Coronary artery bypass

Coronary Artery Bypass: Need,Risks,Preparation,Procedure, Recovery

Coronary bypass surgery is the invasive procedure used to redirect the blood around a section of partially or a fully blocked artery in the heart. The surgery improves the blood flow to the heart muscles. So, it aims to reduce the discomfort caused due to a lack of blood flow to the heart. During the procedure, the surgeon takes a healthy blood vessel and connect it beyond the blocked arteries in the affected person’s heart. In most of the cases, the healthy blood vessel is taken from the arm, leg, or chest region. The procedure, also known as CABG does not cure heart diseases that trigger blockages caused due to coronary artery disease or atherosclerosis), it eases the symptoms caused due to the conditions. So, it eases symptoms like shortness of breath or chest pain. For some people, the invasive procedure improves the function of the heart. It also reduces the risk of fatal complications like death due to heart disease.

Different Types Of Coronary Artery Bypass

Coronary artery bypass

Depending on the number of arteries blocked, your surgeon suggests the following types of coronary artery bypass surgery:

  • For one blocked artery, you need to undergo a single bypass.
  • People with two blocked arteries need to undergo a double bypass.
  • For three blocked arteries, your surgeon suggests a triple bypass.
  • People with four blocked arteries need a quadruple bypass.

The number of blocked arteries increases your risk of heart diseases like heart failure, heart attack, or other cardiac problems. An increase in the number of blocks in the arteries can make the surgery more complex and longer.

Reasons For Undergoing Coronary Artery Bypass

People need to undergo coronary artery bypass when the plaque (material in the blood) builds on the arterial walls. So, it results in reduced blood flow to the heart muscle. It is a type of CAD (Coronary Artery Disease), also known as atherosclerosis. With reduced blood flow to your heart, you feel fatigued and exhausted. Atherosclerosis is a condition affecting any artery in the blood. You also need the procedure due to the narrowing of coronary arteries, which increases the risk of suffering from a heart attack. CABG is also suggested for too severe blockages. Such blockages are difficult to manage using medications or other treatment options.

Determining The Need For Coronary Artery Bypass

Coronary artery bypassA team of doctors, including a cardiologist, assesses the patient’s condition to determine if they can undergo coronary artery bypass surgery. People with certain medical conditional can face complications during surgery. These conditions can also eliminate the possibility of undergoing CABG. The conditions increasing the risk of complications are:

You need to inform your doctor regarding your underlying health problems before the surgery. So, talk in detail regarding the medical and family history. Also, inform the doctor regarding the medications (prescription or OTC medications) you take. Remember, planned surgeries tend to have positive outcomes compared to emergency surgery.

Need For Coronary Artery Bypass

Coronary bypass surgery is not suggested for people suffering from a mild heart condition. It is an option when you suffer from a blocked artery to the heart. The doctor suggests the invasive procedure during the following scenarios:

  • People experiencing severe chest pain triggered due to several narrowed arteries. These arteries supply blood to the heart muscles. So, the narrowing can leave the heart muscles short of blood supply during light physical activity or rest.
  • You suffer from one or more diseased coronary artery and the malfunctioning of the left ventricle (the heart’s pumping chamber).
  • People suffering from artery blockage with angioplasty (inserting and inflating a tiny balloon temporarily and widening the artery) is not appropriate. You have undergone a previous angioplasty or unsuccessful placement of a stent (a small wire mesh tube) to hold an artery in place. CABG is also ideal when you suffer from restenosis (narrowing of an artery after stent placement).
  • CABG is also an emergency option to save the life of patients who suffer from a heart attack or fail to respond to other treatment options.

But, for the results of the surgery to remain positive for a long period, you need to make some lifestyle changes. After the procedure, take medications as per the instructions of your doctor. Also, take the medication needed to reduce the risk of blood clot development, lower blood cholesterol, and aid in proper heart functioning without any complications.

