As you get ready for coronary artery bypass graft (CABG) surgery, it may be helpful to know what to expect both before and after your procedure.
Preparing for your procedure
To prepare for your surgery, you’ll first meet with your surgeon to discuss your medical history, the medications you take and any questions you have.
You also may need some tests to help your surgeon precisely plan your procedure, and be alert to any special considerations for your heart and your health status.
Tests you may have before bypass surgery include:
- Chest X-ray – This image of the heart and lungs includes blood vessels, ribs and bones of the spine.
- Electrocardiogram (EKG/ECG) – This test records the electrical activity of the heart. It can tell you if your heart is beating normally or if there are areas of the heart that aren’t working properly.
- Cardiac catheterization – This procedure helps visualize inside coronary arteries to look for problem areas. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
- Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves. The valves are checked for stenosis (stiffness or tightness) and regurgitation (leakage). These conditions may be able to be fixed during your surgery.
The diseases that cause coronary artery disease—atherosclerosis and arteriosclerosis—often affect other arteries in the body.
If your physician hears signs of abnormal blood flow in your carotid arteries (the arteries in your neck that bring blood to your brain), then an echocardiogram or CT angiogram of these arteries may be performed. They may also do these tests if your heart disease is particularly severe or if you’ve had a stroke or a mini-stroke (called transient ischemic attack, or TIA).
If you have a lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema, you may need a pulmonary function test to determine whether your lungs are strong enough to tolerate surgery. This test also can help determine if your symptoms are related to your lung disease or to your heart disease.
After your procedure
After bypass surgery, you’ll require intensive nursing care for the first 24 hours. Your family can visit but may be asked to leave the room at times.
You may be on a machine called a ventilator to help you breathe. You’re on the ventilator until you wake up from anesthesia and are breathing well on your own. Most patients are on the ventilator for only a few hours after surgery, until they wake up and are alert and strong enough to breathe on their own. If you’re awakening and the breathing tube is not yet ready to come out, you receive pain medication and additional sedation to keep you comfortable. Nurses are at your bedside constantly as you awaken. They’ll monitor your comfort and administer medications.
You’re connected to monitors and tubes after surgery, including a heart monitor, blood pressure monitor and catheter in your bladder to drain your urine.
After the ventilator is removed, your health care team helps you use a breathing exercise device every hour while you’re awake. It’s important to cough and breathe deeply to prevent congestion and lung problems. Tell a member of your health care team if you have pain. Your comfort is important, and it affects your breathing. The better you’re breathing, the quicker you’ll recover.
The day after surgery
You continue to be on a heart monitor and oxygen monitor. Your health care team helps you sit in a chair. Increasing activity helps your lungs and bowels regain normal function. As soon as the breathing tube is out, you’re encouraged to drink and eat as soon as possible. It’s a normal side effect of the anesthesia wearing off to feel nauseated or to not want to eat. Narcotic pain medication also can upset your stomach.
Two days after surgery
You begin to walk short distances in the room and out in the hall, assisted by members of your health care team. Walking is one of the most important things you can do to promote your recovery. It helps expand your lungs and prevents congestion. You should walk at least two to three times each day.
Days three, four and five after surgery
You continue to walk in the hallways several times a day, gradually increasing the distance you walk.
It’s not uncommon to feel a little swollen or bloated with fluid after heart surgery. Your surgeon may prescribe a water pill to help your body get rid of the extra fluid.
Continue walking in the hall at least two to three times each day. Try to extend the distance you walk each time you’re out of bed.
Typically, you stay in the hospital for four to six days after surgery. You’re discharged when you can eat regular foods, have had a bowel movement, can walk in the hallways, have a normal temperature, and tubes and monitors have been removed. If you don’t feel strong enough to go home or feel that you need more time for recovery, then you may need a short stay in a rehabilitation facility. Your health care team can help decide if this is recommended in your case.