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What is
coronary
artery
bypass
surgery?
This is a
type of
heart
surgery.
It's
sometimes
called CABG
("cabbage").
The surgery
reroutes, or
"bypasses,"
blood around
clogged
arteries to
improve
blood flow
and oxygen
to the
heart.
Why is
this surgery
done?
The arteries
that bring
blood to the
heart muscle
(coronary
arteries)
can become
clogged by
plaque (a
buildup of
fat,
cholesterol
and other
substances).
This can
slow or stop
blood flow
through the
heart's
blood
vessels,
leading to
chest pain
or a heart
attack.
Increasing
blood flow
to the heart
muscle can
relieve
chest pain
and reduce
the risk of
heart
attack.
How is
coronary
bypass done?
Surgeons
take a
segment of a
healthy
blood vessel
from another
part of the
body and
make a
detour
around the
blocked part
of the
coronary
artery.
* An artery
may be
detached
from the
chest wall
and the open
end attached
to the
coronary
artery below
the blocked
area.
* A piece of
a long vein
in your leg
may be
taken. One
end is sewn
onto the
large artery
leaving your
heart—the
aorta. The
other end of
the vein is
attached or
"grafted" to
the coronary
artery below
the blocked
area.
* Either
way, blood
can use this
new path to
flow freely
to the heart
muscle.
A patient
may undergo
one, two,
three or
more bypass
grafts,
depending on
how many
coronary
arteries are
blocked.
Cardiopulmonary
bypass with
a pump
oxygenator
(heart-lung
machine) is
used for
most
coronary
bypass graft
operations.
This means
that besides
the surgeon,
cardiac
anesthesiologist
and surgical
nurse, a
competent
perfusionist
(blood flow
specialist)
is required.
During the
past several
years, more
surgeons
have started
performing
off-pump
coronary
artery
bypass
surgery
(OPCAB). In
it, the
heart
continues
beating
while the
bypass graft
is sewn in
place. In
some
patients,
OPCAB may
reduce
intraoperative
bleeding
(and the
need for
blood
transfusion),
renal
complications
and
postoperative
neurological
deficits
(problems
after
surgery).
What
happens
after bypass
surgery?
After
surgery, the
patient is
moved to a
hospital bed
in the
cardiac
surgical
intensive
care unit.
Heart rate
and blood
pressure
monitoring
devices
continuously
monitor the
patient for
12 to 24
hours.
Family
members can
visit
periodically.
Medications
that
regulate
circulation
and blood
pressure may
be given
through the
I.V.
(intravenously).
A breathing
tube
(endotracheal
tube) will
stay in
place until
the
physicians
are
confident
that the
patient is
awake and
ready to
breathe
comfortably
on his or
her own.
The patient
may feel
groggy and
disoriented,
and sites of
incisions —
both the
chest and
the leg, if
a segment of
blood vessel
was taken
from the leg
— may be
sore.
Painkillers
are given as
needed.
Patients
usually stay
in the
hospital at
least three
to five days
and
sometimes
longer.
During this
time, some
tests will
be done to
assess and
monitor the
patient's
condition.
After
release from
the
hospital,
the patient
may
experience
side effects
such as:
* Loss of
appetite,
constipation
* Swelling
in the area
from which
the segment
of blood
vessel was
removed
* Fatigue,
mood swings,
feelings of
depression,
difficulty
sleeping
* Muscle
pain or
tightness in
the
shoulders
and upper
back
Many of
these side
effects
usually
disappear in
four to six
weeks, but a
full
recovery may
take a few
months or
more. The
patient is
usually
enrolled in
a
physician-supervised
program of
cardiac
rehabilitation.
This program
teaches
stress
management
techniques
and other
important
lessons
(e.g., about
diet and
exercise)
and helps
people
rebuild
their
strength and
confidence.
Patients are
often
advised to
eat less fat
and
cholesterol
walk or do
other
physical
activity to
help regain
strength.
Doctors also
often
recommend
following a
home routine
of
increasing
activity —
doing light
housework,
going out,
visiting
friends,
climbing
stairs. The
goal is to
return to a
normal,
active
lifestyle.
Most people
with
sedentary
office jobs
can return
to work in
four to six
weeks. Those
with
physically
demanding
jobs will
have to wait
longer. In
some cases
they may
have to find
other
employment. |
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