Risks Associated With Coronary Artery Bypass

CABG is open-heart surgery, so the possibility of experiencing any complications during or after the invasive procedure is high. The possible complications arising due to the procedure include:

  • Risk of bleeding
  • Arrhythmias (Heart rhythm irregularities)
  • Stroke
  • Develop infection in the chest wound
  • Trouble thinking/focusing or memory loss (It improves within six to twelve months)
  • Kidney problems
  • Risk of heart attack (when the blood clot break loose after the procedure)

While modern medical technology has reduced the risk of developing complications. But, the risk of developing complications depends on your overall health before the procedure. The risk of complications increases when the surgeon performs it on you as an emergency procedure. People with other underlying health conditions like diabetes, kidney disease, emphysema, or peripheral artery disease (blocked artery in the legs) have increased chances of suffering from risks.

Preparing For Coronary Artery Bypass

Follow the specific instructions regarding the activity you can perform. Also makes changes in your diet or medication as per your doctor’s suggestions before the surgery. After the procedure, make sure you make arrangements to ensure you can heal properly without any complications. Get the assistance of a friend, family member, or care workers to drive you from the hospital or complete your routine tasks that can become difficult after the procedure. Follow the guidelines suggested by the surgeon regarding resuming your activities or performing daily chores.

What To Expect With Coronary Artery Bypass?

What To Expect With Coronary Artery Bypass?

The invasive procedure puts a lot of questions in your mind. So, you need to talk to your doctor in detail regarding the procedure. Here is the gist of what to expect when you undergo coronary artery bypass:

Before Coronary Artery Bypass Procedure

The surgery can take place when the doctor suspects an underlying heart problem that needs immediate attention or as an emergency procedure. For the planned procedure, you need to get admitted to the hospital a day before the surgery or as the doctor suggests. The hospital conducts tests to checks your blood sugar, pressure, and other vital signs before the procedure.

The Coronary Artery Bypass Procedure

Remember, the surgery can take between 3 to 6 hours depending on the severity of your condition. You need general anesthesia for undergoing the procedure. Based on the severity and the location of the blockages in your heart. Before the procedure, the surgeon provides general anesthesia through a breathing tube inserted in your mouth. The tube is attached to a ventilator that helps you breathe during as well as immediately after the surgery. During the procedure, a heart-lung machine assists in the normal flow of blood and oxygen through the body. The particular type of surgery performed after making a long incision and using the heart-lung machine is known as on-pump coronary bypass surgery.

The Coronary Artery Bypass Procedure

During the procedure, the surgeon cuts through the center of the chest. It is specifically made along the breastbone. For exposing the heart, the surgeon spreads open the rib cage. The surgeon temporarily stops the heart using medication. To ensure good oxygen and blood supply to the body, a heart-lung machine takes over. Then, a healthy section of the blood vessel is attached to the ends below and above the blocked artery. The blood vessel is often taken from the lower leg or from inside your chest wall. The surgery aims to redirect the blood flow around the narrowed part of your affected/diseased artery. After the completion of the procedure, the surgeon restores the heartbeat and disconnects the heart-lung machine. Your surgeon closes the chest bone with wire. Until the bone heals, the wire remains in the body.

Other Surgical Techniques

Apart from the above-mentioned technique, there are other options available for performing CABG. The options are:

Beating Heart or Off-Pump Surgery

Beating Heart or Off-Pump Surgery

The procedure as the name suggests uses a piece of special equipment to stabilize a specific section of the heart while it is still beating. It is a challenging surgical option as your heart still moves during the procedure. So, your doctor may not suggest it for everyone.

Minimally Invasive Surgery

As the name suggests, your doctor performs the procedure with small incisions. So, coronary artery bypass is complete by making minimal incisions. The surgeons make the incisions with the help of video imaging and robotics. It helps operate in a small region in your chest. Several variations like a keyhole or port-access surgery are available.

Recovery After Coronary Artery Bypass At Hospital

Once you undergo the surgery, you need to spend 24 to 48 hours at the hospital’s intensive care unit. It is to monitor your progress after the surgery. The breathing tube remains in your throat for making it easier to breathe until you awaken. Your doctor begins cardiac rehabilitation when you are still in the hospital. The rehabilitation program includes educating you and suggesting an exercise program designed for a speedy recovery. After leaving the hospital you can continue with the monitored programs. It is usually in an outpatient setting. Once you are safe enough to try it at home, you can continue the maintenance program for a speedy recovery.

