FAQS about your BYPASS surgery

You may need to change some aspects of your lifestyle or habits. Only you can make that decision. It make sense to reduce the risk factors of heart attack that you can control. This means…

• Don't smoke, and avoid others' tobacco smoke.
• If you have high blood pressure, keep your blood pressure below 140/90mmHg, or below 130/80mmHg if you have diabetes or kidney disease.
• Keep your blood cholesterol below 200mg/Dl and your LDL cholesterol below 100mg/Dl, or lower than 70mg/dl if indicated by your doctor, by eating less saturated fat and cholesterol, and taking cholesterol-lowering medicines (statins).
• Be physically active by gradually building up to a total of at least 30 minutes of moderate0intensity physical activity on all or most days of the week.
• Keep your weight at a healthy level. (Avoid being overweight or obese.)
• Manage diabetes (if you have it).
• Take medications as prescribed by your doctor.

FAQs ABOUT YOUR BYPASS SURGERY

What is coronary artery bypass graft (CABG) surgery?
In this surgery, arteries or veins are taken from another part of your body. These vessels are connected directly to the coronary arteries on the surface of your heart beyond the blockages. This way, blood can flow through them t bypass the narrowed or closed points. That channels more blood to the heart muscle. The arteries or veins used in the operation are expandable. Removing them doesn't significantly affect the blood flow where they're taken. Usually the arteries used are from the inside of the chest along the breastbone (internal mammary/thoracic artery). If vein is used, most often it comes from just beneath the skin on the inside of the leg (saphenous vein). Sometimes veins may be taken from the back of the legs and arms, and sometimes arteries in the abdominal cavity can be used. Rarely, a vein from a donor or an artificial blood vessel may be need. This only happens when a patient's own arteries or veins
can't be used.

Coronary Artery Bypass
Operations are usually done using a heart – lung machine. This machine makes it possible to stop the beating of the heart during surgery. Then the grafts are precisely connected to the coronary arteries.

How long should my home routine be?
Try to follow these guidelines:

• Get up at normal hour.
• Bath or shower if possible.
• Always dress in regular clothes. (Don't stay in sleeping clothes during the day!)
• Take time to rest in the mid-morning and mid-afternoon or after periods of activity.

Rest periods after activity are helpful. After activity are helpful. After a morning walk of a few blocks, take a short nap when you get home. The ability to do more comes with time, and walking is one of the healthiest and best activities.

Because of your chest incision, your doctor won't want you to lift any objects weighing five pounds or more. Ask your doctor for tips on strength training as part of your recovery after your incision has healed. You should have no problem doing any these activities helping with light work around the house; going the theater, restaurant, store or church; visiting friends; going for a ride in the car; climbing stairs. Your doctor will probably prescribe participations in a cardiac rehabilitation program that includes diet and exercise. Sticking to this program usually allows most patients to walk two or three miles a day within a few weeks after their operation. Such distances usually require outside exercise. If it's very hot or cold, try walking in an enclosed shopping mall or on a treadmill. Temperature extremes force your body to work harder. It's unwise to force yourself to walk great distances outdoors when it's too hot or cold.

Who will visit before my operation?
The surgical staff will visit to examine you, discuss the details of your operation and answer questions. The nursing staff will also evaluate your needs, make you as comfortable as possible, give you information and answer questions.  In addition, the anesthesiologist will evaluate you and discuss details related to anesthesia and plans to care for vital body functions during your operation. Other members of the technical staff may come to draw blood, insert intravenous catheters (IVs), and tell you how to breathe and care for your lungs after your operations. Someone will tell you when your operation is scheduled. Heart operations are usually scheduled in advance and begin on time. Occasionally an operation may be delayed because other patients have emergency needs. If this happens, your operation will be rescheduled as soon as possible.

What will be done before the operation?
Before your operation, much of your body hair will shave off, especially from your chest (if you're a man) and legs. You'll probably be asked to shower and wash with antiseptic soap to remove bacteria from your skin. This reduces the chance of infection. You should remove personal items such as glasses, contact lenses, dentures or detachable bridge work, watches and jewelry and give them to family members for safekeeping. You'll probably able to take usual medications on schedule, but ask your doctor first. About an hour your operation, you'll be given medications that will make you relaxed and drowsy. Attendants will wheel you to the operating room on a rolling bed. After you're in the operating room, the anesthesiologist will give you an anesthetic that brings sleep and freedom pain during the operation. Then the surgeon will operate.

