Cardiothoracic

The Cardiothoracic Service provides care for patients with heart or lung problems who require surgery or other similar invasive tests and treatments. We perform around 600-700 heart operations and 200-300 lung operations every year.

As well as treating patients from Wellington city, Porirua and the Kāpiti Coast, we also treat patients from Hutt Valley, Midcentral, Wairarapa, Whanganui, Hawkes Bay and Nelson–Marlborough. 

Heart or lung transplants and most paediatric surgery cases are referred to Auckland.

Further information 

• Cardiac rehabilitation
• The Heart Foundation are a good source of information about heart disease, treatments, and supports for patients and families with heart disease
• The Lung Foundation have information about lung cancer.
• Cardiac rehabilitation in the Wellington area
• Coronary artery bypass and heart valve replacement patient information sheets

The Cardiothoracic Service provide emergency( acute) and planned (elective) surgeries such as:

Cardiac Surgery

• Coronary artery bypass graft surgery (CABG)
• Heart valve surgery
• Aortic aneurysm repairs (an abnormal bulge in the wall of the major blood vessel carrying blood from your heart.)

Thoracic Surgery

• Removal of lung tissue for treatment or diagnosis of tumours
• Management of problems with the space that surrounds the lung, which is called the pleural space. Common problems are a collapsed lung, also called a pneumothorax (when air is in the pleural cavity), an effusion (when excess fluid builds up in the pleural cavity), or when infection causes problems there.
• Chest trauma - e.g. fractured ribs or sternum following a fall or accident. This may be managed with or without surgery.

You must be referred to our service by a medical doctor – this will usually be your GP or another hospital specialist.

Your GP may refer you for emergency (acute) or planned (elective) surgery.

If you are having heart surgery, you may also be referred to a Cardiologist for ongoing care after the operation.

Your cardiologist will refer you for surgery. Cardiologists are specialists who treat heart diseases but don’t perform operations. They refer patients from Wellington and the wider region for consideration of heart surgery.

The referring cardiologist is responsible for arranging for any tests required such as angiograms or ultrasound heart scans to be carried out..

Our team will then provide a recommendation to the referring cardiologist. This is usually one of:

1. Further tests. These might be new tests, or repeating previous tests if they were too long ago. This is to ensure that our team have the necessary information to give advice on treatment options.
2. A non-surgical plan. Surgery is not always the best treatment option. There are procedures and medications that are sometimes the best treatment for coronary or heart valve disease. Cardiologists carry out these procedures.
   Patients from outside of Wellington may need to travel to Wellington hospital for those procedures.
3. Recommendation for surgery. Patients are then placed on the waiting list for surgery. We may still need to run more tests before having the surgery, for example all patients planning heart valve operations will need to have had a dental assessment and complete their dental treatments before having their heart operation

A variety of specialists may refer patients for consideration for lung surgery. These include respiratory doctors, GPs, or oncologists (cancer doctors). They may need to arrange for scans or lung tests before making the referral.

Our team will then advise on whether surgery may be beneficial, and any other tests or treatments that may be required. Sometimes they recommend that patients see a surgeon in clinic to discuss surgery options.

If the referral is related to a possible cancer, a cancer nurse coordinator will help  manage the various tests and treatments patients need. Every DHB has a cancer nurse coordinator.

Non-surgical lung procedures are dealt with according to clinical priority.

Once surgery has been recommended and tests completed, patients are placed on a wait list for surgery. The cardiothoracic team send out a letter explaining this in a pack with other information, which may include:

• A health questionnaire for patients to complete and return.
• An information leaflet about the proposed operation.
• A leaflet about the Wellington Regional Heart and Lung Unit
• National Travel Assistance scheme information
• A dental checklist - for patients who need to complete a dental assessment prior to their operation
• Anticoagulation (blood thinners) information - for patients who are likely to need to take this type medication after their operation e.g. certain types of heart valves.

The waitlist is not a simple queue. Every patient’s need for surgery is prioritised according to the severity of their condition, the ability to benefit from surgery, and the risks of delaying surgery. Patients are added or removed from the list every week and the priorities may change. The most urgently needed operations happen within a few days of  being put on the list. Less urgent heart operations are expected to happen within 90 days of being added to the list. Lung operations for cancer are subject to the “faster cancer treatment” target. Read more about the targets

A cardiothoracic liaison nurse manages the waitlist. They may call patients to make sure that the information pack has been received and discuss what happens next. They also contact you when there is a date for your  operation. If you are on the wait list you should be available and ready for your operation. You should tell the liaison nurse if any significant life events make you unavailable for specific time periods; if your symptoms progress; if other illnesses are diagnosed; or if you chose to have your operation in the private healthcare system.

Each patient’s own DHB is responsible for some aspects of them getting the operation. Your home DHB may be able to support you with travel to and from Wellington; or any help, which may be available for a support person. Every DHB has a coordinator for travel between DHBs who helps with this.

The National Travel Assistance scheme (NTA) provides financial support for some patients who have to travel to other DHBs for treatments. Eligibility for this depends on a variety of factors such as age, distance travelled, frequency of appointments, and Community Services Card status. Read more information about the scheme

If you think you may be eligible for this, you should register with the scheme to check your entitlement as soon as you are on the waitlist for surgery.

Patients are usually only allocated to a specific surgeon when the actual date of operation is booked in. Sometimes dates have to be changed due to urgent needs of other patients or other factors. A different surgeon may then do the operation. Elective patients are usually admitted to the ward the day before their operation, and meet their surgeon then. Acute patients will already be in hospital, or transferred to Wellington from their local hospital a few days before their operation.

Read more about your cardiac surgery
Read more about your thoracic surgery

Inpatient services are based in ward 6 South – The Wellington Regional Heart and Lung Unit. Read more information about the ward

Patients are discharged from the ward when they have had their operations or treatments and are well enough to not need hospital care anymore. Patients from out of Wellington who have been transferred urgently by air ambulance for an operation, may still need to make arrangements to get back home from Wellington afterwards.

If you live alone you may wish to arrange for family or friends to stay for a few days after you get home from the operation. This is especially important after heart operations (coronary artery bypass or heart valve surgery) when we recommend that patients have a support person available for a week. An alternative to this is for patients to arrange convalescent care, or access support from their own DHB. Every DHB has social workers who can assess what support may be available, and whether these are funded or not.

You should not drive for at least four weeks after having heart surgery.

Follow up after discharge depends on what is required. Most patients will be given a prescription for medications to get from a pharmacy. Patients are often asked to see the GP a few days after leaving hospital. Surgeons or other specialists sometimes want to see patients in clinic a few weeks after their operation.

Patients who have had heart operations are usually referred to a cardiac rehabilitation or specialist cardiac nurse service. These support recovery and ongoing wellbeing, as well as reducing patients’ risk of future heart events. 

For more information about recovering from heart surgery view our home management guidelines.