With no complications, you can leave the hospital a week after the surgery. You need to take it easy for some time. So, get assistance as you will find it difficult to complete the everyday simple tasks. You need aid to walk even for a short distance. So, it is better to ask a family member, friend or a caretaker to assist you until it is possible to complete the tasks without external aid. After getting discharged from the hospital, you need to monitor your body closely for signs and symptoms. Certain signs indicate a serious problem, which requires immediate medical attention. So, call your doctor when you experience the following:

  • Rapid heart rate
  • Fever
  • Experience new pain around the chest wound
  • Worsening of existing pain around the operation site
  • Reddening around the wound on the chest
  • Bleeding or any other discharge from the surgical wound

Recovery Process At Home After Coronary Artery Bypass

While the recovery period can differ from one person to another, you can get back to your life in a period of six to twelve weeks. By four to six weeks, you can resume normal activities like driving or light physical activities. But, you need to make sure to have the approval from your doctor before resuming any activity.

Discomfort While Recovering

It is common to feel soreness in the areas of cuts made for the surgery. So, you need to continue to take prescription painkillers as suggested by the doctor for a few weeks. To make the discomfort less, you can follow the steps suggested below:

  • Try to opt for loose, breathable, and comfortable clothing that does not rub on the wounds.
  • As you recover at home, you feel tired and exhausted. It is normal and you never have to panic as the body uses a lot of energy to promote wound healing.
  • Listen to your body and slowly start simple activities. By three months, you will recover fully and resume your normal activities.

Wound Care After Coronary Artery Bypass

Remember, the coronary artery bypass surgery uses metal wires to hold the sternum (breastbone) together. These wires are permanent. The stitches closing the skin at the chest region will dissolves once your skin heals. The stitches dissolve over several weeks. When you leave the hospital, your healthcare team offers instructions on how to take care of your wounds at home. Always keep the wound site clean. It is important to avoid sun exposure to the affected area for speedy healing. You can expect a scar in the area where your surgeon makes the incision as well as the place of extraction of the grafted blood vessel(s). The scar seems prominent at first, but it fades over time.

Activities After Coronary Artery Bypass

You need to follow the advice of your healthcare team regarding resuming your regular activities. You need to take it slow and wait until you recover. Avoid strenuous activity hindering your healing. In most cases, you can do light activities in the first few days after the surgery. So, the doctor permits to do the following:

  • Cooking
  • Playing indoor games like cards or board games
  • Walk for short distances
  • Lift light objects

You can do moderately strenuous activities after six weeks. So, you can perform the following after getting the all-clear from your doctor:

  • Driving
  • Vacuuming
  • Carry children
  • Mow the lawn
  • Have sex

Go To Work After The Surgery

The length of time you need off work varies from person to person. For people who are not working in a physically strenuous job, they can resume their regular job within six to eight weeks. But, people with jobs involving a lot of lifting objects or standing need to recover well before getting back to work. It is also essential to wait until you recover fully when you have experienced any complications. When you recover, it is better to build activities gradually over time. So, take time while performing activities and take rest when you feel tired.

Emotional Aspects Of Recovery After Coronary Artery Bypass

Recovering from the CABG surgery does not mean you have to get back your physical strength, but also your mental as well as emotional well-being. The pain and distress caused by the surgery can affect your mental health. You can feel depressed and suffer from the following signs:

  • Cry easily
  • Experience mood swings
  • Feel anxious
  • Fear
  • Get frustrated
  • Irritable
  • Unable to focus/concentrate
  • Have bad and good days

You feel restriction on your physical activity. It leaves you with fewer options to leave your house and get some focus back. So, you feel frustrated and emotionally vulnerable. Understand that the feelings of depression are very common among patients undergoing major surgery. It can also evoke feelings of envy when you see other people who live their lives without any physical discomfort. You tend to compare your distress due to suffering from pain with others who are healthy. Instead of feeling down, you need to take the following steps to deal with mental issues caused by the surgery:

Positive Thoughts

You have to eliminate any negative thoughts from your mind. It is important to remember that you will start feeling better in a short tie. With a little patience and proper care, you will get back to a more comfortable life than before. After undergoing the procedure, the blood starts to flow more to your heart. So, you can get rid of the stressing symptoms like shortness of breath, chest pain, and other issues.

