General Information

DEFINITION--Using a section of the patient's leg vein to bypass a partial or complete blockage in the coronary-artery system.

BODY PARTS INVOLVED--Heart; coronary arteries; chest wall; large veins of legs.

REASONS FOR SURGERY

• Angina pectoris.
• Restoration of blood to the heart muscle after a heart attack.
• Prevention of a possible heart attack, if coronary arteries have narrowed.

SURGICAL RISK INCREASES WITH

• Obesity; smoking.
• Recent or chronic illness such as: severe heart attack; high blood pressure; thyroid disease; or diabetes mellitus.
• Chronic obstructive pulmonary disease (COPD).

What To Expect

WHO OPERATES--Cardiovascular surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood studies; chest x-ray; cardiac catheterization; ECG; sonogram (See Glossary for all).
• During surgery: ECG; angiograms (See Glossary).
• After surgery: ECG; chest x-ray; sonogram.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe. Breathing is performed for the patient by the anesthetist's machines.

DESCRIPTION OF OPERATION

• A section of the patient's large leg vein is removed and set aside to be used as the bypass vein graft. If a mammary artery (located in the chest) is used, no surgery is done on the leg.
• An incision is made through the breastbone, and the chest is spread open to expose the heart.
• The heart is stopped with a chemical solution that temporarily paralyzes the heart muscle fibers and the heart's temperature is reduced. Circulation is performed by a heart-lung machine.
• The bypass vein graft is sutured in place to allow blood flow to resume beyond the blocked area.
• After reheating the heart, it is given a mild electric shock that causes heartbeat to resume.
• The breastbone edges are rejoined with metal suture material, and muscles, tissue and skin are closed with lighter sutures.

POSSIBLE COMPLICATIONS

• Heart rhythm abnormalities.
• Excessive bleeding.
• Infection; kidney failure.
• New area of injury to the heart muscle; stroke.

AVERAGE HOSPITAL STAY--6-10 days.

PROBABLE OUTCOME--Angina pectoris is cured in almost all cases. Probability of future heart attacks is reduced. Allow about 6 weeks for recovery from surgery.

Postoperative Care

> Move and elevate legs frequently while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Antiarrhythmics to prevent heartbeat irregularities. > Digitalis to strengthen the heart muscle. > Anticoagulants to decrease the likelihood of blood clots.

> To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Resume driving 1 month after returning home. > Resume sexual relations when your doctor determines that healing is complete. > Ask your doctor for advice about an exercise rehabilitation program.

DIET--Low-salt; low-fat; high--fiber (see Appendix for diets).

Call Your Doctor If

> Pain, swelling, redness, drainage or bleeding increases in the surgical area.