart surgery. All required dental work needs to be complete before they come. We will give you a form to take to your dentist. Have them fill it out, and ask them to fax it to our case coordinator at 780-407-3598. Bring a copy with you to your child’s pre-operative appointment at the Pre-Admission Clinics.

Some children may need antibiotics before dental cleanings and treatments. Check with your child’s cardiologist if you are unsure whether or not antibiotics are required.

If your child has already seen the dentist recently (within six months of your child’s surgery date), ask your dentist for a letter confirming that your child was seen and that all the required dental work was completed. Have them fax this to the case coordinator at 780-407-3598.

When to Call the Surgical Case Coordinator

If your child is ill before or on the day of surgery, your child’s surgery may be postponed. Contact the surgical case coordinator by calling 780-407-7709 for any of the following reasons:

  • If your child has had a respiratory illness at any time in the three weeks prior to surgery
  • If any family member has even a minor cold or runny nose
  • If your child was exposed to chicken pox, measles, mumps, or flu viruses in the three weeks before the heart surgery
  • If your child has special medical needs or needs specific equipment for their stay
  • If your child is started on antibiotics or blood thinner medicines (including aspirin) before surgery

If Your Child is on Medication

Children can continue to take most medications until the day of their surgery. Sometimes, certain medications (especially blood thinners including aspirin) need to be stopped several days before surgery. If you are unsure of what medications to stop, call your surgical case coordinator or cardiologist to confirm.

What to Bring

View complete packing list

For your child’s safety, it is important that the bedside space is clean and clear of clutter. If you plan to stay at the hospital with your child, bring only what is really needed. This ensures that the staff has quick and easy access to your child at all times.

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Pre-Admission Clinics

The Pre-Admission Clinics (PAC) is an outpatient clinic that prepares children and their parents for surgery.

The Surgical Case Coordinator will phone you with the date and time of your PAC appointment. Typically, this appointment is a day or two before surgery and the arrival time is usually 7:00 am.

People You Will Meet

Some of the people you will meet*:

  • A nurse who will discuss your child’s general health history and what to expect before and after surgery.
  • The team in the Cardiology Clinic (4C2) for ECG and echocardiogram.
  • The surgeon to discuss the operation and answer any questions you may have.
  • The anesthesiologist (the doctor who will sedate your child during the operation).
  • The specialized nurse or resident (doctor in training), who will do a more detailed history and physical examination of your child.

You may also meet:

Other healthcare team members may be consulted to ensure the complete care of your child while in hospital.

Tests

Some tests your child will have*:

*We are unable to schedule definite times for any of the persons or tests above because all are based on availability of the team members. We will make every effort to have your day completed in a timely manner.

Tour

You will be offered a tour of the Pediatric Cardiac Intensive Care Unit (PCICU) and/or the Cardiology Inpatient Unit (4C) depending on the type of heart surgery your child is having. This is where your child will be transferred after finishing in the OR. This tour is optional, but it is highly recommended if this is your child’s first heart surgery.

Your Questions

Some things you could ask:

  • Can I walk over to the OR with my child?
  • How long will the surgery take?
  • How will I know when they are done?
  • Where will I meet my child after surgery is finished?
  • What will my child look like when they come out of the operating room?

We encourage you to write your questions down in advance and bring them with you.

Day Before Surgery

The pre-admission clinic nurses will contact you the afternoon before surgery to tell you:

  • What time your child’s surgery is scheduled for
  • What time your child must stop eating and drinking
  • What time to come to the hospital in the morning
  • Where to go on the morning of surgery

NPO means nothing by mouth. All children, even babies, need to have an empty stomach before going for surgery. This includes stopping tube feeds.

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Day of Surgery

Children are usually admitted to the hospital on the day of surgery. You may be asked to register with the Admitting Department, or to go to 1C3 Pre-Admission Clinics (PAC) directly. Admitting is located on the main floor of the hospital, behind the glass elevators.

After registering with admitting, you will return to the pre-admission clinic where you were on the day of your PAC visit. The nurses there will get your child ready for surgery.

Getting Ready for Surgery

Your child will:

  • Change into a hospital gown and receive an identification band
  • Have their blood pressure, pulse, and breathing rate checked and recorded
  • Have numbing cream put on both hands or both feet for the intravenous line
  • Get any pre-operative medication as ordered by the doctor
  • Wait with his/her family for the porter to take him/her to the OR

In The Operating Room

Ask your anesthesiologist during your PAC visit if you can go with your child as they are transported to the OR. Sometimes, one parent or guardian is allowed. If you go, you will be asked to wear a hat over your hair and a gown over your clothes to prevent outside germs from coming into the clean environment of the operating room.

Once your child arrives to the OR:

  • A nurse will check your child’s identification band against the chart
  • Your child will be moved onto the operating table
  • Monitors will be attached to record blood pressure, heart rate and oxygen saturations
  • The anesthesiologist will sedate your child
  • An OR staff person will escort you out of the OR to the waiting area or parent lounge

During the Surgery

Your child could be in the operating room for an hour or more just getting prepared before the actual operation begins. After your child is comfortably sleeping under the supervision of the anesthesiologist, the team will continue to prepare your child. They will use many types of equipment to monitor and support your child during surgery. Some of these will still be in place after the surgery is over and when your child leaves the OR.

