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Understanding Coronary Artery Bypass Surgery (CAB)

If you have severe coronary artery disease (narrowing or blockage of the vessels which send blood to the heart) or have suffered a heart attack, your doctor may recommend coronary artery bypass surgery (sometimes referred to as open heart surgery). Narrowed or blocked arteries cannot supply the heart adequately with blood. Usually the surgery is recommended for life-threatening blockages or for some patients that experience angina to the degree that medication does not help. Surgery is recommended because the blockages in the arteries cannot be dissolved or removed and blood supply to the heart is greatly decreased.

The purpose of a surgical bypass is to "reroute" blood around the narrowed or blocked section(s) and restore blood flow to all parts of the heart muscle. A blood vessel will be removed from your leg or chest. One end will be attached to your heart's aorta; the other end to the coronary artery below the blockage. This graft creates a natural "detour" for blood flow around the diseased section of artery. Most patients require more than one bypass.

Through the development of a machine called the heart-lung bypass machine, doctors are able to rest your heart long enough for surgery. The heart-lung machine takes over the functions of the heart and lungs by cleansing and oxygenating the blood and pumping it through the body. After the surgery is complete, your heart and lungs resume this work.

The surgery is performed through an incision usually made through your breast bone (sternum). Vein(s), usually the saphenous leg vein(s), may be removed or an artery inside the chest called the internal mammary artery may be used to form the bypass vessels. The bypass vein from the leg is divided to be used for several grafts if needed. As previously mentioned, one end of the graft is sewn into the aorta (the large artery that carries oxygen-rich blood to the body) and the other end is sewn into the coronary artery below the blockage. Oxygen-rich blood will flow directly from the aorta, through the bypass graft and to the heart muscle. This is very much like a detour in a road. The blocked areas of the coronary artery are not removed; they are simply bypassed. The number of bypass grafts will depend on the number and extent of blockages. This surgery does not cure coronary artery disease. Together with reducing as many risk factors as possible, it will help you maintain better coronary health.

Before the procedure:

  •   Tell your doctor what medications you take, and ask if you should stop taking them before the procedure. Also mention if you are allergic to any medications.
  •   Have any routine tests that your doctor prescribes. These may include blood tests or an electrocardiogram (ECG).
  •   Don't eat or drink anything (including water) after midnight the night before your procedure.

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Frequently Asked Questions about CAB Surgery

Before Surgery

How Will I Contact the Hospital Staff?

Before you check into the hospital, you will be contacted by a staff member in the Surgical Pre-Admission office. They will ask you questions about your medical history and insurance information to make your check-in process when you arrive at the hospital as short as possible. Shortly after your admission, a nurse will obtain your vital signs (temperature, pulse, respirations, and blood pressure), a short list of allergies and medications. This will enable our staff to determine the best plan of care for you.

What Kind of a Room Will I Have?

We will try to arrange the type of room you've requested, but hospital census and your condition at admission may affect this. After surgery, we will again check room preference with you and make every effort to see that your wishes are honored. If your choice is not immediately available, your name will be placed on a waiting list.

When Will I See My Surgeon?

You will see your surgeon the afternoon or evening before surgery. He will explain the exact surgical procedure he has planned for you and will give you the approximate time schedule for the next day. It may be helpful for you to write down any questions before his visit.

What Can I Expect the Day Before Surgery?

Along with your surgeon and his staff, the anesthesiologist, a nurse from the Cardiovascular Intensive Care Unit (CVICU) and a respiratory therapist will visit you to explain the care they will be providing. Blood will be drawn for laboratory tests. You may need to have a chest x-ray and ECG. Someone from the operating room will give you a surgical prep and a shower with antibacterial soap. This prep will include your legs. You will be asked to sign a Surgical Consent Form and a Blood Consent Form. Heart surgery is a vascular surgery and there is some blood loss. These forms give your approval to the surgeon to perform the operation necessary to repair your heart and to receive blood if your levels fall too low and if it's necessary to help you recover. All blood is checked closely by the American Red Cross. If you or your family would like to see one of the hospital chaplains, one of the nurses will contact them for you.

