Coronary artery bypass graft surgery is one of the treatment options for coronary heart disease (the cause of problems such as angina and heart attacks).
In coronary heart disease, blood flow to the heart is inadequate because one or more of the coronary arteries have become narrowed or even obstructed in parts by fatty material and thickening of the inner lining of the arteries (atherosclerosis).
The principle behind coronary artery bypass surgery is to divert blood flow around the narrowed segment of the affected coronary artery (or arteries). This is done 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: 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 blood vessel, which can be taken from the leg (the saphenous vein), the forearm (radial artery) or the chest (internal mammary artery).
The blood vessel graft is attached at one end to the aorta (the big main artery which carries blood from the heart to the rest of the body) and at the other end to the narrowed coronary artery, but downstream from the narrowed section. Blood will then flow from the aorta, through the graft and out into the coronary artery to the heart muscle.
Several coronary arteries may be bypassed in one operation, hence the terms triple bypass and quadruple bypass.
Preparing for coronary artery bypass surgery
If you smoke, you must stop. 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.
Medicines and other treatments
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.
The recovery period after surgery is about 4 to 6 weeks, although full recovery can take up to 12 weeks.
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 what you would like done (or not done) in the event of complications, and who you have nominated to help make treatment decisions for you if there are complications during or after the surgery and you cannot communicate your wishes.
Coronary artery bypass surgery: what to expect
During the operation, you may be given medicines to temporarily stop your heart beating and be connected to a heart-lung bypass machine, which takes over the job of pumping blood around the body.
A technique called ‘off-pump coronary artery bypass graft surgery’ or ‘beating heart surgery’ allows surgeons to carry out coronary artery bypass graft operations without stopping the heart and using a heart-lung bypass machine, by stabilising the part of the heart being worked on. However, not everyone is a suitable candidate for this type of surgery.
Minimally invasive direct coronary artery bypass grafting techniques, where the chest bone is not opened to reach the heart, are newer techniques that may be available for some people.
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.
You will be in hospital for about 5 to 7 days after a coronary bypass operation, although this may need to be longer. When you first arrive home do not tire yourself out by having too many visitors.
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. Avoid heavy lifting for 12 weeks after surgery. Follow the activity guidelines given to you prior to discharge from the hospital.
If a leg vein is used for the graft, 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 in the area that the graft blood vessel was taken from, which will also gradually disappear.
Physiotherapy is important and you can do much to help your recovery by practising the exercises you are taught by physiotherapists in hospital. 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; and
- advice on your gradual return to normal work and leisure activities.
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.
Some medicines may be necessary after cardiac surgery but it may eventually be possible to stop many of these. You should not change or stop taking any of your medicines without discussing this with your doctor.
It is likely you will need to continue taking some medicines long-term, such as a cholesterol-lowering medicine.
You may 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 and other activities
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, depending on individual recovery and the nature of the work. See your employer when you are feeling stronger to discuss your return to work and any work modification that may be necessary. If you do have work-related problems, your doctor may refer you to a rehabilitation officer who is trained to help in these matters.
Full household work should be possible within about 6 weeks after getting home, but be guided by your doctor.
As with other physical activity, sexual activity should be within the limits of your symptoms.
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 private vehicles, the Austroads guideline is that you should not drive until 4 weeks following coronary artery bypass surgery and when cleared by your doctor. If in doubt, discuss this with your doctor.
The operation simply relieves mechanical obstruction of the coronary arteries and it is still necessary to continue measures to prevent progress of the underlying coronary heart disease.
- Diet. You should continue eating a low-fat diet.
- Never smoke.
- Take regular physical activity. 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 physical activity 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.
- Maintain a healthy body weight. 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. Maintaining a healthy body weight is important for heart health.
- Keep stress levels low.
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 Heart Foundation branch in your area.