Waiting while your child is in the OR

While your child is having their surgery, you will be holding all of your child’s and your own personal belongings. On the day of surgery, bring only what you and your child need for the first 24 hours, and only what you can carry. You can bring the rest once settled in your room after surgery.

Your PAC nurse or surgeon will tell you how long the surgery might take. The length of time that a child will be in the OR is sometimes difficult to estimate. The teams in PAC and the OR will make sure that you know the plan for receiving updates while your child is in the OR. When the surgery is done, the surgeon will come and meet with you at a designated location to discuss how the surgery went and how your child is doing. Before leaving PAC, make sure your cell phone number is up-to-date in your child’s chart.

After Surgery

Once the surgery is complete, your child will be transferred from the operating room to one of the following two units:

The Pediatric Cardiac Intensive Care Unit (PCICU) on the 6th floor of the Mazankowski Alberta Heart Institute (Maz)

The 4C Cardiac Inpatient Unit on the 4th floor of the University of Alberta Hospital (UAH)

Daily Bedside Rounds

Parents are encouraged to be present for, and to participate in, daily rounds with the healthcare team. This is where the team meets to discuss your child’s medical status and clinical plan. You will learn more about how your child is doing as well as any tests, treatments, or procedures that may be needed. After the team is done, you are encouraged to ask questions. These rounds take place at your child’s bedside and typically start around 8:00 a.m. Some days, it may take most of the morning for the team to make their way around the unit as they visit each patient.

Breast Feeding Moms

There are breast pumps available for your use. Sterilization bags and one set of attachments will be provided to you for the length of your baby’s hospitalization. Labels and bottles will also be provided. Unlabeled breast milk will be disposed of. There are freezers where your milk can be stored. Talk to your bedside nurse for more information on how to locate these freezers and supplies.

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Discharge

Readiness for discharge is not determined by time, but by meeting a set of required criteria. Some children may take only a few days to meet discharge criteria. Others may require a week or more. Once your child meets the criteria specific to their age and condition, discharge from hospital can be considered.

Most children can go directly home after discharge from hospital. If you have come from another city, your child may be transferred back to the hospital nearest your home. In some cases, patients are required to stay in Edmonton after discharge until they have completed their post-operative clinic visit and the cardiologist feels it is safe to return home. Do not hesitate to ask your doctor or nurse if you have questions or concerns.

Discharge Instructions

When you leave the hospital, you will receive an information sheet that tells you about your child’s care at home. You will also be given a copy of the medical discharge report and the unit discharge instructions. Bring these information sheets with you when you return to the Stollery for follow up at the 4C2 Cardiology Outpatient Clinic, or when see your own doctor next.

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At Home

Activity

Most children increase their activity at their own pace. Teenagers may need reminders not to overexert themselves in the first few weeks. Let your child set the pace. Don’t lift infants or small children under their arms. Avoid rough play and contact sports. Insist on rest periods. Avoid front seats with airbags. Car seats and seat belts should be used properly at all times. Children are generally ready to return to school or day care within one to two weeks after surgery.

Behaviour

Changes in behavior are a normal part of recovering after heart surgery. A child’s surgery is a difficult experience for everyone in the family, and behavior changes are just one of the ways children communicate. You may notice for a while after surgery that your child might cry more, act out in anger, need more attention, or have changes in appetite or sleep routines. These changes are not uncommon. Your presence, patience, and understanding will help to reassure your child that they are safe and well. Your child’s normal personality will come back again, usually within the first few weeks.

Diet

It may take time for your child’s appetite to return to normal. Don’t force your child to eat, but do encourage fluids to keep them well hydrated. Eventually, as they begin to tolerate more and their appetite returns, encourage them to eat a healthy diet to promote healing and recovery. If your child has special dietary needs, your dietitian will provide teaching and resources in hospital to ensure you feel comfortable returning home.

Follow up

After heart surgery, children require an echocardiogram (ultrasound of the heart). This is done at least once before they go home, and again around 10 days after surgery. If your child is still in hospital 10 days after surgery, both echocardiograms will be done before you leave. If you have been discharged before day 10 after surgery, an appointment will be made for you to have this echocardiogram done in your local outpatient cardiology clinic.

Medicine

Children usually require medicine for a while after they go home. You will be given a list of medications that have been ordered, and the necessary prescriptions, before you leave the hospital. Be sure to understand what medicine your child is taking and why. If you have questions, talk to your doctor, nurse, or pharmacist. Call your family doctor or cardiologist for refills before you run out of medication.

When to Call for Help

Emergent Concerns

If you have an emergent concern about your child, call 911 to access emergency services immediately. Some examples of emergent concerns are trouble breathing, seizures, fainting, or not waking up.

Urgent Concerns

If you have any questions or concerns within the first six weeks after your child leaves hospital, and you think they are related to your child’s heart, contact your closest pediatric cardiology clinic during regular business hours. If you need to speak with a physician outside of business hours, call your hospital switchboard and ask to speak with the pediatric cardiologist on call. Examples of urgent concerns include changes in feeding, changes in breathing, extreme or prolonged changes in behavior, changes in colour, signs of infection, or signs of water retention.

  • Edmonton 780-407-8822
  • Calgary 403-955-7211
  • Winnipeg (204) 787-2071
  • Saskatoon (306) 655-1000

Ordinary Health Concerns

If you have questions or concerns about your child’s general health, contact your child’s pediatrician or family doctor. Examples of general health concerns include cough or cold symptoms, rashes, questions about routine immunizations, injuries from ordinary activities.

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