About Your. Bypass Surgery. Our Guide to Understanding Coronary Artery Bypass Graft Surgery

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Augustus Barrett
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1 About Your Bypass Surgery Our Guide to Understanding Coronary Artery Bypass Graft Surgery

2 Understanding Coronary Heart Disease Your doctor told you that you have coronary heart disease (also known as coronary artery disease, or CAD). The coronary arteries are blood vessels that bring blood to the heart muscle. These arteries can become narrowed due to buildup of fatty materials and other substances. This buildup, called plaque, forms within the inner wall of the artery and restricts blood flow. Plaque can tear (rupture) in the vessel and cause a blood clot to form. This is dangerous if the clot blocks a coronary artery, a heart attack can result. Blood clot Ruptured plaque Blood flow Artery wall Your doctor has advised coronary artery bypass graft surgery (CABG) because the blockage in your heart is severe. The surgeon who ll perform your operation can best explain the details of your surgery and recovery. Your peace of mind is why we have created this booklet so you can better understand and discuss your case with your healthcare provider. 1

3 Heart attack Blockage Damaged heart muscle

4 Why Bypass Surgery Is Needed When the coronary arteries are narrowed by plaque, less blood reaches the heart muscle. When the heart doesn t get the blood it needs, you may have symptoms such as fatigue, tightness in the chest or a crushingtype chest pain called angina. (Chest pain should always be evaluated by a doctor.) Without treatment, coronary heart disease can be deadly. A blood clot may suddenly block blood flow through a coronary artery. When this happens, part of the heart muscle may be permanently damaged. This is called a heart attack. (See page 28 to learn the warning signs of a heart attack.) CABG has many benefits. This operation will create new paths to carry blood around the blocked areas. This can improve blood flow to your heart. The surgery should eliminate chest pain or discomfort. It can also reduce fatigue and possibly the need for some medications. CABG can also let you be more active and is likely to add years to your life. 3

5 How CABG Surgery Is Done In this procedure, doctors take arteries or veins from another part of your body. These blood vessels (called grafts) are connected (grafted) directly to the coronary arteries on either side of the blocked parts. This way, blood can flow through the grafts to bypass the narrowed or closed parts of the artery. This brings more blood to the heart muscle. Venous graft Arterial graft Blocked artery Blocked artery 4

6 Where the Graft Arteries Come From Often, the arteries are taken from the inside of the chest along the breastbone. If a vein is used, most often it comes from just under the skin on the inside of the leg. Sometimes, veins are taken from the back of a leg or an arm. Some arteries inside the abdomen can also be used. Removing these arteries and veins won t affect blood flow from the area where they re taken. The body reroutes the blood through other arteries and veins as needed. Common sources of grafts Internal mammary/ thoracic artery Saphenous vein 5

7 Before Surgery It s normal to feel anxious about having CABG surgery. But you may worry less once you learn more about what will happen. Hospital procedures vary, so ask the staff to answer your questions. Tests Prior to Surgery You may go to the hospital before your surgery date for tests. These may include blood and urine tests, a chest X-ray and an electrocardiogram (ECG or EKG). An EKG is a graphic record of the heart's electrical impulses. Other tests may be done as needed. A cardiac catheterization with a coronary angiogram will be done at a time prior to your surgery. This procedure lets the surgeon look at 6

8 the arteries that supply blood to your heart. A thin tube (called a catheter) is threaded into an artery in your arm or leg. It's passed up into the heart and to the coronary arteries. An angiogram is a series of X-ray pictures of the arteries. It's done by imaging using a special contrast dye that s been injected into the bloodstream and flows to the coronary arteries. These tests help your surgeon see exactly where your arteries have blockages. Preparing for Surgery Be sure to tell your doctor about all medicines, supplements, vitamins and herbal remedies you are taking. The doctor will tell you how to take your medicines as you get ready for surgery. You will need to stop eating and drinking for several hours prior to your surgery so your stomach will be empty. Be sure to follow your doctor's instructions. Tell your medical team if you have diabetes so they can help you adjust your medicines and control your blood sugar. Plan to have someone drive you to the hospital on the day of surgery, and arrange for help at home during the first weeks afterwards. Checking Into the Hospital You ll meet the surgical staff at the hospital. They'll examine you, discuss the details of your surgery and answer questions. Besides 7

9 a surgeon, your team will likely include: The nursing staff. Nurses will evaluate your needs and make you as comfortable as possible. They will also give you important information and answer your questions. The anesthesiologist. He or she will evaluate you and discuss details related to anesthesia during your operation. Other members of the technical staff. These healthcare professionals may draw blood and insert intravenous catheters (IVs). They will also tell you how to breathe and care for your lungs after your operation. Before surgery, remove personal items. These include glasses, contact lenses, dentures or detachable bridgework, watches and jewelry. Give them to family members for safekeeping. Some of your body hair will be shaved off, especially from your chest (if you re a man) and legs. You may be asked to shower and wash with antiseptic soap. This helps remove bacteria from your skin to reduce the chance of infection. A short time before your operation, you ll be given medicines that will make you relaxed and drowsy. When it s time for the surgery, you ll be taken to the operating room on a rolling bed. 8 Ask your doctor if you should keep taking your usual medications while in the hospital before your surgery.

