Patient education: Recovery after coronary artery bypass graft surgery (The Basics)

What is coronary artery bypass graft surgery? — This is a type of surgery that is used to treat coronary heart disease. It is also known as "bypass surgery." Doctors also call this surgery "CABG" (pronounced "cabbage").

In people who have coronary heart disease, the arteries that supply blood to the heart get clogged with fatty deposits (figure 1). This can block the flow of blood to parts of the heart muscle.

During bypass surgery, a surgeon uses healthy pieces of blood vessels from other parts of the body (called grafts) to re-route blood. They do this by attaching a graft to the aorta, which is the largest blood vessel in the body, and then to a place below a blockage. This creates a way around the blockage. Sometimes, the surgeon redirects an artery that is supposed to supply the chest muscle and attaches it to the heart. These types of grafts allow blood to get past blockages and to the heart muscle that was not getting enough blood (figure 2).

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

For the first 24 hours after surgery:

●Do not drive or operate heavy or dangerous machinery.

●Do not make any important decisions or sign any important papers.

●Do not drink alcohol of any kind.

You should also:

●Take all of your medicines as instructed.

•Most people need to take at least 2 heart medicines every day. Doctors can prescribe different types of heart medicines. The medicines can help you live longer and prevent blockages in your blood vessels from getting worse. Some also help treat chest pain and other heart symptoms.

•If you have high blood pressure, high cholesterol, or diabetes, your doctor will likely prescribe medicines to treat those conditions.

●Take care of your incisions – You might have stitches, skin staples, surgical glue, or a special skin tape on your incisions.

•Keep your incisions dry and covered with a bandage for the first 1 to 2 days after surgery. Your doctor or nurse will tell you exactly how long to keep your incisions dry.

•Once you no longer need to keep your incisions dry, gently wash them with soap and water whenever you take a shower. Do not put your incisions underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incisions, pat them dry. Your doctor or nurse will tell you if you need to put an antibiotic ointment on the incisions. They will also tell you if you need to cover your incisions with a bandage or gauze.

•Always wash your hands before and after you touch your incisions or bandage.

●Increase your activity slowly – Start with short walks around your home, and walk a little more each day.

●Eat when you are hungry – If you have an upset stomach, it might help to start with clear liquids and foods that are easy to digest, like soup, pudding, toast, or eggs. You can eat other types of foods when you feel ready. If your doctor or nurse gave you specific instructions about what to eat or avoid, follow them.

●Use a stool softener to help prevent constipation, if needed. This is a common problem if you take opioid pain medicines. Follow all instructions for taking your pain medicines.

●Avoid heavy lifting, sports, and swimming for at least a week or 2. Your doctor or nurse will tell you exactly how long to avoid these or other activities, including:

•Driving – Your doctor might not want you to drive again until your chest has healed from your surgery.

•Sex – Check with your doctor about when it is safe to start having sex again. If you had a heart attack, the timing will depend on your heart attack and if you still have symptoms.

After CABG, some people are less interested in sex or do not enjoy sex as much. This can be a side effect of certain heart medicines. It can also happen if people are sad or worried about having a heart attack during sex. If you have problems with sex, tell your doctor or nurse. They might be able to treat those problems.

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments.

If you have stitches or staples, you will need to have them taken out. Your doctor will usually want to do this in 1 to 2 weeks. Some stitches absorb on their own and do not need to be removed. If the doctor used skin glue or skin tape, it will fall off on its own. Do not pick at it or try to remove it yourself.

Once you have recovered from surgery, your doctor will make a treatment plan with you. The goals of this plan are to:

●Treat your coronary heart disease – Even after CABG, some of your heart's blood vessels can still have areas that are narrow (figure 1). Also, your heart muscle might have been damaged before CABG. Your doctor's plan can help lower the chances that these problems will affect your life in the future.

●Help you feel better and have more energy

What is cardiac rehab? — Your doctor might recommend something called "cardiac rehabilitation." This is also called "cardiac rehab." At cardiac rehab, doctors, nurses, and other health professionals teach you how to keep your heart healthy. They will help you:

●Exercise safely – Getting regular exercise can help keep your heart healthy. Your doctor or nurse will work with you to make a safe exercise program. They will tell you how often and how hard to exercise.

Each time you exercise, warm up for 5 to 10 minutes first. Then, you can do "aerobic exercise" for at least 20 minutes. Aerobic exercise raises your heart rate and includes activities such as walking, swimming, and jogging. After you work out, cool down for 5 to 10 minutes.

●Improve your diet – Eating the right foods can help keep your heart healthy. Fruits, vegetables, and foods with fiber can help prevent heart disease and strokes (figure 3). Try to avoid eating foods that can make heart disease worse. These include "trans" fats, which are found in many fast foods. "Saturated" fats, which are found in red meats and many cheeses, can also worsen heart disease. Eating a healthy diet also means limiting white sugar.

●Lose weight, if you have excess body weight.

●Quit smoking, if you smoke – Stopping smoking can lower your chance of getting or dying from heart disease. To quit, you can try nicotine patches, gum, or nasal sprays. (Nicotine is the main drug in cigarettes.) You can also try a prescription medicine to help stop cigarette cravings.

●Cope with feeling sad or worried – Many people feel sad or worried after CABG. Your doctor, nurse, or counselor can help you with these feelings and, if needed, treat your depression.

●Reduce stress – Stress can worsen heart disease.

When should I call the doctor? — Watch for chest pain or symptoms of a heart attack (figure 4). But it is uncommon for people to have a heart attack in the months after CABG.

If you think that you might be having a heart attack, call for an ambulance right away (in the US and Canada, call 9-1-1). Do not try to get to the hospital on your own.

It's also important to watch for signs of an infection, especially during the first 2 weeks after your surgery. Call your doctor or nurse right away if you have:

●Fever higher than 100.4°F (38°C)

●New pain or pain that is worse in your chest or around your chest wound

●Very fast heartbeat

●A wound that is bleeding, draining pus, or has redness around it

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