Questions to Ask Before Open Heart Surgery
For anyone facing a bypass, a valve repair or another open heart operation, and for the family member who will sit in on the pre-op consult with the cardiac surgeon. The questions are grouped the way that consult tends to run: why surgery and why now, the surgeon and the hospital, the operation and its risks, intensive care and the rest of the hospital stay, recovery and cardiac rehab at home, and a last group on the consult itself and what to settle before the date. Mark the ones that fit your operation; the note under each says what a solid answer includes and when to press for more, and none of it is medical advice.
The questions
Each question, and why to ask it
Why surgery
What is this operation meant to fix, and can you show me on my own images?
Why ask it
A clear answer names the blocked arteries or the faulty valve and points to them on your angiogram or echocardiogram. If you could not explain it to your family in two sentences afterward, ask for it again or for a sketch, because every later answer builds on this one.
Why open surgery for me, and not a stent, a catheter procedure or medication alone?
Why ask it
Good reasons are about you: where the blockages sit and how many there are, the shape of the valve, diabetes, how well the heart is pumping. 'This is what we do here' is not a reason. If a stent or a catheter valve was ruled out, have the surgeon say what about your heart ruled it out.
If I decided against surgery, what would the next year or two look like for me?
Why ask it
Asking is not refusing, and the answer is the yardstick for every risk figure that comes later. You want the likely course on medicines alone in your case: how the symptoms tend to go, what you could still do, and the danger the surgeon has most in mind. 'You would not do well' needs a follow-up: how likely, and how soon.
How long can this safely wait, and what are you worried might happen in the meantime?
Why ask it
Listen for a time frame, whether that is days, weeks or months, and for the specific event the surgeon wants to get ahead of. The answer also tells you whether there is room for another opinion, a family occasion or a few weeks of getting fitter first.
Is the aim to help me live longer, to feel better, or both?
Why ask it
Some heart operations are done mainly to prevent something, and a person with few symptoms may not feel much different afterward. Knowing the aim tells you what to measure the result by six months on. The surgeon should also be able to say which of your symptoms are not expected to change.
Did a cardiologist and a surgeon review my case together, and did they agree?
Why ask it
Many hospitals discuss these decisions as a group, often called a heart team, though how it is done differs from place to place. Agreement is reassuring. A split opinion is not bad news: it means there is more than one reasonable route, and you should hear the case for each.
How long should the result last, and what would come next if it wears out?
Why ask it
Neither grafts nor replacement valves come with a promise, so a straight answer is a range plus what shortens or lengthens it. Hear what a second procedure would involve, since for a younger patient that can decide which operation to have now.
I would like a second opinion before I decide. How do I get my scans and reports to another surgeon?
Why ask it
A surgeon who is confident in the recommendation will usually say yes and have the office release the files. Irritation or foot-dragging is worth noticing. Whether and how a second opinion is paid for depends on your insurer or health system, so check before you book it.
Surgeon and hospital
How often do you do this operation, and how often is it done at this hospital?
Why ask it
You are asking whether this is weekly work for the surgeon and for the place, because the intensive care nurses and the people who run the machines are part of the result too. If yours is a less common operation, such as a valve repair or a repeat surgery, ask for the number of those, not of heart operations in general.
What are your results for patients like me, and are they published anywhere I can look?
Why ask it
Some countries and regions publish heart surgery results by hospital or by surgeon and others publish nothing, so ask what exists where you are. The most useful answer sets the surgeon's own figures beside what would be expected for patients of similar risk. A bare 'very good' is not an answer.
Who will be operating on me, and which parts do assistants or trainees do?
Why ask it
In a teaching hospital it is ordinary for a trainee to do parts of the operation under supervision. What you want is a plain statement of who is responsible and who is in the room for the critical steps. Vagueness here is the worrying sign, not the presence of a trainee.
Who looks after me in intensive care overnight, and can a serious complication be treated here?
Why ask it
Staffing differs a great deal between hospitals. The reassuring answer says who is in the building at three in the morning, who is on call from home and how quickly you could be taken back to the operating room. If some problems would mean a transfer, ask where to.
When do I meet the anesthesiologist, and what do they need to know about me?
Why ask it
Come ready with any past trouble under anesthesia, loose teeth, crowns or dentures, sleep apnea, reflux, and whether a blood relative has reacted badly to an anesthetic. If no meeting is planned before the day, ask who you should give that list to.