10 During CABG Surgery After you re in the operating room, the anesthesiologist will give you general anesthesia (medication that brings sleep and freedom from pain during the operation). There are different types of CABG surgery that can be used. The most common is traditional bypass surgery. To reach the heart, an incision is made in the chest. Then, the breastbone is divided and held open during surgery. Most CABG surgery is done using a heart-lung bypass machine. This machine takes over the job of the heart For Family and Friends Bypass surgery usually takes three to six hours. The length of time depends upon what has to be done. Hospitals have places where you can wait during surgery. Let the surgeon know where you ll be so he or she will know where to find you when the surgery is over. You ll likely be allowed to visit briefly in the recovery room or intensive care unit (ICU) within an hour or two after the operation. Your loved one will probably still be asleep. 9

and lungs and acts as a temporary pump during surgery. The bypass grafts can then be connected to the coronary arteries. (Review page 4 to see how bypass grafts work.

11 and lungs and acts as a temporary pump during surgery. The bypass grafts can then be connected to the coronary arteries. (Review page 4 to see how bypass grafts work.) Depending on a patient s risk factors, sometimes doctors may be able to use other minimally invasive bypass procedures. These surgeries differ from traditional bypass in that the chest bone is not opened. Instead, several small incisions are made on the left side of the chest between the ribs. Talk to your cardiologist or surgeon to determine the best treatment option that is available and right for you. 10

12 After the Surgery After surgery, you ll be taken to a recovery area or ICU. There, you ll wake after the anesthetic wears off. You may not be able to move your legs or arms when you first wake. But in a short time, your body and mind will be coordinated again. In the ICU, you ll have tubes and wires attached to parts of your body. They help the hospital staff monitor your health during recovery. You ll have small tubes called IVs in your arm. They re used to give you medications and fluids, take blood samples and to monitor your blood pressure. One or more tubes in your chest will drain off fluid that builds up during and after the surgery. Small patches or electrodes will be on your chest. They are attached to a bedside monitor. They help monitor your heart rhythm and rate. A breathing tube will be inserted through your mouth into your windpipe. This helps you breathe while your lungs recover. It won t hurt, but it will keep you from talking. The nurses will help you find other ways to communicate. The breathing tube is usually taken out within 24 hours after the operation. 11

13 Recovering in the ICU It can be hard to keep track of time in the ICU. The lights are on 24 hours a day and there s constant activity. You may feel disoriented and confused, especially at night. Pain medicines also may make you feel confused. Temporary confusion isn t serious. It will go away after you re moved to a quieter, less-intensive nursing unit. Normal patterns of sleep, alertness and thought processes will return. Once your breathing tube is removed, you ll be able to swallow liquids. Your return to a regular diet depends on how well you can tolerate the foods. Your nurse will help you to cough and take deep breaths every couple of hours. This helps your lungs recover and stay clear of mucus. You ll get out of bed and sit in a chair or walk around the room as soon as you can. This often happens within a day or two of surgery. You ll be able to have sponge baths right away. Within a few days, you ll be allowed to shower. 12

Managing Pain You ll have some discomfort in your chest where the incision was made. You may have one or more incisions in your leg if a vein was removed to use for the bypass.

14 Managing Pain You ll have some discomfort in your chest where the incision was made. You may have one or more incisions in your leg if a vein was removed to use for the bypass. These incisions also may hurt. You ll be given medicine to relieve any pain you re having. Most patients report soreness, but not severe pain. The soreness comes from the incisions and from muscle spasms in the chest where the breastbone was separated. Good posture, along with gentle arm and shoulder movement, can help relieve the soreness. 13

Recovering in the Hospital The usual hospital stay after bypass surgery is about a week. It depends on whether you have complications and the type of procedure you had.

