Coronary Artery Bypass Graft (CABG)
A coronary artery bypass graft, also called bypass surgery, is an invasive cardiology interventional procedure used to create a new path for blood to take when your coronary arteries are blocked. It involves major open-heart surgery, and your cardiologist will review the benefits and risks of this procedure with you before scheduling.
A closed coronary artery that cannot be reopened may be bypassed using a section of vein from your leg or from the mammary artery in your chest. The vein is attached to the coronary artery where it is healthy on both sides of the blockage, allowing blood to bypass the blocked section.
The Hospital Visit
Bypass surgery is performed in a hospital and is scheduled in advance. When you are admitted, several tests are performed including blood and urine tests, EKG and chest X-ray. Cardiac catherization and angiograms are done during the preoperative hospital stay, unless they were done earlier. Prior to the procedure, the surgical staff, nurses and anesthesiologist will visit you, ask questions and make you comfortable. They are available to answer questions or address concerns you may have.
Prior to the operation, much of the hair from your chest and legs is shaved off, and you may be asked to shower using antiseptic soap. This helps reduce the risk of infection. Medications can generally be taken as usual, but you should consult with your physician first.
About an hour before the operation, medications will be given that make you drowsy. Attendants will bring you to the operating room on a rolling bed. The anesthesiologist will administer the anesthesia, and you will gently fall to sleep. Then the operation will begin.
The operation usually lasts from three to six hours depending on what has to be done. Because each operation varies in complexity, duration times can only be estimated.
The hospital has a place for your family and friends to stay during the operation, and your surgeon will visit with them following the procedure.
After the Operation
Once the operation is complete, you will be brought to the recovery area or intensive care unit. Gradually the anesthetic will wear off and you will wake up. Often you will be confused when you first wake up, but that passes in a short time. Families usually can visit you within an hour or two of the surgery when you wake up.
You will experience some discomfort in the incision that was made to reach your heart. If a vein from your leg was used, the incision in your leg may also hurt. Medication will be given to relieve the pain.
During the recovery period in the hospital, you will be connected to several monitoring devices and have small catheters in place, usually in your arm. These catheters allow the nursing staff to administer fluids, medications and draw blood. A breathing tube will be in your mouth for a short while after the surgery. This tube passes by the vocal cords and goes into the windpipe. It is not painful but does prevent talking. When you no longer need help breathing, the tube is removed, usually within 24 hours.
The Recovery Process
Due to the amount of constant activity in a hospital and 24-hour lights, you may have difficulty keeping track of time during your recovery. Medications may also cause you to be confused.
Once the breathing tube has been removed, you may drink liquids. The progression from liquids to a regular diet is an individual matter.
Usually within a day or two you can get out of bed and sit in a chair or walk around your hospital room. Later you will be able to take short walks in the hall and eventually to climb stairs and walk briskly. These all prepare you for returning home.
Most patients complain of soreness but not severe pain after their surgery. The soreness comes from the incisions and can often be helped with good posture and by moving your arms and shoulders. If the pain is severe, medications can be given.
The incision in your chest will be exposed to air soon after the operation, allowing it to dry. Washing it with soap and water is encouraged after a few days. External stitches or staples are removed from your chest about a week after the operation. These wounds take about six weeks to fully heal. During this time you should avoid lifting heavy objects. The color of the incision will gradually change from purple to a normal color over several months.
The typical hospital stay with bypass surgery is four to six days, depending upon whether there are complications. Your physician will discuss issues such as lifestyle and activities with you before you leave the hospital. As a general rule, the following recommendations apply to most patients:
- Maintain a healthy diet.
- Monitor cholesterol levels.
- Quit smoking.
- Take time to regain strength and energy.
- Take only the medications prescribed.
- If you have a sedentary job, you can return to work in four to six weeks.
- If you have a job in which you perform heavy work, you can return to work after six weeks.
- You may drive when you feel that you are physically able to safely operate a vehicle. It is recommended that you wait a few weeks after leaving the hospital.
- You should consult with a physician before resuming any exercise program or strenuous activity. You may resume sexual relations when you feel comfortable.
- Attend the follow-up appointments.
Notify your doctor if there is any sign of infection (redness or drainage at the incision), fever, chills, increased fatigue, shortness of breath, swelling of the ankles, weight gain over five pounds within a few days, change in heart rate or rhythm, or any other sign that seems disturbing.