The evening before the surgery, you will have supper as usual. After midnight, you will not be permitted to eat or drink anything so your stomach will be empty at the time of surgery. If you are having trouble sleeping, ask the nurse to give you a pill to help you relax.

What Will Happen to My Belongings While I Am in Surgery?

You will not be coming back to the same room after surgery, so we strongly recommend that you send all your belongings home the night before surgery or the morning of surgery. The things you will need in the Cardiovascular Intensive Care Unit are limited to dentures, glasses, toothbrush, comb, robe and slippers. Make sure you give your jewelry to your family for safekeeping. You will not be allowed to wear any of it into the surgery room. Bringing in large sums of money and/or credit cards is also unnecessary.

Day of Surgery

How Do I Get Ready for Surgery?

On the day of your operation, we will wake you in plenty of time to bathe and visit with your family. You will probably leave your room for the operating area at least one hour before your surgery is scheduled. Your family can accompany you to the waiting area. If the time of your surgery needs to be changed by your surgeon, we will notify you of any scheduling changes as quickly as possible.

What Happens When I Get to the Operating Room?

You will be admitted to the receiving area by a nurse who will check your name band, chart and consent form. You will be given an injection that will make you sleep. After that, you will be moved into the operating room. Once there, you will be given anesthesia, and the areas they will be operating on (chest, leg) will be scrubbed with an iodine solution.

Once the area is scrubbed clean and you are in a deep sleep, the surgery will begin. You will not feel any pain during the surgery. The surgeon will open your chest, your heart will be hooked up to the heart-lung bypass machine, a vein will be removed from your leg or internal mammary gland and grafted onto your heart. You will be taken off the heart-lung bypass machine, and your heart and lungs will take back the responsibility of pumping and oxygenating your blood. Your chest will be sutured shut and you will be taken to the Cardiovascular Intensive Care Unit (CVICU) immediately after surgery for round-the-clock observation.

What Type of Anesthesia Will I Receive?

General anesthesia is necessary for heart surgery. The anesthesiologist who visited you the day before will decide the exact medications you will receive. The medicines will relax your muscles and produce a sleep so that you will feel no pain during your operation.

Once you are asleep, a tube will be placed through your mouth into your windpipe (trachea) and connected to a machine that can breathe for you. You will remain on this breathing machine (respirator) until several hours after surgery when the anesthesia has worn off. While the tube is in place, you will not be able to speak, but your voice will return as soon as the tube is removed. The length of time this tube is in place will vary from patient to patient. It is not unusual for your throat to be a little sore or your voice to be a little hoarse from this tube, but this will go away soon.

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After Surgery

What can I Expect After Surgery?

You will be taken to the Cardiovascular Intensive Care Unit (CVICU) immediately after surgery for round-the-clock-observation. The nurses in this unit are specially trained to monitor your progress. Your family will be allowed to visit you in the unit soon after surgery.

The first time your family visits, you will still be asleep from the anesthesia. There will be several pieces of equipment at the bedside. Your heart rate and blood pressure are constantly monitored by a machine. Occasionally a red alarm light will come on and an alarm will sound. This does not mean that something is wrong with your heart; the most frequent cause is a loose monitor lead attached to your chest for monitoring your heart rhythm.

Blood tests, ECGs and chest x-rays will be done on a daily basis for a few days after surgery. This is just another way your surgeon will be monitoring your progress.

There will be one or two bottles on the floor next to your bed partially filled with water. These bottles will be connect to drainage tubes placed in your chest during the surgical procedure and allow for any extra blood that might accumulate in your chest to be drained. Theses drains will generally be removed 24 to 48 hours after surgery.

A small drain is routinely placed in the sac around the heart. This will be brought through the skin and connected to a syringe at the lower part of your chest. This generally stays in place about three days or until there is no drainage.

Some patients will have one or two small wires also coming from the lower part of the chest. These wires are called pacemaker wires and are inserted during surgery as a precautionary measure. Some patients will require the temporary assistance of an external pacemaker to regulate their heartbeat. If your surgeon feels you are a candidate for these wires, they will probably stay in place until close to your discharge date.

