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Coronary Artery Bypass Surgery

Coronary artery bypass surgery is an open-heart procedure whereby a surgeon grafts a vein or artery from another part of your body to a blocked coronary artery in your chest. The grafts take over the function of the occluded coronary arteries and bring needed oxygen-rich blood to the heart. Sometimes as many as four arteries are bypassed in this manner.

Often, the surgeons use the saphenous vein from your leg for this procedure. Sometimes they use one of two internal mammary arteries. These are found inside your chest wall along side the breast bone (sternum). Sometimes another thoracic (chest) artery is used. The vessels that are moved are nonessential in their original location. There will be sufficient blood flow without them.

Why do I need this operation?
Based upon your symptoms and the results of diagnostic tests, your doctor has determined that you have coronary artery disease. Coronary Artery Bypass Surgery is a method of treating this condition.

This operation can eliminate your chest pain, reduce fatigue, increase your exercise capacity and enhance your sense of well-being. For some people, this procedure actually prolongs life.

What is coronary artery disease?
The coronary arteries are found on the surface of your heart. They bring oxygen rich blood to your heart muscle.

Sometimes fat, cholesterol, and other substances are deposited on the inner walls of the coronary arteries. The build up of these substances may form "plaques." which may clog or "occlude" the coronary arteries. This is called, "atherosclerosis" or "hardening of the arteries." When this happens, blood flow becomes restricted. If an artery is completely occluded, no blood can flow through it.

Plaque can also stimulate the formation of a blood clot. The slow build up of a blood clot can narrow the artery even more. The quick build up of a blood clot can abruptly close the artery.

If blood flow is completely blocked , the heart does not get the oxygen it needs and the muscle becomes permanently damaged. This is a heart attack (myocardial infarction).

Some warning signs of coronary artery disease are: numbness, pressure or pain in the chest, arms, jaw, throat or upper back

Your doctor did not diagnose coronary artery disease on the basis of symptoms alone. He ruled out other causes by employing diagnostic tests such as an exercise stress test and cardiac catheterization. The latter can indicate the severity of the disease and which arteries are affected.

What advance preparations should I make for the operation?
Sometimes a blood transfusion is needed during the surgery. You can prepare for this several weeks in advance by banking your own blood. You will have to do this over two or three visits and should leave sufficient time for recovery, between banking blood and surgery. Some hospitals allow your family members to donate blood.

Don't be concerned if you are unable to bank blood. If you do need a transfusion, the blood will be tested first for diseases including HIV.

What immediate preparations should I make before surgery?
Don't eat after midnight of the night before surgery. If you have diabetes, consult your physician before fasting.

Discuss your current medications with your physician. She may advise you to stop taking certain medicines (e.g. anticoagulants) for a few days to a week before the procedure. Ask her if it will be all right to take aspirin.

Stop smoking to improve blood flow and breathing.

You will not be returning to the same room after surgery, so leave all valuables at home. Do not wear any jewelry or contact lenses to the hospital. There is usually no safe place to leave eyeglasses, dentures or detachable bridgework. If you require these items, give them and your wedding ring to a relative, who can return them to you after the operation.

Whom will I see in the hospital?
You will meet with several members of the surgical team which may include, the surgeons, the anesthesiologist (who administers medication to make you sleep during the surgery), a cardiac nurse, a respiratory therapist, a physical therapist, and a nutritionist. Each will explain his role in the surgery. and healing processes. This is the time to seek clarification of any issues which are concern you.

All surgery has potential risks. In coronary artery bypass surgery, there is small risk of heart attack, stroke, or death. There is also a small risk of infection in the leg or chest wounds. Rare occurrences include: breathing or other lung problems, bleeding, and nerve injury. Your doctor will explain all the risks, and ask you to sign a consent form.

Many hospitals welcome family members at this meeting and encourage them to ask questions and voice their concerns.

What happens before the operation?
You will have: blood tests (a few tubes), a chest x-ray, urine analysis and an electrocardiogram (abbreviated EKG or ECG) This last test records your heartbeats. Sometimes, these tests are performed prior to admission.

You will be weighed before and after the operation to determine if you are retaining fluid.

Your chest, groin, and leg hair will be shaved to help prevent infection.

Who will be in the Operating Room?
In the OR, you will see the professionals you've met as well as other members of the surgical team, including the perfusionist. This specialist monitors the "heart-lung" machine that keeps your blood supplied with oxygen and keeps the blood circulating. during the operation. Your blood pressure, temperature and respiration will be closely monitored, as well.

What happens during the operation?
Before the surgery begins, the surgical team will clean and drape you and prepare a sterile environment.

Then a surgeon will begin the operation by making an incision in your chest, and then dividing and separating apart your breastbone.

Ice water is placed on the heart to cool it down. Tubes are then attached to the heart and connected to the heart lung machine. Blood will travel from the upper chambers of your heart, to the machine and then throughout your body.

Once the heart-lung machine has taken over for your heart, the surgeons will clamp the main artery (aorta). Then they remove the bypass vessel and attach it to the blocked coronary artery. They do this by sewing the graft vessel to the coronary artery beyond the blockage. If they are using the saphenous vein, they will sew one end to the coronary artery, and one end to the aorta. If the mammary artery is being used, the second step is unnecessary. The mammary artery is already connected to the aorta.

After the grafting is completed, you will be taken off the heart lung machine. Your heart and lungs will take over again; and the surgeon will rejoin the breastbone with stainless steel wires.

How long does the operation take?
The operation lasts from 3 to 6 hours. You will then go to the Intensive Care Unit (ICU) to recover and be monitored. Your family may visit you there after a couple of hours. Let them know in advance, that you will not look your best. You may be pale and puffy, and you will be surrounded by tubes and wires. You may still be asleep.

What happens in the ICU?
When you awaken in the ICU, you may feel groggy, thirsty, cold, or in pain. The nurse. can give you a pain killer.

You will have a breathing tube in your mouth. Try to relax. The nurse will test your breathing.. As soon as you are breathing on your own, the tube will be removed. You will not be able to talk while the tube is in your mouth, but the nurse will teach you how to communicate for that brief period of time.

At first, you may be disoriented and confused. You may not readily know whether it is day or night or how much time has passed. That is normal. The disorientation doesn't last long.

You will have a fever after the operation. This may last for three or four days.

After the breathing tube is removed , you will be able to swallow liquids. You will be able to eat solid foods in a day or two.

How long does recovery take?
If you have external stitches, they will be removed from your chest about a week after the operation. The stitches will be removed from your leg a few days later. These wounds will change color several times during the healing period, which is about six weeks.

How long will I remain in the hospital?
The usual hospital stay is around five days to a week. You may make one or two room changes after the ICU, as you slowly gain strength.

Within a day or two you will be able to sit in a chair. Usually, you will be walking a day later. Moving about will help the healing process. Walking also prevents the formation of blood clots and reduces ankle swelling.

A nurse or a respiratory therapist will give you coughing and breathing exercises. This is part of the healing process.

You will continue to have EKGs, chest x-rays and blood tests throughout your stay.

What happens when I leave the hospital?
You will be taught how to care for your incision to help it heal and prevent infection.

You will have follow-up visits with your doctor who will monitor your progress.

Arrange in advance for a friend or family member drive you home from the hospital.

During the recovery period, you should take showers instead of baths. Pat, rather than rub yourself dry. You will be most comfortable in clean, soft, cotton garments.

Your doctor will advise you when you may return to work.


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