General Information
DEFINITION--Using a section of the patient's leg vein to bypass a partial or
complete blockage in the coronary-artery system.
BODY PARTS INVOLVED--Heart; coronary arteries; chest wall; large veins of legs.
REASONS FOR SURGERY
- Angina pectoris.
- Restoration of blood to the heart muscle after a heart attack.
- Prevention of a possible heart attack, if coronary arteries have narrowed.
SURGICAL RISK INCREASES WITH
- Obesity; smoking.
- Recent or chronic illness such as: severe heart attack; high blood pressure; thyroid
disease; or diabetes mellitus.
- Chronic obstructive pulmonary disease (COPD).
What To Expect
WHO OPERATES--Cardiovascular surgeon.
WHERE PERFORMED--Hospital.
DIAGNOSTIC TESTS
- Before surgery: Blood studies; chest x-ray; cardiac catheterization; ECG; sonogram (See Glossary for all).
- During surgery: ECG; angiograms (See Glossary).
- After surgery: ECG; chest x-ray; sonogram.
ANESTHESIA--General anesthesia by injection and inhalation with an airway tube
placed in the windpipe. Breathing is performed for the patient by the anesthetist's
machines.
DESCRIPTION OF OPERATION
- A section of the patient's large leg vein is removed and set aside to be used as the
bypass vein graft. If a mammary artery (located in the chest) is used, no surgery is done
on the leg.
- An incision is made through the breastbone, and the chest is spread open to expose the
heart.
- The heart is stopped with a chemical solution that temporarily paralyzes the heart
muscle fibers and the heart's temperature is reduced. Circulation is performed by a
heart-lung machine.
- The bypass vein graft is sutured in place to allow blood flow to resume beyond the
blocked area.
- After reheating the heart, it is given a mild electric shock that causes heartbeat to
resume.
- The breastbone edges are rejoined with metal suture material, and muscles, tissue and
skin are closed with lighter sutures.
POSSIBLE COMPLICATIONS
- Heart rhythm abnormalities.
- Excessive bleeding.
- Infection; kidney failure.
- New area of injury to the heart muscle; stroke.
AVERAGE HOSPITAL STAY--6-10 days.
PROBABLE OUTCOME--Angina pectoris is cured in almost all cases. Probability of
future heart attacks is reduced. Allow about 6 weeks for recovery from surgery.
Postoperative Care
† Move and elevate legs frequently while resting in bed to decrease the
likelihood of deep--vein blood clots.
MEDICATION---
† To help recovery and aid your well--
being, resume daily activities, including work, as soon as you are able.
- Resume driving 1 month after returning home. > Resume sexual relations when your
doctor determines that healing is complete. > Ask your doctor for advice about an
exercise rehabilitation program.
DIET--Low-salt; low-fat; high--fiber (see Appendix for diets).
Call Your Doctor If
† Pain, swelling, redness, drainage or bleeding increases in the surgical area.
- You develop signs of infection: headache, muscle aches, dizziness or a general ill
feeling and fever.
- You experience new symptoms, such as a cough, heartbeat irregularities, leg pain or
constipation.
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