Coronary artery surgery
This information is for those who have been recommended to have an operation for coronary artery disease. Your doctor will have explained why you may need this and what is involved, but this may help you to understand things better.
If you are still uncertain what it is all about, or if there are any problems worrying you, do not hesitate to ask your doctor about them.
How can surgery help in the treatment of angina?
Angina, or heart pain, occurs when insufficient blood reaches the heart muscle at times when it is working hard, such as during exercise or excitement. In coronary artery disease, the reason that this blood flow is inadequate is that the arteries have become narrowed or even obstructed in parts by fatty material and thickening of the inner lining of the arteries.
This process, called atherosclerosis, has developed gradually over many years and, in those who have troublesome angina, more than one branch of the coronary arteries is usually affected.
The principle behind surgical treatment is to bypass a narrowed segment of the artery using a vein or artery graft, which provides a new channel through which blood can flow. The improved blood flow will achieve the main objective of the operation, which is the relief of angina and the prevention of a heart attack.
What is a coronary artery graft?
The graft is usually a small length of vein, which is taken from the leg (the saphenous vein) and joined from the aorta (the big main artery which carries blood from the heart to the rest of the body) to one of the branches of the coronary arteries beyond the narrowed region. Blood will then flow from the aorta, through the vein graft, which is now acting as an artery, and out into the coronary artery to the heart muscle. Several grafts may be necessary to bypass the narrowings which may be present.
A small length of an artery can also be used for the graft instead of a vein. The one chosen is usually the internal mammary artery, which runs behind the breastbone and can readily be spared for grafting purposes. Other arteries running nearby can adequately supply blood to the breastbone area.
Preparing for your operation
There are a few routine investigations you need to have done as preparation for your surgery. These include an ECG (electrocardiogram), chest X-ray, and blood test.
Smoking
If you smoke, you must stop TODAY. Surgeons are very reluctant to operate on those who continue to smoke because of the associated breathing complications after surgery and high risks to life.
It is just as important not to start again after your operation because of overall health risks. You may also block off the new grafts and develop further narrowing in your coronary arteries.
The anaesthetist and surgeon
The anaesthetist and surgeon will see you prior to surgery. The surgeon will explain your operation and provide the opportunity to ask any questions you might have. Members of your family can see the surgeon prior to surgery by making an appointment. Make sure your doctors know all of the medications you are taking, including those you take regularly, those taken on an as-needed basis, both prescription and over-the-counter preparations, and any herbs, supplements and other complementary or alternative therapies.
Business and legal issues
The recovery period after surgery is about 2 to 3 months. Therefore, it is necessary to tidy up any business or legal problems, which could be a worry to you in hospital.
You should inform your employer that you intend to return to work within 6 to 12 weeks and arrange sick leave entitlement accordingly.
You may wish to discuss with your doctor whom you would like to help make treatment decisions for you if there are complications during or after the surgery and you cannot communicate your wishes, or what you would like done (or not done) in the event of complications.
Accommodation for relatives
Cardiac surgical units try to help with accommodation or other social, emotional or practical problems which may arise when patients have major surgery away from their home town.
If you need help, you should contact the social work department of the hospital concerned.
What about the operation itself: what should I expect?
In the past for the surgeon to operate, your heart needed to be stopped for a while and a heart-lung machine would take over the job of pumping blood around the body. Now, however, a new technique called ‘beating heart surgery’ allows surgeons to carry out some bypass operations without stopping the heart, by stabilising the part of the heart being worked on. Not everyone is a suitable candidate for this type of surgery, however.
Regardless of the method used, after the operation, you will be closely monitored in the intensive care unit for about 24 hours. Staff caring for you during this time are highly skilled at attending to your needs.
Physiotherapy
Physiotherapy is important and you can do much to help your recovery by practising the exercises you are taught. Physiotherapists will assist you with:
- breathing and coughing exercises to improve lung function;
- early mobilisation and walking;
- advice on a walking/exercise programme to improve your fitness on discharge; and
- advice on your gradual return to normal work and leisure activities.
