CABG (CORONARY ARTERY BYPASS GRAFTING)
What are the coronary arteries?
The coronary arteries carry blood and oxygen to the heart muscle. In people with coronary artery disease a fatty substance builds up in the walls of the arteries, making the space inside narrower. This makes it harder for the blood to pass through.
If the arteries become narrowed then the amount of oxygen delivered to the heart muscle may be reduced. This can cause chest pain, or other symptoms called angina, or lead to a heart attack.
What is a CABG?
The purpose of Coronary Artery Bypass Grafting (CABG) is to improve the flow of blood to the heart muscle. The surgeon uses sections of healthy vein or artery from the patient’s own arm, leg or chest wall to go beyond (bypass) the narrowed segments of coronary artery and restore normal blood flow to the heart.
The benefits of CABG surgery vary from person to person but can include:
• Reducing your angina
• Reducing the amount of medication you are taking
• Generally make you feel better
• Increase your chance of living longer
Bypass surgery cannot cure your coronary artery disease. It is possible to get new blockages. You can reduce this risk by stopping smoking, taking the tablets your consultant prescribes, adopting a healthy diet and exercising regularly.
WHAT TO EXPECT AFTER THE OPERATION
You should expect to have a scar running lengthways from your breastbone to a point on your midriff, of at least 6 inches long. You may also have some small scars where some drains were after the surgery (below the belly button), a wound on your leg if a vein has been removed to make the graft, or an incision in your arm if a vein has been harvested from there. Don't put any creams on the scar until the scab has completely gone. Until then, unperformed soap (e.g. Dove) and warm water in the shower is fine. Pat dry gently with a clean towel.
If the surgeon has used any stitches (or sometimes clips) which don’t dissolve, then a nurse at your local doctor’s surgery will remove these about 8 to 10 days after the operation. Your surgeon or nurse will advise you exactly when you should have them removed. Wash the stitch sites with plain soap and water and wait until the scab has completely gone before you put cream on the area.
Dressings and wound care
It is common for some of the wounds to leak a small amount of fluid in the days after your operation. Often these can be removed after a few days. If your wound is quite oozy, a district nurse may need to visit you at home to change the dressing for you.Use only soap and water on the affected areas, and keep them clean and dry. You should be able to bathe as normal, but if showering, turn your back to the spray to avoid irritating the wound. Try to use water that is not too hot or cold, and don’t soak or rub the affected areas until they are completely healed.
You’re bound to feel some soreness in your chest immediately after surgery, and you may get pain in the surrounding muscles, such as your neck and arms. This is normal and usually eases off over the 3 to 4 weeks. You may experience discomfort in your chest for a while after the initial healing phase but for most people this will resolve after a few months.
It is important to continue to use your arms normally during this period as it will help with healing if you keep your muscles strong. If a vein has been removed from your leg, you will also have some swelling there, and some patients get pins and needles, or numbness. It is better to take regular painkillers throughout the day then to wait until the pain worsens, as it is then more difficult to manage. Paracetemol is usually enough but check with your doctor if you are unsure.
Patients commonly report after a bypass operation that they have strange, vivid and often scary dreams. It is unclear why this occurs but it is thought to do with the length of the operation, combined with the anaesthetic and the use of the bypass machine. Unfortunately there is no prevention however know that they will soon become less frequent and stop occurring completely in a few months. You may find that you need to take a sleeping tablet for a few months.
Your body is using a lot of energy to heal itself, so you will feel more tired than normal - sometimes it can come upon you suddenly but don't feel that it's going to be that way forever. As your physical activity levels improve you will steadily start to feel less tired. Take regular rests and don't overdo it - now is not the time to get on top of the DIY list! Taking a 30 minute nap in the afternoon for a few weeks is normal and can really help you to get through the day.
If you feel upset or emotional in the days and weeks after your operation, don’t worry - this is a perfectly normal reaction which many people experience. Talk to your doctor if your mood remains low or your appetite does not return after a couple of weeks.
Returning to exercise
It is important to allow yourself a few weeks to rest after such a major operation. It can take up to 6 weeks to recover from the surgery, and another 6 weeks for the breast bone and wounds to fully heal. During this time, it is recommended that you gradually increase the amount of walking you are doing. Each week, aim to add at least 10% to the previous week. It can be a good idea to create a ‘circuit’ or ‘track’ where you know the distance covered. This could be a few blocks around your neighbourhood. You can then start to increase the amount of ‘laps’ you do each week. That way, you are never far from home and you can keep an eye on how much exercise you are doing. If you are feeling extra tired, take a day off and rest. Never push yourself out of your comfort levels. The key is to build up gradually and before you know it you should feel fitter than before the operation. This is due to an increase in blood flow and oxygen to your heart, making it more efficient. If you are keen to begin a gym programme, talk to us about what exercises are safe and we can develop a programme that is suitable for you.
Please ask us if you have any questions at all. We specialise in helping people return to full fitness and health after heart surgery. We will develop a personalised programme specific to you, your condition, your surgery and you current medications. Contact us now for a free phone consultation.