Which office handles the cost and the insurance approval, and can I have an estimate before the date?
Why ask it
The surgeon is rarely the person who knows, and how it works depends entirely on your country and your coverage. Where there are bills, ask whether the surgeon, the anesthesia, the hospital stay and rehab are charged separately and whether each is covered. Get the name of the person you spoke to.
Operation and risks
Can you take me through the operation in order, from the first incision to closing my chest?
Why ask it
Two or three minutes in plain words is enough, and a surgeon who can do that can usually explain everything else. If you would rather not hear the physical details, say so and let your family member listen to that part for you.
Where will the incisions be, and is a smaller-incision approach a real option for me?
Why ask it
Smaller or robot-assisted approaches suit some operations and some bodies and not others, and they depend on what this surgeon does regularly. The two things to pin down are whether the smaller route changes the result or only the scar and the first weeks, and how many the surgeon has done that way.
Will I be on a heart-lung machine, and will my heart be stopped while you work?
Why ask it
Have the surgeon say what the machine does, who runs it and roughly how long you would be on it. Some bypass operations are done on a beating heart without the machine. If that was considered for you, the reason it was chosen or ruled out is worth hearing.
If this is a bypass, how many grafts do you expect to do, and where will the vessels come from?
Why ask it
Grafts are usually taken from inside the chest, a leg or a forearm, so the answer tells you where else you will have a wound. Mention varicose veins, earlier vein surgery, or a job or instrument that depends on one hand. Skip this one if your operation is on a valve.
If this is a valve operation, do you expect to repair it or replace it, and with what kind of valve?
Why ask it
The final call is sometimes made in the operating room, once the valve can be seen. Settle beforehand what goes in if a repair is not possible, because a mechanical valve and a tissue valve ask different things of you for years afterward. That choice should be one you made with the surgeon, not one you wake up to.
Could you end up doing more than we planned once you can see my heart?
Why ask it
Plans do change on the table: an extra graft, a second valve, a treatment for an irregular rhythm. Which additions are likely in your case, and what would each add in time and risk? With that answered, nothing on the consent form, or in the surgeon's report afterward, comes as a surprise.
How long will the operation take, and how will my family get news during and after?
Why ask it
The time given is an estimate, and running over is not in itself bad news. Have your family hear that from the surgeon directly. Agree who will be called, on which phone, and whether anyone gives an update partway through.
What are the chances I do not survive this operation, and what is that figure based on?
Why ask it
It is hard to say out loud, and it is a question cardiac surgeons expect. Many use a risk calculator that takes in your age, heart function and other conditions, so ask which of yours move the number most. Set the figure beside the one for not operating, because one number on its own tells you little.
Which complications concern you most in my case, and what do you do to prevent each one?
Why ask it
A recited list of everything that can happen is less useful than the two or three the surgeon picks for you: stroke, kidney trouble, bleeding, a lung or wound infection. For each one, ask how often this team sees it and what would be done if it happened.
How likely is confusion or foggy thinking afterward, and how long does it tend to last?
Why ask it
A good answer separates confusion in the first days from slower thinking in the weeks after, says how often the team sees each in patients your age, and names what they do to head it off. Your family should hear it too. They are usually the first to notice, and it frightens them less if they were warned.
How common is an irregular heartbeat after this surgery, and what would you do about it?
Why ask it
Rhythm problems in the days after a heart operation are something these teams deal with routinely. Find out whether one would mean extra medicine, more nights in the hospital or a blood thinner for a while. Hearing it now makes a monitor alarm at night far less alarming.
How likely am I to be given blood, and what if I do not want a transfusion?
Why ask it
If you object to transfusion for religious or other reasons, this consult is the moment to say so, not the morning of surgery, because the team needs time to plan around it and record your wishes. Otherwise ask what they do to keep blood loss down, including whether your own blood can be collected and returned.
ICU and hospital
What tubes, drains and wires will I wake up with, and when does each one come out?
Why ask it
Get the whole list: the breathing tube, chest drains, a bladder catheter, lines in the neck and wrist, perhaps temporary pacing wires. The order in which they usually come out gives you and your family a set of milestones for the first days.
Will I be awake while the breathing tube is in, and how do I tell someone I need something?