RETURNING HOME

Can leaving the hospital cause mixed feelings?
It's not unusual to feel nervous or depressed about returning home. Sometimes these feelings are prompted by concerns about leaving the security of the hospital, with its expert medical team and equipment. Home care, by comparison, may seem uncertain. Have confidence that your doctor won't send you home until he or she thinks you're ready.

Should I make special plans for getting transportation home?
Patients are usually driven by their families. If you must travel by bus, train or airplane, special arrangements can be made to broad before other passengers. If needed, make arrangements for a wheelchair in advance by contacting the carrier's passenger service personnel.

What about a special diet?
The doctor, dietician or nursing staff will explain how to modify your eating style. It's wise to reduce your coronary risk factors as much you can by reducing saturated fat cholesterol and salt in your diet. It's also important to avoid being overweight. Moderation and common sense usually6 are the best guides in both eating and drinking.

What will I feel after returning home?
It's common to feel weak when you get home. A healthy college student out to bed for just one week loses about 15 percent of muscle strength. It's no surprise, then, that after a hospital stay you may feel tired and weak when trying to resume the routine of home life. Most patients complain of soreness but don't have severe pain. The soreness comes from the surgical incisions and muscle spasms. Often good posture and moving your arms and shoulder will help this. If you have severe pain, the nurse will give you medicine if you ask seldom lasts more than three days.

Why are tubes and wires connected to my body?
After your surgery, you'll have tubes and wires attached to parts of your body. They provide for safe, efficient recovery. IVs, which are small tubes, will be in place, usually in your arm. They're used to help the hospital staff give you drugs and fluids, withdraw blood samples and continuously monitor your blood pressure. One or more tubes in your chest will drain off fluid that usually accumulates during and after the operation. Small patches or electrodes on your chest are attached to an oscilloscope. They let the nursing staff monitor the ECG for the heart rhythm and rate.
Small wires may be attached to your lower chest. They permit pacing of your heart, if need. A breathing tube (endotracheal tube) in your mouth goes by your vocal chords into your windpipe. It won't hurt but will keep you from talking. The nurse will help you other ways to communicate. The breathing tube will be removed when you no longer need help breathing. It's usually taken out within 24 hours after the operation. What should I expect in the ICU? It's hard to keep track of time in an area where the lights are on 24 hours a day and where there's constant activity. Consequently, you may become disoriented and confused, particularly at night. Pain medicines also may make you feel confused, temporary confusion isn't serious and will go away within a day or two after you're moved to a quieter, less-intensive nursing unit. As you're able to rest, normal patterns of sleep, wakefulness and thought processes will return.

How long will the operation last?
Bypass surgery usually lasts from three to six hours. The length of time depends upon what has to be done. The doctor can estimate how long your operation may last, but the actual time could be different.

What arrangements can be made for my family during operation?
Hospitals have places where your family and friends can wait during surgery. Be sure the surgeon knows where to reach them when your surgeon is over.

AFTER YOUR OPERATION

Where will I go after my operation?
You'll be taken to a recovery area or intensive care unit (ICU). Here you'll regain consciousness after the anesthetic wears off. You may not be able to move your legs or arms when you first wake up, but in a short time your body and mind will again coordinated.

How soon after my operation may my family visit?
Your family may visit briefly in the recovery room or ICU within an hour or two after your operation. You'll probably still be asleep then.

Will I have pain?
You'll have some discomfort where the incision was made to reach your heart. Usually there will be one or more incisions in your leg if a vein was removed to use for the bypass. These incisions also may hurt. You'll be given medication to relieve pain. The hailing of your incisions takes a tremendous amount of energy. That also depletes body strength. This demand for energy drops significantly about three to four weeks after the operation. Exercising is a good way to regain your strength. Walking is especially beneficial after bypass surgery.

Is depression normal?
Depression is common in patients when they first return to home.  The emotional letdown after any operation may cause such feelings. Progress may not seem fast enough, and time may seem to stand still. The best way to work through depression is to be physically active and talk about it with spouse, family or close friends. Family members should be careful not to add to the depression. Patients and their families also commonly feel angry and frustrated. These feelings usually subside as people resume their normal activities.

What medicine should I take?
Only take medicines your doctors have prescribed for you. Don't keep taking medicines you took before the operation unless they're specifically prescribed. Don't even use over-the-counter (non-prescription) drugs like aspirin or ibuprofen without first asking your doctor.

When I should contact my doctor?

