THE IMPLICATIONS OF CORONARY ARTERY BYPASS SURGERY
Before the operation:
Several tests are done before undergoing coronary artery bypass graft surgery, namely, a thorough physical examination, an electrocardiogram, a lung X-ray and blood tests.
In due time, the patient's family doctor and his cardiologist will provide him with all necessary information about the procedure.
The decision on whether or not to go ahead with the surgery depends on the patient's coronary angiography results. This procedure uses X-ray imaging after a contrast dye is injected into the coronary arteries, allowing the physician to identify the artery blockages that are to be treated; it is one in a range of available options.
Once the decision to operate is made, the hospital or someone from the cardiology department contacts the patient to properly inform him about the surgery and give him the date it will be performed. Additional tests may be required as well.
Most hospitals where cardiac surgery is available have a pre-admission service. A pre-admission session involves answering a series of questions, undergoing tests, and signing forms.
It is essential for the patient to bring a list of his current medications to pre-admission. The surgery team will go over that list as some of the medicines will have to be stopped before the procedure.
The patient is to bring all his medications to admission, which is usually done the day before the surgery.
Sound advice before leaving home:
Do not bring any valuables to the hospital, leave them at home.
Personal items are moved with the patient to various rooms, and who knows what might happen?
On an empty stomach:
The patient must fast as of midnight the night before the surgery. A little water is allowed with medication, as authorized by the medical team.
Leaving for the operating room:
When leaving for the operating room, the patient is to change into a hospital gown, remove his underwear, socks, jewelry and watch, as well as nail polish, if applicable.
Duration of coronary artery bypass graft surgery:
It takes an average of 30 to 60 minutes for the anaesthesia team to prepare the patient, and the coronary artery bypass graft surgery usually lasts between 2 and 4 hours.
When the surgery is over, the patient is transferred to the intensive care unit.
A commonly performed surgery:
Coronary artery bypass graft surgery is one of the most practiced surgeries in the world.
It is very safe and performed with operating techniques that are in permanent evolution.
The risks of this type of surgery:
Among the most serious risks associated with coronary artery bypass graft surgery are death, strokes (heart attack (CVA), paralysis), and coma. Fortunately, they seldom happen; it is estimated that, on average, they occur in 1 to 2% of all cases, and during, immediately after surgery or even a few days later.
Other possible complications:
Other less serious risks include cardiac arrhythmias (heart beating too fast or too slow) that occur in one-third of these patients, the need for blood transfusions, accumulation of fluid in the lungs area, infections and kidney problems, to name but a few of the most common ones.
Risks vary, depending on the patient's age and/or other serious illnesses he may suffer from. No two cases are identical, each patient has his own medical history. The patient should not hesitate to tell his doctor about any concerns he may have regarding his upcoming surgery.
Once the patient has been provided with all the details, risks and benefits of his coronary artery bypass procedure, he will be called upon to sign a surgical consent form as his agreement to undergo the operation.
Convalescence and return to normal daily life:
Barring complications, the patient is now transferred to the intensive care unit where he will be closely monitored for the next 24 hours. From there, he will be moved to the cardiac surgery department and be cared for by specialized staff over the next 4 to 7 days, and then made ready for his return home.
Hospital transfer or going home:
After his brief stay in the hospital where the surgery was performed, the patient is either transferred to his reference hospital or he is discharged and goes home.
When leaving the hospital, the patient is handed his doctor's drug prescriptions and a list of his scheduled follow-up office appointments.
The patient is given also the usual home-care advice, instructions on how to take care of his wounds, on resuming his usual activities, returning to work. driving a vehicle and on other concerns he may have.
Medications at home:
Utmost attention should be given to the newly-prescribed medications as some of the patient's former medicines may have been removed or modified.
Pain relievers are prescribed also to reduce pain during convalescence. It is normal for the surgical incision site to be tender or sore for a few days after the procedure, and the patient will experience some fatigue as well.
As soon as he is released from the hospital, the patient or the person who is accompanying him will go directly to the pharmacy to have the new prescriptions filled. Some drugstores have a pick-up and delivery service.
Before he leaves the hospital, a nurse will hand over to the patient or to his accompanying caregiver, should this is the case, specific wound-care instructions; for instance, how to remove bandages and precautions to be taken when the patient is showering or bathing.
Advice and recommendations:
Should there be a significant change in the patient's state of health or blood or pus draining from his wound, the patient is to contact immediately someone from his medical team or go to the nearest hospital emergency unit.
The patient should take his temperature regularly to make sure he is not running a fever, and he should follow rigorously all the guidelines he received before his release from the hospital.
Moving around is important for the patient. He is to get up and walk for short periods at a time and go at it gradually. Walking outside is allowed, however, he should favor short distances and not wait until he is too tired to make it back home.
Follow-up visit with cardiothoracic surgeon:
A follow-up appointment with the operating surgeon is usually scheduled 3 months after the operation.
This time again, the patient is to bring with him his medication list and all pertinent documents such as notes from other health professionals, test results and any information deemed relevant.
When seeing his surgeon, the patient will also bring the notes he wrote down since returning home. These will help the surgeon get a clearer picture of his patient's lifestyle, and how he is feeling overall since the operation.
Follow-up visit with his doctor:
The patient is to schedule a follow-up visit with his cardiologist, internist or family physician. These health professionals are the ones who will look after the patient's long-term follow-up and adjust his medication as needed.
Returning to work:
Usually, the patient may return to work about 3 months after the procedure. An authorization from the operating surgeon is required and will be provided at the patient’s 3 months follow-up appointment with him.
Driving a vehicle:
Driving is allowed 6 weeks after the operation.
A patient should never hesitate to ask questions to his doctors or to a member of his healthcare team. Writing them down is a good idea so none are forgotten, and they will be ready to be handed over on his next follow-up visit.