What are the coronary arteries?
The coronary arteries run on the surface of the heart and carry blood, oxygen, and nutrition to the heart muscle. They are the “fuel pipes” for the heart. Atherosclerosis (hardening of the arteries) can narrow the coronary arteries and compromise the blood supply to the heart. If a coronary artery becomes completely occluded a heart attack may result. This is the leading cause of death in the United States. A partial blockage can result in symptoms of chest pain (angina), shortness of breath with exertion, or abnormal heart rhythms. The purpose of surgery is to reestablish normal blood supply to the heart.
Why might I need CABG surgery?
The surgery will bring extra blood to narrowed heart arteries. The goal is to avoid a future heart attack, eliminate angina, improve heart function, and prolong the patients’ life. The operation is extremely effective in accomplishing these goals. Coronary artery bypass surgery is the most common major operation in the country, in large measure because it works well and is very safe.
What tests are used for coronary artery blockages?
A patient may be proven to have serious heart blockages with or without symptoms. The tests that may point toward problems are:
- EKG Electrocardiogram
- Stress Echocardiogram
- Exercise stress test
- Nuclear stress test Cardiac Catheterization
Cardiac catheterization is the final exam and is performed by running a catheter from a groin artery to the heart. An actual x-ray picture is created showing the course of and any narrowing of the coronary arteries. A cardiac catheterization also evaluates heart function accurately and gives information on the heart valves and pressures in the heart chambers. The catheterization is necessary to evaluate the patients’ need for treatment and to outline treatment options.
What are the alternatives to surgery?
Patients are grouped by the severity and position of their blockages, and by heart function. A tremendous amount of information is available to the treating physicians to determine the safest course of action for the individuals’ situation. Many patients can be treated with medications that alter heart rate and coronary blood flow and reduce symptoms and enable the patients to lead active lives. Other patients are treated with angioplasty and coronary stents. This can open the arteries and provide similar benefits to heart surgery. It is performed in the catheterization laboratory. Some patients are most safely treated with surgery as proven by large studies. A variety of reasons may be present whereby surgery is the safest choice. The anatomy of the blockages, the patients’ heart function, presence of diabetes, and previous failed stents all play a role in the decision.
How is the operation performed?
The operation is performed under general anesthesia through a median sternotomy incision, a vertical incision over the breastbone. The heart is exposed and the patient placed on the heart –lung machine. The heart may be stopped with a special chemical solution or allowed to keep beating. The coronary arteries are bypassed using the internal mammary artery (chest wall), radial artery (arm), or leg vein. The grafts are sewn on to the heart and then to the aorta for inflow. The number of grafts depends on the patients’ anatomy. The heart is then allowed to start working and the patient is removed from the heart lung-machine.
Will the leg incision bother me?
At CVT Surgical Center veins are removed using Endoscopic Vein Harvesting. This method creates only a 1” incision above the knee. The vein is removed using a scope and a video monitor. This advance has virtually eliminated leg pain and the risk of infection in the leg incisions.
What is the recovery period?
The average patient stays in the intensive care unit 1 night and 4 or 5 days in the hospital. The patient then is discharged home and gradually increases activity over the next 4 to 6 weeks when full recovery is achieved.
What is the mortality rate?
The mortality rate from heart surgery depends on the patient’s overall health, age, heart function, and magnitude of the surgery. The overall mortality rate from CABG at CVT Surgical Center is 1%.
What about my medicines after surgery?
Your cardiologist will assist in placing you back on your home medicines at the appropriate point after surgery. In general, medications for diabetes, hypertension, and cholesterol will need to be continued at home.
Can I stay alone after surgery?
You may, although most patients stay with a family member or friend for the first 1 or 2 weeks.
Will I need home health?
All patients are assigned a home health visiting nurse. They will check on the patient as needed usually a couple of times a week for the first few weeks.
When can I drive?
This is an individual decision. Most patients wait to drive until their first post op visit at 3 or 4 weeks. Many young and active patients drive sooner if they are not in pain and not taking pain medications.
When can I go back to work?
Patients performing a desk job may return to work in 3 or 4 weeks. Patients who work hard physically usually take 6 to 8 weeks off.