Call your doctor if you have any sign of infection (redness or damage at the incision), fever, chills, increased fatigue, shortness of breath, swollen ankles, weight gain or five pounds in a few days, change in heart rate or rhythm, or any other sign of symptom that seems unusual.

What will help my recovery?
Deep breathing exercises and coughing are important to help speed and recovery. Coughing reduces the chances of pneumonia and fever and won't harm the incision or bypass grafts. Most patients are afraid of pain or discomfort and don't like to cough after an operation. Still, coughing is essential. You may find it easier to cough if your chest is supported by a pillow, you also can help your recovery by changing positions in bed often.

Is one position better than another for sleeping?
It's best to try to lie on your side at least part of the time, moving every few hours if you can. Lying on your back for a long time isn't good for your lungs.

When can I eat and drink?
Once your breathing tube is removed you'll be able to swallow liquids. How quickly you can progress from liquids to a regular diet depends on your own digestive system.

When can I get out of bed?
You may get out of a bed and sit in a chair or walk around the room as soon as you can, usually within a day or two. Later you can take short walks in the hall. Eventually you can climb stairs and take brisk. Longer walks to prepare for going home.

What about bathing?
You can have sponge baths right away. In a few days you'll be allowed to have a shower and shampoo.

What about the healing of my incisions?
Soon after your operation, your chest wound will be exposed to the air. That lets it dry and begins to heal. After a few days, washing it with soap and water is a good idea.  The number and length of leg incisions varies from patient to patient. It depends on how many vein grafts the surgeon must make.  Some patients have an incision in just one leg while others have incisions in both. Later these incisions will be washed gently with soap and water.  Your ankles may swell. You may also feel a burning sensation when standing up on the leg where the graft was taken. Elastic support stockings help circulation and reduce swelling. Walking helps blood circulate in your leg and also helps your heart. External stitches or staples will remove from your chest about a week after your operation. A few days after later they'll be removed from your legs. If strips of tape are placed over an incision that's been closed by absorbable stitches under the skin, the strips should stay on from about as long as regular stitches since these tapes are a substitute for stitches). These wounds require about six weeks to heal completely. It's smart to avoid lifting heavy objects during this time. The wound color will gradually change from purple to red to pink, returning to normal after several months.

How long will stay in the hospital?
The usual hospital stay after bypass surgery averages about four to six days, but it depends on whether there are other complications. During that period, and beyond, most patients have “good days” and “bad days” with overall progress and gain in strength.

PREPARING FOR SURGERY
It's natural to feel anxious once you've made the decision to have coronary artery bypass graft surgery. You may feel less worried once you understand why you need the operation, meet the members of your medical team and have your questions answered vary, so be   sure to find out about blood donations, visiting hours, conferences with doctors, etc.

When will I be admitted to the hospital?
You may e admitted before your operation date so diagnostic tests can be done. These routinely include blood and urine tests, a graphic record of electrical impulses produced by the heart (an electrocardiogram, often shortened to ECG or EKG), chest X-ray and other test and procedures. Cardiac catheterization with coronary angiograms is due at this time unless it's been done before. (A cardiac catheterization is the process of examining the heart by introducing a thin tube [catheter] into a vein or artery and passing it into the heart. An angiogram is a series of X-ray pictures made of the blood vessels or the hearts chambers by tracing a special dye that's been injected into the bloodstream). If these tests have already been done, you be admitted directly for the operation.

What about sexual relations?
You may resume sexual relations when you feel ready. If you have questions, ask your doctor.

Will I be able to drive?
You may begin driving any time you feel physically able to operate the vehicle safely. It's usually best to wait a few weeks after leaving the hospital before you try to drive.

When should I schedule returns appointments to see the doctor?
Routines for postoperative visits vary depending on a patient’s needs and the wishes of each doctor. Patients usually are advised about future appointments when they're discharged from the hospital. Make an appointment with your personal or family physician soon after returning to home.

What about dental treatment?

You won't need any special precautions during dental treatment unless you also have coumadin or persantine, be sure to tell you dentist.

PLANNING FOR THE FUTURE

What changes should I make in my lifestyle?
Bypass surgery is done to restore a person to and active and full life. This includes making it possible to have a sense of well-being, returning to work or active retirement, be physically active, enjoy hobbies, etc.

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

CARDIAC AND PERIPHERAL VASCULAR CENTER
Tel. no. (632) 988-1000 / (632) 988-7000 ext. 6299 / 6243

CENTER FOR PATIENT PARTNERSHIP
Tel. no. (632) 988-1000 / (632) 988-7000 ext. 6444