15 Recovering in the Hospital The usual hospital stay after bypass surgery is about a week. It depends on whether you have complications and the type of procedure you had. During that period (and beyond), most patients have good days and bad days. But you should see overall progress and gain strength. Lung Recovery Deep-breathing exercises and coughing are important to help speed lung recovery. Coughing reduces the chances of pneumonia and fever. Coughing won t harm the incision or bypass grafts. You may be afraid of pain or discomfort caused by coughing. Still, coughing is very important after this kind of surgery. You may find it easier to cough by using a pillow to support your chest. The nurses will help you find the most comfortable position. 14

16 Leg Swelling Your legs or ankles may swell after surgery. You may also feel a burning sensation when standing on the leg where the graft was taken. You may be given elastic support stockings. These help blood flow and reduce swelling. Walking Walking helps blood circulate in your legs. It also helps your heart. Your surgical team will tell you when you can get out of bed and begin to walk. You ll likely start by taking short walks in the hall. Wound Care A few days after your operation, your chest wound will be exposed to the air. This lets it dry and helps it start to heal. After a few days, you may wash the incision with soap and water. The number and length of leg incisions depend on how many vein grafts the surgeon makes. Some patients have an incision in just one leg. Others have incisions in both. Like your chest incision, leg incisions can eventually be washed gently with soap and water. 15

After Discharge External stitches or staples will be removed from your chest about a week after surgery. A few days later, they ll be removed from your legs.

17 After Discharge External stitches or staples will be removed from your chest about a week after surgery. A few days later, they ll be removed from your legs. Strips of tape are often placed over an incision that s been closed by absorbable stitches under the skin. In this case, the strips should stay on for about as long as regular stitches. Your surgical wounds require about six weeks to heal completely. Avoid lifting heavy objects during this time. The wound color will gradually change from purple to red to pink. The skin will take several months to return to normal. 16

Cardiac Rehab Before you leave the hospital, talk with the staff about finding a local cardiac rehabilitation program. Cardiac rehab programs provide exercise, education and counseling services.

18 Cardiac Rehab Before you leave the hospital, talk with the staff about finding a local cardiac rehabilitation program. Cardiac rehab programs provide exercise, education and counseling services. They help heart patients increase physical fitness, reduce heart symptoms, improve health and reduce the risk of future heart problems. In a cardiac rehab program, you can increase your physical activity level safely while healthcare professionals monitor you. 17

19 Life at Home After CABG It s not unusual to feel nervous about going home. These feelings may be caused by concerns about leaving the security of the hospital. Homecare, by comparison, may seem uncertain. Have confidence that your surgeon won t send you home until he or she thinks you re ready. 18

20 Getting Home It s best for a family member or close friend to drive you home. If you must travel by bus, train or airplane, ask to board early. If needed, request a wheelchair. You can do this by contacting the carrier s passenger service staff. Talk to your doctor before you leave the hospital about when to resume driving. It is usually recommended that you wait a few weeks after leaving the hospital before you try to drive. Developing a Home Routine Expect to feel weak when you first get home. It s likely that you may feel tired and weak when trying to resume the routine of home life. The healing of your incisions takes a lot of energy. That also reduces body strength. This demand for energy drops a few weeks after the operation. Try to follow these four guidelines for developing a routine: Get up at a normal hour. Bathe or shower, following your doctor's instructions. Dress in regular clothes. Don t stay in sleeping clothes during the day. Take time to rest in the mid-morning and mid-afternoon, or after periods of activity. 19

21 Changes to Your Diet Your doctor or a member of the nursing staff will discuss how to modify your eating habits after your surgery. To reduce your risk factors, eat less saturated fat, trans fat and sodium (salt). If you're overweight, losing weight will also help improve your heart health. Taking Medication Take only medicines your doctors have prescribed for you. Don t keep taking medicines you took before the operation unless you ve been told to. Don t use overthe-counter (nonprescription) drugs like aspirin or ibuprofen without asking your doctor. 20

22 Doctor s Appointments How often you see your doctor after surgery may vary. It depends on your needs and the wishes of your doctor. Before you re discharged from the hospital, you ll schedule a visit to remove your stitches or staples. It s also smart to make an appointment with your personal or family doctor soon after going home. Call your doctor right away if you have any sign of infection, such as increasing redness, swelling, drainage or bleeding at the incision sites. Also call if you have: Fever Chills Increased fatigue Shortness of breath Swollen ankles Weight gain over five pounds in a few days Change in heart rate or rhythm Any other unusual signs or symptoms 21

23 Physical Activity Discuss physical activity with your doctor before leaving the hospital. You will likely need a transition period of about four to six weeks before resuming exercise or sexual activity. When your doctor says it's okay, regular physical activity is a good way to get your strength back. Walking is especially helpful after bypass surgery. If it s very hot or very cold outside, try walking in an enclosed shopping mall or on a treadmill. Very hot or cold temperatures force your body to work harder and may put excess strain on your heart. Be sure to include rest periods after any activity. After a morning walk of a few blocks, take a short nap when you get home. You'll be able to do more with time. Because of your chest incision, it s important not to push, pull, twist your body, or lift anything heavier than five to eight pounds for up to eight weeks after your procedure. Ask your doctor for tips on strength training as part of your recovery after your incision has healed. Other activities you can do when your doctor says you're ready: help with light activities around the house; go to the theater, restaurant or store; visit friends; go for a ride as a passenger in the car; or climb stairs. 22

Managing Depression Depression is common in patients after CABG. The emotional letdown after any surgery may cause such feelings. Progress may not seem fast enough.

