Fast track cardiac surgery

This page explains about fast track cardiac surgery and what to expect when your child comes to Great Ormond Street Hospital (GOSH).

A new ‘fast track’ way of working has been developed for particular heart operations, which are considered to be of lower complexity.

We have been successfully using fast track cardiac surgery since January 2006. We are doing more operations this way as new surgical techniques and ways of working are developed. We believe that fast track cardiac surgery will be far more convenient for you and your child.

The advantages of fast track over other ways of working is that children tend to spend less time in the Cardiac Intensive Care Unit (CICU), often between three and five hours compared with 24 to 48 hours previously. Children who have had fast track cardiac surgery usually spend less time in hospital too, usually going home two to three days afterwards compared with between five and seven days previously.

We can achieve these shorter times by removing the breathing tube and waking up your child earlier after the operation. It also involves making sure your child is out of bed and walking with all tubes and monitoring lines removed on the day after the operation.

Preparation for the operation is exactly the same whether your child is having fast track or regular cardiac surgery.

If your child is on the waiting list for surgery, a date will be sent to you for the pre-admission clinic. It is important that you come to this as it helps prepare you and your child for admission to the hospital and also ensures that all the tests required before surgery are completed well in advance.

At the clinic your child will be seen by a doctor or specialist nurse practitioner and will have blood tests and any other pre-operative tests that may be required. These often include a chest X-ray, ECG and echocardiogram. A nurse and the play specialist will explain about the surgery and you will also be shown around the intensive care or high dependency units.

Your child will be woken up in the recovery room and the breathing tube will be removed then, or soon afterwards in the Cardiac Intensive Care or High Dependency Units. The care of children having fast track cardiac surgery will be overseen by a team of specialist nurse practitioners.

If everything goes according to plan, your child will be fast tracked out of intensive care on the same day. As with any surgical procedure, there is always a small risk of problems occurring, which can potentially delay your child’s length of stay.

The nursing staff will monitor your child’s pain relief throughout so that he or she is able to cough and move about comfortably. Your child will be able to give pain relief, depending on his or her age and condition, using patient administered analgesia. This is a safe method of giving post-operative pain relief which allows your child to self-administer small amounts of pain relief using a pump operated using a hand-held trigger.

When the trigger is pressed, the pump delivers a pre-set amount of pain relief through the infusion line. As the amount of pain relief is pre-set, there is no possibility of your child having too much. In our experience, most children aged seven or over can understand patient administered analgesia and operate the trigger. In addition to patient administered analgesia, your child will also have paracetamol.

Our aim is that we will transfer your child to the High Dependency Unit on Bear Ward on the afternoon of surgery. The High Dependency Unit is for patients who require less intensive care. We encourage your child to take deep breaths and also to cough, both of which help chest expansion and clear the lungs.

Once he or she is breathing well and is awake and alert, your child can have a small amount to drink, usually two to three hours after surgery.

On the morning after surgery, your child will have his or her chest drains and other lines removed. We encourage your child to move as much as possible to get back to his or her normal routine. Once your child is moving about and recovering well, he or she will be moved to a ward bed in Bear Ward to recover fully.

Before your child is discharged home, the nurses will give you advice about continuing pain relief and instructions for looking after the operation site. They will also explain about follow up arrangements, including a review appointment with a cardiologist. Depending on the type of operation your child had, this will be between one and four weeks after surgery.