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CORONARY-ARTERY BYPASS GRAFT

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---

    Your doctor may prescribe:

  • Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Antiarrhythmics to prevent heartbeat irregularities. > Digitalis to strengthen the heart muscle. > Anticoagulants to decrease the likelihood of blood clots.

† 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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