Why ask it
Waking with a tube in your throat and no voice is frightening if nobody told you it was coming. Two things to learn: how long the tube usually stays in at this hospital, and how the nurses communicate until it is out, whether by nods, hand squeezes or a board.
When can my family first see me, and what should they be ready for?
Why ask it
Visiting rules are set by each unit, so ask about hours, how many people at once and whether children may come. Then get the surgeon or a nurse to describe how you will look: asleep, pale, puffy, attached to machines. A relative who has been told is far less shaken at the bedside.
What will I be given for pain, and what if it still hurts too much to cough?
Why ask it
Staff usually want you coughing and breathing deeply early on, so pain that stops you doing it is something to report and not to put up with. Say now which painkillers have made you sick or muddled before. If you have a history with opioids that you want handled carefully, raise it here.
How soon will I be out of bed, and what will each day in the hospital ask of me?
Why ask it
Many units have people sitting in a chair and then walking sooner than patients expect, and the plan here may be written down as a day-by-day pathway. Ask for a copy. It lets you see whether you are on track and gives a visitor something practical to help with, such as a walk down the hallway.
How many nights should I plan for in intensive care, and how many in the hospital altogether?
Why ask it
Take the answer as a range for this hospital, not a promise. The follow-up is what most often adds days, so that a longer stay reads as ordinary and not as a sign things went wrong. Whoever is picking you up needs the range too.
What do I have to be able to do before you send me home?
Why ask it
Criteria are more useful than a date: walking a set distance, managing a flight of stairs, pain controlled by pills, a steady rhythm, a dry wound. Describe your home while you are asking, the stairs and who is there, since that is part of the decision.
Might I go to a rehabilitation facility first instead of straight home?
Why ask it
It depends on your strength before the operation and on who is at home, so say plainly if you live alone or your partner is frail. Raise it at the consult, not from the hospital bed. Finding a place takes time, and who pays for it varies by country and by insurance plan.
Recovery and rehab
What will the first two weeks at home be like, and does someone need to stay with me?
Why ask it
An honest answer describes ordinary days: tired by lunchtime, short walks, poor appetite, broken sleep. Find out for how many nights the team wants another adult in the house. Your family needs that figure to arrange time off before the date, not after.
What must I not lift, push or pull while my breastbone heals, and for how many weeks?
Why ask it
These rules differ from one surgical team to the next, so get this team's version in writing, with weights and weeks. Then test it against your real life: a grandchild, a dog on a leash, grocery bags, pushing up out of a chair, the car's seat belt across your chest.
How do I care for the chest wound and the leg or arm incision?
Why ask it
Ask to be shown before discharge instead of told: how to wash, what to leave alone, what to wear over it. Find out which changes are expected and which need a same-day call, and where spreading redness, discharge, fever or a clicking feeling in the breastbone fall on that list.
Which medicines will I go home on, and which of my old ones stop?
Why ask it
The list often looks quite different after heart surgery. You want it in writing at discharge, with a reason beside each drug, which are for a few weeks and which are long-term, and who renews them. Compare it line by line with the list you came in with and ask about anything that vanished.
Who refers me to cardiac rehab, when does it begin, and what if there is no program near me?
Why ask it
Do not assume the referral is automatic. A good answer has a name, a starting week and what the program involves. If the nearest one is a long drive, ask about a home-based or online version, and check what your insurer or health service covers.
When can I drive, and does anyone official need to be told about the operation?
Why ask it
The surgeon will have a rule of thumb, but licensing authorities and car insurers in some places have their own, and commercial licenses are often treated separately. Ask how it works where you live. Line up rides to the first follow-up visits before you go in.
When can I go back to work, and what if my job is physical?
Why ask it
Describe what the job really involves: lifting, driving, shifts, stress, a long commute. Bring up starting with shorter days, and what paperwork the surgeon's office can complete. Sick pay and disability rules depend on your employer and where you live, so ask your workplace early.
Do many of your patients feel low or tearful afterward, and what help is there?
Why ask it
Hearing a surgeon say that it happens makes it much easier to admit to later. Get a name for who to tell, whether that is the rehab team, your regular doctor or a counselor attached to the unit. If the question is brushed aside, put it to the nurse, who will have seen it.
Once I am home, what should make me phone your team, and what should make me call an ambulance?
