Heart bypass surgery Health Article

Indications

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended for:

• Disease of the left main coronary artery
• Disease of three or more vessels (triple vessel disease)
• Cases in which nonsurgical management (medication or angioplasty) hasn't worked

The earliest symptoms of ischemic heart disease include chest pain (angina) and shortness of breath. You may have no symptoms; mild, intermittent chest pain; or more pronounced and steady pain. Some people have CAD that is severe enough to make everyday activities difficult.

Symptoms that usually bring a person to a doctor are a feeling of heaviness, tightness, pain, burning, pressure, or squeezing. This is usually behind the breastbone, but sometimes it is also in the arms, neck, or jaw. Some people have heart attacks without ever having any of these symptoms first.

In cases where there are no symptoms, a doctor may suspect CAD and perform a stress test to determine if it is present. CAD is sometimes suspected if there is a family history of heart disease and a combination of other factors, including:

• Cigarette smoking
• Diabetes
• High blood cholesterol
• High blood pressure
• Male gender

Because CAD varies so much from one person to another, the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment.

Risks

When considering the risks of CABG, it is important to remember that bypass surgery has been performed for more than 30 years. It is the most frequently performed major surgery in the United States. Cardiovascular surgeons have received extensive training in bypass techniques.

As with any surgery, your health before surgery is a major consideration in determining your risks. Health conditions that should be considered before surgery are:

• Age -- patients over 70 are at a slightly higher risk for complications
• Gender -- women have a slightly higher risk
• Having another serious medical condition (such as diabetes, peripheral vascular disease, kidney disease, or lung disease)
• Previous heart surgery -- puts a person at a higher risk

Possible risks in having CABG are:

• Blood clots
• Death (very small risk)
• Heart attack
• Sternal wound infection (this complication most often occurs with obesity, diabetes, or having had previous CABG)
• Stroke (the risk is greatest in those over 70)

About a third of patients have "post-pericardiotomy syndrome" a few days to 6 months after surgery. The symptoms of this syndrome are fever and chest pain. It can be treated with medication.

The surgery site in the chest or the graft site (if the graft was from the leg or arm) can be itchy, sore, numb, or bruised.

Some people report memory loss and loss of mental clarity or "fuzzy thinking" after CABG.

As with all surgeries, there is a risk for heavy bleeding. In case you need a transfusion during or after surgery, ask your doctor about banking your own blood beforehand. You may also have family or friends with a compatible blood type donate blood for your surgery. The hospital, Red Cross, or local blood bank can provide family members and friends with necessary information about blood donation for your surgery.

There are general risks from anesthesia. These include reactions to medications and problems breathing.

Expectations after surgery

In most people who have heart bypass surgery, the grafts remain open and functioning for 10 to 15 years.

CABG will improve blood flow to the heart but NOT prevent the coronary blockage from returning. Lifestyle changes are necessary:

• Don't smoke
• Eat a healthy diet
• Get regular exercise
• Treat high blood pressure and high cholesterol

Convalescence

After the operation, you will spend 5 - 7 days in the hospital. You'll spend the first 2 hours in an intensive-care unit (ICU). In the ICU, heart function is monitored continuously.

You may need the temporary assistance of a breathing tube for a few hours after surgery. Two to three tubes in the chest drain fluid from around the heart and are usually removed 1 - 3 days after surgery.

A urinary catheter in the bladder drains urine until you are able to void on your own. Intravenous lines (IV) provide fluids and medications. Nurses watch the monitors and check vital signs (pulse, temperature, breathing) constantly.

When constant monitoring is no longer needed, usually within 12 - 24 hours, you will be moved to a regular or a transitional care unit. You can gradually resume activity. You may begin a cardiac rehabilitation program within a few days. The incision in the chest does not bother most people after the first 48 - 72 hours.

After surgery, it takes 4 - 6 weeks to start feeling better. During recovery it is normal to:

• Have a poor appetite -- it will take several weeks for it to return.
• Have swelling in the leg if the graft was taken from the leg. Raising the leg and wearing elastic TED hose for several weeks helps reduce swelling.
• Have difficulty sleeping at night -- this will improve.
• Have constipation.
• Have mood swings and feel depressed -- this will get better.
• Have difficulty with short-term memory or feel confused -- this also improves.

The full benefits from the operation may not be determined until 3 - 6 months after surgery. You may resume sexual activities 4 weeks after surgery. All activities that do not cause fatigue are permitted. Your doctor will help you determine the schedule for resuming normal activities.