Coronary Artery Bypass Graft

What you should know

• Coronary artery bypass graft surgery is also called open heart surgery, or CABG. A CABG is done to open up blocked arteries in your heart. An artery is a blood vessel (tube) that carries blood with oxygen through your body. Parts of your heart may not get enough blood if an artery is blocked. When one or more of these arteries is blocked, you may have a heart attack. You may have mild to severe chest pain and a hard time doing daily activities such as climbing stairs or walking.
  
  
• CABG surgery can improve blood flow to the heart by bypassing (sending blood around) the blocked part of an artery. During surgery, a blood vessel from another part of your body is used to bypass the blocked artery. This bypass may restore blood flow to your heart muscle. The healthy blood vessel may be taken from your leg or chest and is called a graft. After CABG surgery, you will need to make some lifestyle changes. These changes include eating healthy and low fat foods, exercising, and quitting smoking. It may take six weeks, or more, for you to return to your usual activities. Having a CABG may relieve your chest pain and prevent heart problems such as a heart attack.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• Your incisions may get infected. Certain diseases, such as diabetes, put you at higher risk for life-threatening problems, such as infection. You may bleed too much and need a blood transfusion. You may have very fast heartbeats that are not regular in rhythm. Your heart may not get enough oxygen and have trouble pumping blood through your body after surgery. You may feel sad most or all of the time after a CABG. There is a chance that your signs and symptoms may come back. If they come back, you may need another CABG.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. You may have fluid buildup around your heart. This fluid puts pressure on the heart, causing it to not work properly. You may also have fluid buildup around your lungs. This may make it hard for you to breathe after surgery. These problems may be life-threatening.

Getting Ready

Before your surgery:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine. Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your surgery.
  
  
• Caregivers will monitor your blood sugar closely before, during, and after surgery. This will help lower your chance of getting an infection. You may need a blood transfusion if you lose a large amount of blood during surgery. You may be able to donate your own blood before surgery. This is called autologous blood donation. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• You may need to have blood drawn for tests. You may need an electrocardiogram (ECG), or an echocardiogram. Both of these tests look at how your heart is working. You may need a special kind of x-ray that uses dye so that caregivers can see your arteries better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any food or metal. You may need these or other tests. Ask you caregiver for more information about the tests you may need. Write down the date, time, and location of each test.
  
  
• Your caregiver may give you antibiotic medicine before surgery. This medicine kills germs and may help prevent infection. Your caregiver may give you medicine to thin your blood. This medicine helps prevent blood clots from forming. Your may also need medicines to help prevent a fast or fluttering heart rhythm. Ask your caregiver for more information on what medicines you may need before surgery.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be taken to the room where your surgery will be done. Medicine called anesthesia will be given to keep you asleep and free from pain during the surgery. Special intravenous (IV) tubes may be used to show how you are doing during surgery. Caregivers will clean your skin with a special soap to help prevent infection. Sterile sheets will be put over you to keep the surgery area clean.
  
  
• During surgery, an incision (cut) will be made in your chest. After opening your chest, your ribs may be cut or spread apart so your caregiver can reach your heart. Your heart is slowed or stopped so that caregivers can work on your heart. If your heart is stopped, your blood will be pumped through your body by a machine. A separate incision may be made to remove the graft. The graft is a piece of healthy blood vessel taken from somewhere else in your body, such as your leg. The graft will be sewn to your artery above and below the block. The graft is used to bypass the blocked vessel and reconnect blood flow to your heart muscle. After surgery, the blood will again be allowed to flow through your heart. The incision where the graft came from will be closed with stitches and covered with bandages. The chest incision will be closed using a strong wire, staples, or stitches (thread), and covered with bandages.

After your surgery:

You will be taken to a room where you can rest until you are awake. Your caregiver will check on you often. You may be on monitors that your caregivers can watch from outside your room. Do not try to get out of bed until your caregiver says it is okay. A bandage will cover your incisions to keep the area clean and dry to prevent infection. A breathing tube may be left in your mouth and throat after surgery. The tube may be hooked up to a machine called a ventilator, which will breathe for you. The breathing tube will be taken out as soon as you can breathe on your own.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You have a fever.
  
  
• You cannot make it to your surgery on time.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
  
  
• Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
  
  
• Feeling sick to your stomach
  
  
• Having trouble breathing
  
  
• A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
  
  
• Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.