Why ask it
Leave with two written lists and a number that is answered at night. If you live a long way from the hospital that operated, ask which emergency department to go to and what to tell them about the surgery. Put the lists on the fridge, where whoever is with you can find them.
When should I expect to feel like myself again?
Why ask it
Tell the surgeon what 'myself' means: the garden, the golf course, the grandchildren, the stairs at work. With that, the surgeon can give rough markers at six weeks, three months and a year and say which goals are realistic. Be wary of 'good as new in a couple of weeks'.
What do I need to change for good so the repair lasts?
Why ask it
An operation usually deals with the damage and not with whatever caused it. The useful answer names the one or two things that matter most in your case, whether that is smoking, blood pressure, cholesterol, blood sugar or weight, and who will keep an eye on each after the surgical team signs off.
When do I see you after the operation, and who follows me in the years after that?
Why ask it
Get the sequence: the wound check, the surgeon's visit, the first appointment with your cardiologist, any scan of the repair. Ask who adjusts your medicines in the gap between them. If a valve is being put in, ask what lifelong checks or precautions come with it and whether you will be given a card to carry.
Consult and next steps
Can a relative listen in by phone, or may I record the part where you explain the operation?
Why ask it
This one belongs at the start of the consult, not the end. It is hard to take in a conversation like this while you are frightened, and a recording lets the family hear it firsthand. Rules on recording vary by place and some surgeons prefer notes, so ask before you press the button.
What can I do in the weeks before surgery to come through it better?
Why ask it
A useful answer is specific to you: smoking, blood sugar, a dental check, low iron, daily walking, breathing exercises. Some hospitals run a preparation class or a 'prehab' program, so find out whether this one does. 'Nothing, just show up' deserves a follow-up if you smoke or have diabetes.
Can you write down what to do with each of my medicines in the days before surgery?
Why ask it
Bring the bottles or a full list, supplements included, and go through it one line at a time. Blood thinners and diabetes medicines are ones where the exact day tends to matter, so get dates, not 'a few days before'. If a pharmacist or another doctor later tells you something different, call this team before changing anything.
What still has to happen before the date, and who books each thing?
Why ask it
There may be blood tests, scans, a pre-admission visit, a trip to the dentist or a special wash for the night before. Sort the list into what the hospital arranges and what is yours to do. The other half of the question is what would get the operation postponed, such as a cold, a skin infection or a bad tooth, and who to tell if one turns up.
What time do I arrive on the day, and what should I bring or leave at home?
Why ask it
Hospitals differ on when to stop eating and drinking, what to wash with and what may come in with you, so get this one's instructions in writing and not from memory of a phone call. Glasses, hearing aids, dentures and a phone are the things you will want back first, so settle who holds them while you are in intensive care.
What should I do if my symptoms get worse while I am waiting?
Why ask it
The answer should sort changes into those that mean a call to the office and those that mean emergency care without a call first. Getting worse may also move your date forward, so find out who makes that decision. Write it all down for whoever lives with you.
Who speaks for me if I cannot, and which forms should be on file before I am admitted?
Why ask it
The documents go by different names and carry different weight depending on the country or state, so ask what this hospital uses and how to complete it. Then talk to the person you name about what you would want if recovery went badly. It is a hard conversation, and a kinder one than leaving them to guess.
Is there a nurse or coordinator I can call with the questions I think of later?
Why ask it
Heart surgery programs often have one, and that person is usually easier to reach than the surgeon. Get the direct number and the hours. Questions tend to arrive the night after the consult, so keep a running list and make one call instead of five.
What do your patients most often say they wish they had known beforehand?
Why ask it
Someone who has heard it many times answers quickly, and the answer is usually something practical that no leaflet mentions. Put the same question to the nurse. If you would like to hear it from a patient, ask whether the unit can put you in touch with one or with a support group.
Getting clear answers at the consult before heart surgery
Practical guidance for the conversation itself
Preparing for the pre-op consult
Bring what the surgeon may not have
Carry a current list of every medicine and supplement with doses, your allergies, past operations and the names of your other doctors. If your angiogram or echocardiogram was done at a different hospital, call ahead to check that the images have arrived. A surgeon who has only the written report can tell you much less.
