Coronary Artery Bypass Graft Surgery

Outlook

As a coronary artery bypass graft surgery (CABG) patient, you have just undergone major surgery. Even though specific problems in your heart have been addressed, your body has been through a lot, and you will need time to recover and regain your strength. Everyone’s recovery is unique.

Your recovery will begin in the hospital’s intensive care unit (ICU) and typically will continue in another area of the hospital for three to five days before you go home. Once you have been discharged from the hospital, recovery typically takes six weeks or more.

In the ICU

After bypass surgery, you’ll be moved to the ICU. The hospital’s ICU is specially equipped to monitor your vital signs, and the medical professionals you will meet there have training in safeguarding more vulnerable patients. You may not wake up from the anesthesia for two to four hours. During this time, you will continue to breathe through the breathing tube with help from a ventilator, a machine that will move air in and out of your lungs, essentially “breathing” for you. This will enable you to breathe easily and take good, deep breaths. Your hands will be restrained to prevent you from pulling the tube out. The tube will be removed when you’re breathing well on your own.

Most patients can have short visits from family members in the ICU a few hours after their surgery. Because you’ll still have the breathing tube in place, you won’t be able to talk. You may communicate with notes or by shaking your head. However, early removal of the breathing tube after the surgery may occur (if your lungs can breathe on their own) soon after surgery to minimize the risk of lung infection.

When you wake up, you’ll have several other tubes attached as well, most of which will be removed the day after surgery:

• A stomach tube is inserted through the nose down to the stomach. This tube prevents nausea and keeps air from bloating the stomach. You won’t feel pain from the tube, but your nose may drip.
• A Foley catheter (thin, flexible tube) inserted in your bladder enables the care team to monitor your urine. You may have a normal urge to urinate while the catheter is in place. For a short time after it’s removed, you may feel a stinging sensation when you urinate.
• Chest tubes, which are inserted at the end of the operation and drain fluid, preventing fluid from accumulating in the chest cavity. The chest tubes will be removed when the drainage stops.
• An arterial line (a plastic small tube) in the artery of your wrist is used to monitor blood pressure and draw blood gas samples.
• IV tubes, which supply fluids, medications, and blood as needed.
• Pacemaker wires attached to the pacemaker box, which are attached to your heart. If the heart rate slows down, this pacemaker will work to get your heart rate up.

The day after surgery

Typically, on the day after surgery, and when the breathing tube is removed, you’ll begin to drink clear liquids, and you’ll receive solid foods as you can tolerate them. You may also be able to sit up on the side of your bed. On this first day, you’ll also begin breathing and coughing exercises which are important measures for reducing the risk of lung complications such as pneumonia. Many patients will be moved out of the ICU to another area of the hospital. When you’ve moved, you’ll wear a small, portable device that monitors your heart rate, called a telemetry monitor.

The second day after surgery

On the second day after surgery, you’ll typically be expected to sit in the chair and walk two or three times. You’ll begin to eat solid foods as your appetite returns, but the amount you drink will be limited to six to eight cups of liquid over 24 hours. You’ll sit in a chair for meals.

Your hospital stay will typically be three to five days after you’re moved from the ICU to another unit. Sometimes, you might need inpatient therapy to help with your recovery, and the treatment team might send you to an inpatient rehab center for a few days before you go home.

Recovery at home

After CABG, a typical recovery at home is six weeks, though recovery can take anywhere from four to 12 weeks.

When you arrive home, you and your caregiver—a family member, friend, or home health aide you have identified before the surgery—will be instructed to do the following:

• Monitor for symptoms of infection in the chest incision, such as fever, rapid heart rate, worsening incision pain, or bleeding from the wound. Your care team will provide information about what symptoms may indicate a complication. Contact your doctor right away if any of these symptoms occur.
• Clean the chest incision and any incisions from the grafts according to your doctor’s instructions. A graft is the blood vessel removed from your chest, leg, arm, or other sites in the body to be sewn in to reroute blood around a blockage in your heart artery. You’ll have an incision in your chest from the open-heart bypass surgery, and you’ll have incisions from any sites from which grafts were taken.

It’s important to keep all follow-up appointments with your healthcare providers and to take prescribed medications exactly as indicated. If you have any concerns about your medications, don’t stop taking them without contacting your doctor—doing so can be dangerous.

Your doctor will give you clearance when it’s safe to resume specific activities. People in strenuous occupations may need to wait longer than those in less-strenuous positions to return to work. Most surgeons discourage driving a car for six weeks after CABG. Your physician will advise when you can resume physical activities, including sexual activity.

Cardiac rehabilitation

During the recovery period, you may begin participation in a cardiac rehabilitation program if prescribed by your doctor. You may begin cardiac “rehab” while in the hospital and continue it in the months moving forward. Cardiac rehab is, in part, a structured exercise program that can help you increase your physical activity level while under the direct supervision of medical professionals. The program also includes work with dieticians, occupational therapists, psychologists, and other healthcare providers who can help you recover from your surgery and feel confident that you have the skills to adopt a heart-healthy lifestyle.

Regaining physical strength and eating a diet of nutrient-rich foods are critical to a successful recovery from CABG and to returning to the lifestyle you want to live. Studies have shown that cardiac rehab is more than just a good idea; it can be a lifesaver. Recent research has found that patients who complete cardiac rehab are more likely to be alive five years after a heart event than those who don’t.

The months ahead

CABG corrects blockages in the arteries, but it doesn’t cure the underlying heart disease process. Long-term recovery will involve fighting the risk factors contributing to your coronary artery disease (CAD). Some risk factors, such as family history, can’t be changed, but others, such as dietary and exercise habits, can be. Medical professionals and support groups are available to help you make lifestyle changes.