24 Managing Depression Depression is common in patients after CABG. The emotional letdown after any surgery may cause such feelings. Progress may not seem fast enough. Going to cardiac rehabilitation is a great way to deal with common feelings of depression. You'll get physically stronger while you're there, and learn about selfcare and stress management. You can also talk about your feelings with your spouse, family or close friends. If your feelings of depression don't go away or get worse, talk with your healthcare provider. He or she can tell you what treatment options might be best for you. 23

25 Life After Bypass Surgery Bypass surgery can restore a person to an active and full life. This includes returning to work or active retirement, being physically active, enjoying hobbies and maintaining a sense of well-being.

26 Lifestyle Changes After surgery, you may need to change some aspects of your lifestyle to reduce some of the risk factors of heart attack: Don t smoke. Avoid others tobacco smoke. If you have high blood pressure, keep your blood pressure below 140/90 mm Hg. If you have diabetes or kidney disease, you should target a lower level of 140/85 mm Hg. Get your cholesterol checked and talk to your doctor about your numbers and how they impact your overall risk. Be active. Build up to at least 40 minutes of moderate-intensity physical activity three to four times a week, such as brisk walking. Keep your weight at a healthy level. Avoid being overweight or obese. Manage diabetes, if you have it. Keep your blood sugar within normal levels. Take medication as prescribed by your doctor. Keep a current list of your medicines with you. Manage your stress level. Getting enough sleep, deep breathing, meditation or walking can help. 25

27 Other Considerations Here are some other things to keep in mind after your bypass surgery. Returning to Work People who work in an office or perform low-intensity activities can usually go back to work in about four to six weeks. People who perform heavy work may need to wait six weeks or longer. Ask your doctor when it's okay for you to return to work. Resuming Sexual Activity Talk to your health care provider about when you can return to sexual activity. After heart surgery, sex can usually be resumed in six to eight weeks. But it takes more time for the incision and breastbone to heal. So, it s important to avoid positions that put strain on the chest incision or cause discomfort. Dental Care Unless your doctor says otherwise, you likely won t need to take special precautions during dental treatment. But if you re taking aspirin, Coumadin or Persantine, be sure to tell your dentist before you have any work done. 26

28 For More Information We want people to experience more of life s precious moments. To do that, we want to help you be healthier in heart and mind. It s why we ve made better heart and brain health our mission. Life is why we have created many educational booklets like this to help you and your family make healthier choices to reduce your risk of heart disease and stroke, manage disease or care for a loved one. Everyone has a reason to live a longer, healthier life. What s the why in your life? Maybe it s walking your daughter down the aisle. Watching that perfect sunset with your spouse. Or simply giving your grandchild a big hug. Whatever your why, we encourage you to write it down here. Look back at your why often, and use it to inspire you as you work to live a longer, healthier life. is why. To learn more, call us toll-free at AHA-USA1 ( ) or contact your nearest American Heart Association office. You can also visit our Web site, heart.org. For information on stroke, call STROKE ( ) or visit us online at strokeassociation.org. 27

29 Heart Attack Warning Signs Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort. Here are some of the signs that can mean a heart attack is happening. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath. This may occur with or without chest discomfort. Other signs. These may include breaking out in a cold sweat, nausea or lightheadedness. As with men, women s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. Stroke Warning Signs Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, or trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness or loss of balance or coordination Sudden, severe headache with no known cause F.A.S.T. is an easy way to remember how to recognize a stroke and what to do. Spot a stroke FAST. Face drooping. Arm weakness. Speech difficulty. Time to call Dial Fast Heart attack and stroke are life-or-death emergencies every second counts. If you suspect you or someone you are with has any of the symptoms of heart attack or stroke, immediately call or your emergency response number so an ambulance can be sent. Don t delay get help right away! For a stroke, also note the time when the first symptom(s) appeared. If given within 3 to 4.5 hours of the start of symptoms, a clot-busting drug may improve the chances of getting better faster. Cut along dotted line and keep

30 For heart- or risk-related information, call the American Heart Association at AHA-USA1 ( ) or visit us online at heart.org. For stroke information, call our American Stroke Association at STROKE ( ) or visit strokeassociation.org. For information on life after stroke, call and ask for the Stroke Family Support Network. The statistics in this brochure were up to date at publication. For the latest statistics, see the Heart Disease and Stroke Statistics Update at heart.org/statistics. National Center 7272 Greenville Avenue Dallas, Texas , American Heart Association. All Rights Reserved. Published and distributed by The StayWell Company, LLC. To order, call:

About your Bypass Surgery

Why do I need bypass surgery? About your Bypass Surgery If you have coronary artery disease that means one or more of the arteries that supply your heart muscle with blood is blocked. Your doctor may suggest