Coronary Artery Bypass Grafting

Why is this procedure done?

Normally, you have many blood vessels that bring blood to the heart muscle. If one of them is blocked, your doctor will try to restore normal blood flow. This surgery uses another blood vessel to let the blood flow around the one with the blockage. You may have surgery on more than one blocked blood vessel. After surgery, you may have more blood flow to your heart muscle. This may lower your risk of heart attack or chest pain. � �

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What will the results be?

It will greatly increase blood flow to your heart muscle. You may have a lower risk of heart attack. Many people have less chest pain and are able to exercise more. � �

What happens before the procedure?

Your doctor will take your history and do an exam. Talk to the doctor about: � �

All the drugs you are taking. Be sure to include all prescription and over-the-counter (OTC) drugs, and herbal supplements. Tell the doctor about any drug allergy. Bring a list of drugs you take with you. Ask about what drugs you should or should not take.
Any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin � �, Plavix � �, ibuprofen, Aleve � � (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding. Do not stop these drugs until after you have checked with your doctor. Talk to your doctor about them.
When you need to stop eating or drinking before your procedure.

Your doctor may order: � �

Electrocardiogram (ECG)
Chest x-ray
Coronary angiogram
Heart catheterization

You will not be allowed to drive right away after the procedure. Ask a family member or a friend to drive you home. � �

What happens during the procedure?

Once you are in the operating room, you will be given a drug to make you sleepy and stay pain free. The staff will put an I.V. in your arm to give you fluids and drugs. Small stickers will be placed on your chest so the doctor can see your heart rate and rhythm. Your vital signs will be taken a lot during the procedure. When you are asleep, the doctors put a tube in your mouth to help you breathe. You will have a tube in your bladder to drain urine.
Your doctor will make small cuts in your skin. The chest will be opened through a cut in your breastbone so the doctor can see where to operate. The doctor will put in special pacemaker wires to help make sure your heart rhythm is steady. If needed, a heart and lung bypass machine will be connected. This machine works like your heart and lungs during surgery and pumps oxygen-rich blood to your body. Some kinds of heart bypass surgery are done while your heart is still beating.
Your doctor will take other blood vessels from the chest wall or from the leg. Doctors sometimes use arteries in the chest or arm to make the grafts work better and stay open longer than using veins from the leg. These vessels are "grafts. " �
These grafts connect to the blood vessel just above and below the blocked part. This graft makes the bypass around the blockage. Sometimes, your doctor makes more than one graft if there is more than one blocked vessel.
When the grafts are in place, your doctor will close the cuts made with stitches or staples and cover it with clean bandages. The operation may take 4 to 5 hours.

What happens after the procedure?

You will go to the Intensive Care Unit (ICU) to recover after surgery. You may still have machines and tubes connected to you. These may include a heart monitor, the pacemaker wires, and the tube to drain your urine. You may have a tube in your chest to drain blood and air from your cut site. You may still have a tube in your mouth to help you breathe. You will have a line in your arm or neck to measure your blood pressure in your artery, and two or more I.V. lines to give you drugs and fluids.
The staff will take out your breathing tube when you are awake and strong enough to breathe. You may have a sore throat afterwards. The other tubes and wires will all be taken out in a few days. You will wear tight socks on your legs to help increase blood flow. The socks pump on and off to prevent blood clots.
Within a day or two, you will get out of bed to a chair. The staff will help you begin to walk around. Doing coughing and deep breathing exercises will help keep your lungs clear. You will get drugs through your I.V. to help with your pain.
You will need to stay in the hospital for 5 to 7 days.

What lifestyle changes are needed?

Eat a heart healthy diet. Eat foods low in fats, sugars, and salt. Eat high-fiber foods, which include fruits and veggies. Your doctor can help you make a plan about the changes in your diet.
Exercise regularly. Ask your doctor what kinds of exercises are best for you.
Avoid smoking and alcohol. Your doctor can help you learn about how to slowly stop smoking or drinking.
Talk to your doctor about when it is safe to have sex and when you can return to your work.

What drugs may be needed?

The doctor may order drugs to: � �

Lower cholesterol
Help with pain
Control blood pressure
Keep heartbeat regular
Prevent blood clots
Prevent infection

What problems could happen?

Internal bleeding or bleeding at the cut site
Wound infection
Stroke or heart attack
Pneumonia
Blood clot in the lung
Kidney failure

When do I need to call the doctor?

Activate the emergency medical system right away if you have signs of a heart attack or stroke. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery. Call for emergency help right away if you have: � �

Signs of heart attack:
- Chest pain
- Trouble breathing
- Fast heartbeat
- Feeling dizzy
Signs of stroke:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause

Call your doctor if you have: � �

Signs of a very bad reaction. These include sudden shortness of breath or a sudden onset of chest pain; soreness or redness above or below your knee, more pain behind your calf; more swelling in your calf, foot, or ankle. Go to the ER right away.
Signs of infection. These include a fever of 100.4 � �F (38 � �C) or higher; chills; redness, swelling, very bad sore throat, cough, more sputum or change in color of sputum, pain with passing urine, burning, urgency, and blood in the urine.
Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
Any signs including pain, upset stomach, throwing up that does not go away even with drugs you are taking
Rapid heart rate
You are not feeling better in 2 to 3 days or you are feeling worse

Where can I learn more?

American Heart Association � �
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300434.pdf � �
National Heart Lung and Blood Institute � �
http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/ � �
The Society of Thoracic Surgeons � �
http://www.sts.org/patient-information/adult-cardiac-surgery/cabg-information � �

Consumer Information Use and Disclaimer

This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. � �

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