Cardiac Surgery - coronary artery bypass

The purpose of coronary artery bypass surgery is to improve the blood supply to an area of the heart that has been deprived of adequate circulation.

How bypass surgery is done

Coronary bypass surgery is actually a combination of two surgical procedures that are performed simultaneously. One incision is made in the leg to remove a vein which will be used as a graft to create a new coronary artery. A second incision is then made in the chest to enable the surgeon to reach the heart.

Sometimes more than one coronary artery is blocked, and it is necessary to insert more than one graft. The terms double bypass, triple bypass, and quadruple bypass indicate how many grafts are required.

The graft is usually taken from the saphenous vein in the leg or the internal mammary vein. Since the legs and arms have numerous other blood vessels, these veins are not missed, and circulation remains good after surgery. The length and number of incisions depend on how many bypasses are needed. Coronary artery bypass surgery generally takes three to six hours, depending on how many bypasses are needed.

What cardiac surgery patients can expect

Many patients are admitted to hospital for one to three days prior to the operation. Once hospitalised, patients will be given a Betadine bath and hair wash.

After midnight, or the day before surgery, you will not be allowed to eat or drink anything. An hour before surgery you will be given medication to make you relaxed and drowsy - once you are in the operating theatre, you receive a general anaesthetic.

After surgery you will spend one to two days in the intensive care unit, so you can be monitored closely. Don't be alarmed by the tubes, wires and equipment connected to your body - this is completely normal following heart surgery. Equipment in this case will include an electrocardiogram (ECG) to monitor your heart, chest tubes to drain fluid from your heart, a breathing tube to help you breathe, urinary catheter to drain urine from your bladder and an intravenous (IV) tube in your neck. Each of these will be removed as you regain consciousness.

You won't be able to talk because of the breathing tube so a nurse will show you other ways of communicating. This tube will remain in place for approximately six hours, or as soon as the effects of the anaesthetic have passed and you can breathe on your own.

For the first few days, most patients experience moderate pain and tenderness around the areas of the incisions. Inform the nurse if you experience pain becomes too intense, and you will receive medication to make you more comfortable.

Once the breathing tube is removed, you will start with breathing and coughing exercises and will be given oxygen via a mask. Doing these exercises helps clear your lungs and prevents infections such as pneumonia. Because you are sore, this may be uncomfortable at first, but is very important to ensure a speedy recovery.

Valve surgery patients

Valve surgery patients will need four to five days bed rest after the operation, and will then be allowed to sit up in a chair. You will receive a bed bath daily, and your back will be rubbed frequently. It is very important that you do your breathing and leg exercises as demonstrated by your physiotherapist.

Do not be disillusioned if your progress seems to be slow, recovery from valve surgery takes time and you need to be patient.

Your exercise programme differs from that of bypass patients. Exercises are to be restricted and taken at a much slower pace.

Bypass surgery patients

Bypass patients will probably start getting out of bed on the second or third day after surgery. This may be very tiring at first, but your strength will improve and you will find that you can walk a little further each day.

Patient care

For ten weeks after surgery remember to support your chest when coughing, sitting up, moving about in bed, and when rising from a chair. You should remain on your back when lying in bed. Coughing does not affect the stitches or bypass graft. You may feel depressed on the fourth day and two weeks later. You may also experience memory lapses, hallucinations and lose track of time and which day it is - don't be alarmed as all these symptoms are common and also temporary.

Standing or walking may produce a slight burning sensation in the leg where the graft was taken and your ankle may also swell. These symptoms will gradually disappear. Elastic support stockings help decrease the swelling, and foot and ankle exercises, together with walking, help the circulation in your legs and hasten the healing process. Stockings must be worn for five weeks after the operation. Elevate your legs when sitting. Stockings should be removed at night and washed for use the following day.

A slight fever is not unusual after bypass surgery. You will be given aspirin or an aspirin substitute for three to four days until your temperature returns to normal.

Wound care

You may shower on the fourth day and your suture line will be painted with Betadine or Mercurochrome twice a day. These wounds are left exposed.

Weight monitoring

Today most surgeons use stitches that dissolve. If you have regular stitches or staples they will be removed from your chest and leg ten to fourteen days after surgery.

We do monitor your weight daily as fluid retention can occur. Your bowel movements will normalise as you become more mobile. In the meantime eat extra fibre to compensate.

Visitors

As you tire easily after heart surgery, we strongly recommend that visitors are restricted to two people per visit.