During your surgery, a tube or catheter will be inserted in your bladder and connected to a drainage bag. This tube may cause you to have a sensation of pressure or a feeling that you have to urinate. It is necessary for us to be able to monitor your kidney function right after surgery, but this tube will generally be removed 24 to 48 hours after surgery.

The tube that was placed in your trachea for anesthesia and breathing may cause discomfort as you wake up. Generally, we are able to remove this shortly after you are awake. After the tube is removed, you will be started on oxygen from a mask or a nasal prong. You will remain on the oxygen as long as your doctor thinks it necessary. You will be reminded to cough and do deep breathing exercises for a few days after surgery. You will be given a special "coughing" pillow. Be sure to use this as a splint against your chest to make your coughing exercise easier and less painful.

Intravenous (IV) lines will be put in during surgery. These will give you fluid, medications and blood. Usually the morning after surgery, you will have one IV left in place. Generally, this is placed in a large vein that lies beneath your collar bone. This IV is usually left in place for three days or as long as your surgeon thinks it is necessary.

Because of the need for frequent attention, you will find that during your stay in CVICU, you will sleep at intervals. The noise, activity and light in CVICU will seem bothersome and sleeping for long intervals is difficult. You will probably return to your normal sleep pattern after your transfer to a regular hospital room.

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When Can I Start to Get Out of Bed?

Most patients will start sitting up in a chair for brief intervals the day after surgery. Some patients will be too weak or have some reason their physician thinks they should not progress this rapidly. Your activity will depend on your progress, but frequently patients start taking short walks 48 hours after their surgery. You will gradually increase your activity each day. Nurses are always available to assist you in getting into and out of bed. Do not use the bed rails to pull yourself up; this will increase your post-operative pain and may delay healing of your breast bone.

How Long Will I Be in CVICU?

The usual length of stay in the Cardiovascular Intensive Care Unit is 24 to 48 hours. Age, your condition prior to surgery and how you progress after surgery all affect the length of your stay.

After CVICU, Then Where?

Once your physician is ready for you to transfer, you will be transferred to one of the hospital's cardiac floors. On the cardiac floors, you will wear a small box that looks like a radio. This will allow technicians to continue to monitor your heart, although you will not see any other equipment or personnel in the room with you. The nurses will also be monitoring your vital signs (blood pressure, pulse, temperature and breathing).

You will stay in this area until your physician thinks you are ready for discharge. The routine care in this area will be planned so that you are able to rest and sleep frequently. The nurses will help you with your progression of activity. Since this will be your last stop before discharge, you will be encouraged to begin performing your activities of daily living with minimal assistance from the nurses.

When Will I Start to Eat?

Most patients are able to eat the day after their surgery. Diet will vary with the individual, their health condition and their physician's preference. If you wish to speak to a dietitian about the particular diet your physician has ordered, tell your physician or nurse and it will be arranged.

Why Do the Nurses Keep Telling Me Not to Cross My Legs?

Crossing your legs puts pressure on the veins, causing circulation to slow down. This can lead to blood clots. Try not to cross your ankles or to sit with your knees crossed. To assist the circulation in your legs, especially after surgery when your activity level is restricted, practice rotating your feet at the ankle.

Why Do I Get Weighed Every Day?

Weighing you every day is important to see how much fluid your body is retaining. Retention of fluid during and after surgery is normal and to be expected. It generally takes a few days to eliminate the excess fluid. Sometimes you will be given medication to help get rid of this excess fluid.

When Can I Take a Shower or Bath?

You are allowed to get into the shower when your temporary wires are removed. The nurses will help you make arrangements for this. At home, if you want to bathe, have someone help you out of the tub while you are still regaining your strength. You may want to buy grab bars for the toilet or bath area or tub benches to sit on while showering. These are especially helpful if you live alone and need help. Use warm water instead of hot. Hot water tends to make you dizzy and tired.

How Will I Feel After Surgery?

