Overview
This transcript explains the on-pump coronary artery bypass graft (CABG) procedure, reasons for its use, surgical steps, associated risks, and important pre- and post-operative instructions for patients.
Heart Anatomy and Coronary Artery Disease
- The heart is located in the chest, protected by the sternum, and pumps blood through arteries and veins.
- Coronary arteries supply oxygen-rich blood to the heart muscle.
- Coronary artery disease occurs when arteries are blocked by plaque, leading to chest pain, heart attacks, or death.
Purpose and Process of CABG Surgery
- CABG creates new pathways, or bypasses, to route blood around blocked arteries using vessels from the leg or arm.
- The procedure uses blood vessel "grafts" from other body areas or the internal thoracic arteries.
- CABG can be performed using "on-pump" (heart stopped, heart-lung machine used) or "off-pump" (heart beats during surgery) methods.
- Procedure details depend on the number, location, and severity of blockages, as well as surgeon experience.
Steps of On-Pump CABG Surgery
- You will receive anesthesia to remain pain-free and asleep.
- Blood vessel grafts are harvested and chest incision is made to access the heart.
- Heart-lung machine is connected, heart is cooled, and temporarily stopped.
- Surgeon sews grafts into place; after completion, the heart is restarted and the heart-lung machine removed.
- Drains are placed, sternum is closed with wires/plates, and incisions are dressed.
Post-Operative Care and Recovery
- Initial recovery occurs in the intensive care unit (ICU) with close monitoring and pain management.
- Patients are encouraged to gradually increase activity and follow wound care instructions.
- Early reporting of symptoms like dizziness, pain, difficulty breathing, or swelling is important.
Risks and Potential Complications
- Major risks include bleeding, stroke, heart attack, irregular heart rhythm, memory issues, infection, and blood clots.
- The risk of death is approximately three percent for this surgery.
- Individual risk is affected by age, overall health, severity of disease, and surgeon's experience.
Lifestyle Changes and Long-Term Management
- Surgery is not a cure for heart disease; long-term health depends on lifestyle changes such as diet, exercise, and not smoking.
- Ongoing medication may be required to prevent blood clots.
- Management of underlying conditions like diabetes, high cholesterol, and hypertension is essential.
Pre-Operative Instructions
- Do not eat or drink after midnight before surgery unless instructed otherwise.
- Only take permitted medications with a sip of water.
- Follow specific instructions about aspirin and blood thinners.
Communication and Decision-Making
- Patients should discuss any questions regarding the procedure, risks, and alternatives with their physician to understand reasons for surgery and expectations.
Recommendations / Advice
- Follow all care instructions before and after surgery.
- Report promptly any signs of infection, bleeding, or complications.
- Maintain healthy lifestyle practices and adhere to prescribed medications for best outcomes.