Heart Bypass Surgery

Heart bypass surgery is an open-heart surgery that is done to reroute or "bypass" blood around clogged arteries. Arteries are the tubes in which blood flows to and from the heart. Over time they can become blocked by a buildup of plaque, which is a combination of fat, cholesterol, and other substances. This blockage, known as atherosclerosis, lowers the blood and oxygen supply to the heart. Heart bypass surgery, also known as coronary artery bypass graft surgery or CABG, reroutes the blood around these clogged arteries.

How is the procedure performed?
The two most common forms of heart bypass surgery are:

• saphenous vein bypass. A large vein, called the saphenous vein, is removed from one of the legs. One end of the vein is attached to the aorta, the large artery leaving the heart, and the other end is connected to the coronary artery below the blockage.
• internal mammary artery bypass. An artery called the internal mammary artery, located behind the breastbone, is used to bypass the blocked coronary artery.

There are two ways of doing heart bypass surgery. In one method, a heart-lung machine is used during the surgery to keep the blood oxygenated while the heart isn't pumping. Another way of doing surgery is know as off-pump, or beating heart surgery. In this surgery, the heart continues beating while the surgeon works on the bypass grafts. Be sure to ask your surgeon which type of procedure is best for you.

If leg veins are being used for the bypass graft, there may be a long incision on one or both legs from where the vein was taken. In another type of procedure for taking the vein (known as endoscopic vein harvesting) , there will be several small incisions instead of long incisions.

What happens right after the procedure?
After surgery, the person is taken right away to the intensive care unit, or ICU. He or she will be given medication for the first few hours to make him or her sleep. When the person awakens, he or she should not be alarmed to find:

• a breathing tube, called an endotracheal tube, down the windpipe. This tube is attached to a ventilator, or artificial breathing machine, to ensure deep breaths and to make it easier for the person to breath. This will usually be removed on the same day as surgery, when he or she is awake, and able to take deep breaths
• a stomach tube, called a nasogastric tube, in the nose to drain the stomach and prevent nausea and stomach swelling
• a narrow tube, called a urinary catheter, in the bladder to measure the amount of the urine the body is making.
• one or two tubes in the chest to drain fluid from around the heart
• many intravenous, or IV, lines to give fluids, medications and blood as needed
• a small tube in the wrist to monitor blood press ure closely
• a tube in the neck to monitor how well the heart is pumping and to allow an easy, painless way to draw blood

The person will be given pain medication as needed.

On the first day after surgery, many of the tubes will be removed. The person may be transferred to the step down unit, or telemetry unit, if there have been no problems. In the telemetry unit the person will:

• be asked to breath deeply and cough often to prevent pneumonia
• be encouraged to sit at the edge of the bed and dangle his or her feet
• have the chest tube and urinary catheter removed
• eat, if possible, starting with clear liquids
• be given pain medication if it is needed
• begin walking the day after surgery. This will help to prevent blood clots from forming, and reduce ankle swelling.

The average hospital stay following heart bypass surgery is 4 to 5 days.

What happens later at home?
The recovery time at home will last for about 6 weeks. During this time, the incision will heal slowly, with some redness, tenderness and swelling present for several months. The person will be advised to:

• have a check-up with the surgeon about 10 to 14 days after the surgery
• take showers instead of baths for 4 to 6 weeks until incision is completly healed.
• begin a walking program
• avoid lifting and straining for 4 to 6 weeks
• not drive for 4 to 6 weeks
• resume sexual activity as desired after the first check-up with the surgeon
• rest twice a day for the first few weeks, and get 8 to 10 hours of sleep at night
• expect some constipation if pain medication has been used often, eating extra fruits and vegetables can be helpful to prevent constipation.

This is a good time for a person to start thinking about changing his or her lifestyle and addressing any coronary risk factors that may have contributed to his or her heart problem. For instance, a person should:

• quit smoking if he or she smokes. Smoking after heart bypass surgery increases the risk of the bypass artery clogging again.
• control his or her blood pressure. If medication is prescribed, it should be taken as directed.
• follow a diet low in fat, cholesterol, and sodium.
• lose weight, if needed
• walk or do other exercise each day

What are the potential complications after the procedure?
All major surgery carries the risks of bleeding, infection and death. After heart surgery, irregular heart rhythms, known as arrhythmias may also occur. If lifestyle changes aren’t made, the new grafts may block, just like the natural arteries did. Incision and chest muscle pain may last for months. Some numbness in the skin near the incision may also occur. However, this problem often gets better over time.

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