Bypass Surgery

Coronary artery bypass surgery is a heart operation. It uses blood vessels to go around or “bypass” clogged coronary (heart) arteries so blood can flow through the new vessels to the heart muscle the way it should. 

 

Bypass Surgery Coronary artery bypass surgery is a heart operation.

 

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What To Expect After Coronary Artery Bypass Grafting

Recovery in the Hospital

After surgery, you will typically spend 1 or 2 days in an intensive care unit. Your heart rate and blood pressure will be continuously monitored during this time. Intravenous medicines (medicines injected through a vein) are often given to regulate blood circulation and blood pressure. You will then be moved to a less intensive care area of the hospital for 3 to 5 days before going home.

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Care after bypass surgery aims to reduce the risk factors for heart disease and includes strategies to help patients and family members to stop smoking, control high blood pressure, improve cholesterol levels, begin exercising regularly, and reduce stress. Some of these changes can be made by adjusting lifestyle habits through diet and exercise. However, lifestyle changes alone may not be adequate and medications are often needed.

 

Discharge from the hospital — Patients with an uncomplicated heart attack usually go home after about five days in the hospital. In some cases, the hospital stay is longer. If complications have occurred, discharge is delayed until the person's condition is stable.

 

Before leaving the hospital, it is important for the patient and family to participate in and understand the discharge plan. Make sure all questions are answered and obtain written directions for how to take all medications. After bypass surgery, it is common to start new medications and stop or adjust the doses of previous medications.

 

Medications — Most people who have had bypass surgery are sent home with prescriptions for several medications, most of which are taken every day. Each of these drugs improves survival and some also help to prevent or treat recurrent chest pain.

 

  • Antiplatelet therapy — Clopidogrel (Plavix®) and aspirin are antiplatelet medications that is given to help prevent the formation of blood clots that can block the graft. Clopidogrel is continued for at least one year after surgery while aspirin is usually recommended indefinitely.

 

  • Beta blockers — Beta blockers slow the heart rate, lower blood pressure, and decrease the heart's demand for oxygen. If a person cannot tolerate a beta blocker, a calcium channel blocker may be substituted.

 

  • Nitrates — A nitrate, either as short-acting nitroglycerin, or as a long-acting preparation (isosorbide mononitrate or dinitrate). These drugs dilate coronary blood vessels, bringing more blood to the heart muscle. Nitrates also reduce the amount of blood returning to the heart, which decreases the heart's demand for oxygen. Nitrates are often given to treat or prevent further episodes of chest pain. Nitrates may be given to patients after CABG if some of the coronary blood vessels could not be bypassed.

 

  • ACE inhibitor — ACE inhibitors are often used to treat high blood pressure. In addition, ACE inhibitors can reduce the incidence of ischemic events after CABG. Ischemic events include death, repeat bypass surgery, angioplasty or stent placement, heart attack, ischemic stroke, transient ischemic attack (TIA), or recurrence of angina.

Examples of angiotensin converting enzyme (ACE) inhibitors include captopril (Capoten®), enalapril (Vasotec®), lisinopril (Zestril® or Prinivil®), and ramipril (Altace®).

 

  • Lipid lowering therapy — Almost all patients are given a medication to lower lipids after CABG. Cholesterol lowering can be beneficial both before and after CABG because it can halt the progression of atherosclerosis in both native and graft vessels.

 

Lipid therapies are recommended even for patients who have values that are in the "normal" range. The goal level for "bad" cholesterol.

 

Wound care — After discharge from the hospital, the patient is usually given instructions about how to care for their chest and/or leg wounds. It is important to follow these instructions closely and to notify a healthcare provider immediately if there are questions or concerns.

 

  • Avoid heavy lifting and extremes of shoulder movement (eg, as in tennis, baseball, and golf) for six to eight weeks after surgery to allow for complete healing of the breast bone

 

When to seek help — If the patient develops any of the following signs or symptoms of wound infection, a healthcare provider should be contacted immediately. Most wound infections develop within 14 days of the surgery:

 

  • - Fever greater than 100.4º F (38º C)
  • - New or worsened pain in the chest or around the incision
  • - A rapid heart rate
  • - Reddened skin, bleeding or pus-like drainage from the incisio

 

Ongoing Care

Care after surgery may include periodic checkups with doctors. During these visits, tests may be done to see how the heart is working. Tests may include EKG, stress testing, and echocardiogram.

 

CABG is not a cure for coronary artery disease. You and your doctor may develop a management plan that includes lifestyle changes to help you stay healthy and reduce the chances of CAD getting worse. Lifestyle changes may include quitting smoking, making changes in your diet, getting regular exercise, and lowering and managing stress.

 

In some cases, your doctor may refer you to a cardiac rehabilitation program. These programs can help you recover through supervised physical activity and education on how to make choices that reduce your risk for future heart problems and help you get back to your regular lifestyle after surgery.

 

Doctors supervise these programs, which include counseling about lifestyle changes as well as exercise training to build strength and energy. Cardiac rehab programs may be offered in hospitals and other community facilities. Ask your doctor whether you're a candidate for cardiac rehab.

 

Taking medicines as prescribed also is an important part of care after surgery. Medicines may be prescribed to manage pain during recovery; lower cholesterol, blood pressure, and the chance of developing blood clots; manage diabetes; or treat depression.