You will experience may different feelings after surgery. These feelings can usually be attributed to lack of sleep, frequent activity in your room, the structured hospital environment, physical discomfort from the surgical procedure, lingering anesthesia and unfamiliar people. You may feel tired, irritable or even depressed. As you catch up on your sleep and as the time of discharge approaches, these feelings should lessen or disappear.

You may experience soreness along your chest or leg incision or in your back or shoulders. Pain medications are available to help with this discomfort. The medication will help you to rest and relax, which is very important during the recovery period. You will not be on pain medication long enough to become addicted to it. Please do not hesitate to ask for pain medication as you need it.

When Will I Go Home?

Everyone progresses at a different rate. Therefore, the usual time for discharge is from 5 to 7 days after surgery.

Return Appointment

At the time of discharge, your surgeon will arrange an appointment in two weeks with either him or your cardiologist. Your surgeon will tell you who you are to see and when.

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After Surgery

What Happens the Day of Discharge?

After your surgeon or cardiologist has seen you, given you your prescriptions and discharge instructions, you are ready to be checked out of the hospital. A member of your family can go to the business office and take care of this while you are getting dressed. If you have questions, please ask at the nurses' station on your floor.

Once you've been checked out by the business office, tell your nurse that you're ready to leave. The nurse will arrange for you to be taken to your car in a wheelchair.

What About the Trip Home?

You will need someone to drive you home and to help you with your belongings. If you have a long trip, have them bring a pillow and blanket so that you can rest. Stop for short rests, walk around and exercise your legs.

When Can I Anticipate Full Recovery?

Individuals will increase their activities at different speeds. Some days will seem better than other days. Week by week you should be able to increase your endurance and activities. When you first go home, dressing, personal hygiene, reading, writing, visiting, walking and resting should fill your day. You may go out for short car rides if you have someone to drive you. You can expect it to be about six weeks to three months before you will completely recover.

How Much Exercise Should I Do?

Walking will be your best form of exercise. It will help speed your recovery and increase your strength. Walking will help strengthen your heart muscle and lets the heart perform the same amount of work with less stress. It's all right to climb stairs. Go slowly and rest frequently if you become tired, short of breath or dizzy. Avoid heavy lifting or activities that cause you to strain. Ask your doctor about our Cardiac Rehabilitation Program.

When Can I Resume Former Activities?

    Housework - You should not plan to assume total responsibility for the household, care of children or meal preparation until you have had your return visit to your physician. Try only light household duties at first.
    Recreation - Physical activities (golf, tennis, swimming, fishing, etc.) other than walking should be postponed for 4 to 10 weeks.
    Driving - Do not drive for 3 to 6 weeks. When you go for your checkup, ask your doctor when you can resume driving. Avoid prolonged car trips.
    Sex - Have sex only when you and your partner feel well rested. Build up to intercourse gradually without putting unrealistic performance goals on each other. The partner that has had the surgery should be in the more passive position and should not place any weight on the arms for the first 6 weeks.

What About Smoking?

Smoking is a proven risk factor for developing heart disease. Stop smoking and ask others not to smoke around you. Smoking increases your heart rate, narrows the blood vessels, raises blood pressure and damages the lungs. The American Heart Association has booklets for special techniques or programs to help break the smoking habit. Baptist Medical Center also has a Nicotine Dependence Program sponsored by the Health Management Center to help you or a family member to stop smoking.

Call Your Doctor If:

  •   You feel any shortness of breath or chest pain
  •   You have drainage from your incision site (red or yellow-green)
  •   You have continuous or increasing pain at your incision site
  •   You have an incision that is swollen, red, warm or sore to touch
  •   You have a fever over 100 degrees Fahrenheit
  •   You have a rapid heart rate (over 100 beats per minute)

Coronary Artery Bypass surgery can help in the treatment of coronary artery disease, but it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create your heart problems in the first place. Some risk factors are smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce risk factors can help keep your heart condition from getting worse and may even improve the health of your heart and help prevent another surgery.

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For Direct Physician Referral & Appointments: 501-227-8478 or 1-888-BAPTIST(227-8478)

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