Get Help From Family And Friends

It can be important to keep your family and friends around you during your recovery. They can go on walks with you or just sit and chat. You can ask your family or friends to put your children, grandchildren, or pets in your lap so you can feel close to them. Even though you need to be careful of your chest wound, you should continue to be affectionate with your family and friends. Affection can improve your mood and make you feel less lonely.

Deal With Depression

If you suspect depression, then make an appointment with the doctor. You need to see a doctor to deal with the condition and get treatment sooner. Depression is a mental issue that can affect your physical health. You need to see a specialized doctor (psychologist) for getting treatment for depression.

Maintaining Positive Results Of Coronary Artery Bypass Surgery

After you undergo the coronary artery bypass, you will feel better. It is because the procedure alleviates your symptoms. You can enjoy the results for as long as ten to fifteen years. But, as time progresses, it is possible that your new graft used in the bypass can become clogged or your other arteries experience similar blocks. It leads to requiring another invasive procedure or angioplasty. So, you need to make some changes in your lifestyle to enjoy the long-term outcome. Follow the instructions suggested by the doctor regarding taking medications. It is to prevent any blood clots. You also need to take steps to lower high blood pressure, cholesterol, and control diabetes. With the following lifestyle changes, your chances of positive outcomes increases:

Stop Smoking

Smoking is bad for your heart health. When you inhale cigarette smoke, it enters your bloodstream. So, it reaches the other body parts and contaminates it with the chemicals present in the smoke. So, these chemicals destruct or damage your blood vessels as well as the heart. People who have undergone CABG surgery are more vulnerable to the effects of cigarette smoke.

DASH Diet

After the surgery, try to follow a healthy diet plan like DASH (Dietary Approaches to Stop Hypertension). It is recommended by the doctor to people who want to lower their blood pressure levels. But, it is also effective in reducing the risk of heart problems. People following a DASH diet can also see weight loss and offer essential nutrients needed for your body. The diet mainly focuses on whole grains, vegetables, fruits, and lean meats. It is a healthy eating plan developed by researchers who noticed a reduction in high blood pressure in people who follow a plant-based diet.

Healthy Weight

You need to avoid the risk of further heart disease by including a healthy diet. It helps you maintain the ideal weight and avoid any issues to the heart. Here are the foods you can include and avoid to maintain the healthy weight:

Foods To Include After Coronary Artery Bypass

  • Meat
  • Eggs
  • Fish (containing omega-3 fatty acids like sardines or mackles)
  • Tofu
  • Nuts
  • Legumes
  • Wholegrains
  • Low-fat dairy
  • Healthy fats (like avocado, oils from nuts, oily fish)

Foods To Avoid After Coronary Artery Bypass

  • Sugary soft drinks
  • Excess alcohol consumption
  • Excess salt
  • Sugary foods

Achieve a healthy weight and try to maintain it by including more fruits and vegetables. Include workouts for effective weight loss.

Exercise Regularly

Include physical exercise in your daily routine. It improves blood circulation to all parts of your body and eliminates the accumulation of cholesterol in your blood vessels.

Manage Stress

Stress can worsen your condition. So, you need to release the negative energy from your body. Try to include relaxation techniques like meditation, yoga, and other techniques that help you relax. When you stop worrying about things and take it easy, your heart health improves.

Conclusion

If your doctor suggests coronary artery bypass surgery, then you need to undergo it as early as possible. After the surgery, you will feel relief from the severe signs like chest tightness, high blood pressure, or shortness of breath. It will improve the quality and quantity of your life. While the procedure increases the blood flow to your heart, you need to take some steps to prevent the disease from escalating. Make some simple yet effective lifestyle habits to prevent heart problems. So, if you want to see positive surgery outcomes that stays for a long time, then make healthy lifestyle changes. Talk to your doctor and follow the dietary as well as other changes you need to make after the surgery for lasting results.

View Article Sources
  • https://www.mayoclinic.org/tests-procedures/coronary-bypass-surgery/about/pac-20384589
  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/coronary-artery-bypass-graft-surgery
  • https://cardiacsurgery.ucsf.edu/conditions–procedures/coronary-artery-bypass-grafting-(cabg).aspx

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