The recovery process
You will be in hospital for about 5 to 7 days after the operation, although this may need to be longer. When you first arrive home do not tire yourself out by having too many visitors.
You should continue your exercises when you leave hospital as this will help to relieve the aches and pains in your chest wall and shoulders.
It takes at least 6 weeks for the bones in your chest to heal so you should expect some discomfort for that time. You should work to a plan of gradually increasing daily activities, particularly walking. Follow the activity guidelines given to you prior to discharge from the hospital.
Your leg may have quite a long scar on it and it may need a dressing until it is well healed. If there is any swelling, you should rest with the leg elevated for an hour or 2 and wear an elastic stocking. The tissue beneath the scar may feel hard and tender but ultimately will loosen and become soft. There is often some numbness and tingling, which will also gradually disappear.
What about medication?
Some medications may be necessary after cardiac surgery but it may eventually be possible to stop most of these. You should not change or stop taking any of your tablets without discussing this with your doctor. It is likely you will need to continue taking tablets long-term to lower blood pressure and cholesterol and reduce the risk of further blockages developing.
Follow-up arrangements
You must have regular medical supervision and maintain contact with your own family doctor and your cardiologist or physician. A follow-up appointment about 6 weeks post-surgery (discharge) will be arranged with the cardiologist who referred you for surgery.
If you do not receive an appointment within 6 weeks, please contact the cardiology department at the hospital where you were treated. Three months after surgery, arrange with your doctor to have a blood cholesterol check. It is important to have regular checks.
Returning home
Many patients feel a little anxious and depressed about leaving the security of a hospital to go home. This is quite normal after an operation. The best way to get over this is to talk about it with your close family members or friends. Partners may also experience similar concerns.
If these feelings continue, it is important to discuss them with your doctor.
Returning to work
The aim should be to return to work within 6 to 10 weeks after surgery. Some people will achieve this earlier and others may require longer. See your employer when you are feeling stronger to discuss your return to work and any work modification that may be necessary. Full household work should be possible within about 6 weeks after getting home, but be guided by your doctor.
If you do have work-related problems, your doctor may refer you to a rehabilitation officer who is trained to help in these matters.
Any other points?
Austroads, the association of Australian and New Zealand road transport and traffic authorities publishes Assessing Fitness to Drive, the latest national guidelines and standards for assessing a person's fitness to drive.
For drivers of cars, light trucks and motorcycles, the Austroads guideline is that you should not drive until 4 weeks following surgery and when cleared by your doctor. If in doubt, discuss this with your doctor or cardiologist.
Similarly, the Cardiac Society of Australia and New Zealand guidelines (2002) state that a person may be fit to drive 4 weeks after coronary artery bypass grafting if there is no angina on mild exertion, no pain which would interfere with driving and no abnormal heart rhythms or other conditions which would make the person unfit to drive.
Will I have to change my lifestyle?
The operation simply relieves mechanical obstruction of the coronary arteries and it is still necessary to continue measures to prevent progress of the underlying disease. You should continue eating a low fat diet and certainly cigarettes are out.
You should also be able to do more exercise than before: in particular, try walking regularly. You should avoid really strenuous sporting activities such as squash or vigorous tennis singles. Talk to your doctor about the type of exercise you can do safely: golf and tennis doubles should be no problem, and jogging is also permissible provided you train up to it gradually and in consultation with your doctor.
You will probably lose weight during the period of your operation, but be careful that you do not regain excessive weight during your recovery period.
As with other physical activity, sexual activity should be within the limits of your symptoms. It uses about as much energy as climbing 2 flights of stairs, although less strenuous methods of love-making, such as the unwell person underneath or lying side-by-side, may be best.
Goals for life
- Not smoking.
- Eating a low fat, low salt diet.
- Taking regular physical activity.
- Maintaining a healthy body weight.
- Keeping stress levels low.
Cardiac rehabilitation
Cardiac rehabilitation programmes offer you and your family information and support on a variety of cardiac related subjects to help you in your recovery. Contact nursing staff prior to discharge, your doctor, or the National Heart Foundation branch in your area.
Last Reviewed: 07 September 2009
Sponsored links