Say what you came to settle
Some people come to decide whether to have the operation, some to choose between surgeons, and some have decided and want to know what happens next. Say which you are in the first minute. It changes which parts of the conversation the surgeon spends time on.
Choose your questions before you go
Nobody asks every question on a list like this. Mark the eight or ten that matter most to you, put the ones you are most afraid to ask near the top, and leave space under each for the answer. Handing the surgeon a copy at the start is fine if that is easier than reading them out.
Ask for a drawing
Many surgeons will sketch the heart and mark what they plan to do, or bring up your own images on a screen. Keep the sketch or photograph it. It is the easiest way to explain the operation to the rest of the family that evening.
Send each question to the right person
The surgeon is the one to ask why, what and how risky. A coordinator or specialist nurse usually knows more about dates, tests and the hospital routine, the anesthesia team about the day itself, and the billing office about cost. That leaves the consult for the questions only the surgeon can answer.
Making sense of the numbers
Ask where a figure comes from
A risk percentage may come from a calculator fed with your details, from the hospital's own results or from the surgeon's experience. Each is useful and each means something different. Asking for the source is not doubting the surgeon. It tells you how much weight the number can carry.
Always ask for the other side
The risk of operating only means something next to the risk of not operating, or of the alternative treatment. Ask for both over the same stretch of time. If the surgeon cannot put a figure on waiting, ask for it in words: likely, possible or rare.
Have it said as people, not percent
'So many in a hundred' is easier to picture than a percentage, and it helps to hear it both ways: how many have the complication and how many do not. Ask the surgeon to put the main risks that way, and write them down as they were said.
Treat volume and results as context
How often a team does an operation and what its published results look like are fair things to weigh, along with how far the hospital is from home and how the surgeon dealt with your questions. A hospital that takes on sicker patients can have figures that look worse for that reason alone, so ask how results are adjusted before you compare two places.
Name the outcome you fear most
Tell the surgeon whether it is a stroke, losing your independence, a long stay in intensive care or not waking up. It may not change the recommendation. It does change what the surgeon takes time to explain, and it belongs in your notes.
For the family member going along
Agree your job beforehand
Ask the patient what they want from you: taking notes, asking what they forget, or raising the one question they cannot bring themselves to ask. Do not answer for them. The surgeon needs to hear the patient describe their own symptoms and wishes.
Ask your own questions too
You may be the one at home in the first weeks, so the questions about lifting, washing, medicines, warning signs and who to phone at night are partly yours. Tell the team you will be the caregiver and ask what you should be shown before discharge.
Plan the day of the operation
Find out where to wait, roughly how long it will be and how news will reach you. Bring a charger, something to eat and one other person if you can. Agree with the wider family that updates will come from you, so the unit is not answering six separate calls.
Before the first visit to intensive care
Ask a nurse to tell you what you will see before you walk in. The patient may be asleep, swollen and surrounded by equipment whose alarms sound for minor reasons. Short visits are normal at first, and sitting quietly holding a hand is enough.
Look after yourself in the weeks at home
Recovery at home is tiring for the helper as well. Line up someone to relieve you for a few hours, take the offers of meals, and tell your own doctor or the rehab team if you are not coping. Some hospitals have a group or a phone line for caregivers, so ask.
When the consult is harder than you expected
The surgery is urgent and there is no time for a list
Some people meet the surgeon from a hospital bed, with the operation a day or two away. Keep to a handful: what is being done and why it cannot wait, who is operating, the main risks for you, how the family will get news, and what the first days afterward look like. The rest can be asked later.
You feel pushed to decide on the spot
Ask directly how long you can safely take and what you should do to stay safe in that time. If the answer is days or weeks, you can go home, read your notes and come back with more questions. If it truly cannot wait, the surgeon should be able to say why.
The answers are all jargon
Stop the surgeon at the first word you do not know and ask for it in everyday language, or on the drawing. Then say back what you understood and let them correct you. Signing a consent form for something you could not describe is the thing to avoid.
You cannot bring yourself to ask about dying
Write the question down and hand it over, or have your companion ask it. It is a question surgeons expect, and one that can be answered gently. Leaving it unasked rarely makes the fear smaller.
You remember a question in the parking lot
Call the coordinator or send a message through the patient portal the next day, with your name, the date of your consult and the question. If several come up, ask whether a short second appointment or a phone call can be booked before the date.