FAQs

WHAT AFTER CABG SURGERY?

• How do patients recover after CABG surgery?

  Sutures are removed from the chest prior to discharge and from the leg (if the saphenous vein is used) after 7 to 10 days. Even though smaller leg veins will take over the role of the saphenous vein, a certain degree of swelling (edema) in the affected ankle is common. Patients are advised to keep their leg elevated when sitting. This swelling usually resolves after about six to eight weeks. Healing of the breastbone takes about six weeks and is the primary limitation in recovering from CABG surgery. Patients are advised not to lift anything more than 5 kg or perform heavy exertion during this healing period. They are also advised not to drive for the first four weeks to avoid any injury to the chest. Patients can return to normal sexual activity as long as they minimize positions that put significant weight on the chest or upper arms. Return to work usually occurs after the six week recovery, but may be much sooner for non-strenuous employment.

  Exercise stress testing is routinely done one year after CABG surgery.We begin cardiac rehabilitation programs about a week dyer surgery . Rehabilitation consists of a 12 week program of gradually increasing monitored exercise lasting one hour three times a week. Patients are also counselled about the importance of lifestyle changes to lower their chance of developing further CAD. These include stopping smoking, reducing weight and dietary fat, controlling blood pressure and diabetes, and lowering blood cholesterol levels.

• What are the risks and complications of CABG surgery?

  Overall mortality related to CABG is 3-4%. During and shortly after CABG surgery, heart attacks occur in 5 to 10% of patients and are the main cause of death. About 2% of patients require exploration because of bleeding. This second surgery increases the risk of chest infection and lung complications. Stroke occurs in 1-2%, primarily in elderly patients. Mortality and complications increase with:

  • Age (older than 70 years)
  • Poor heart muscle function
  • Disease obstructing the left main coronary artery
  • Diabetes
  • Chronic lung disease
  • Chronic kidney failure.

  Mortality may be higher in women, primarily due to their advanced age at the time of CABG surgery and smaller coronary arteries. Women develop coronary artery disease about 10 years later than men because of hormonal "protection" while they still regularly menstruate (although in women with risk factors for coronary artery disease, especially smoking, elevated lipids, and diabetes, the possibility for the development of coronary artery disease at a young age is very real). Women are generally of smaller stature than men, with smaller coronary arteries. These small arteries make CABG surgery technically more difficult and prolonged. The smaller vessels also decrease both short and long-term graft function.

• What are the long-term results after CABG surgery?

  A very small percentage of vein grafts may become blocked within the first two weeks after CABG surgery due to blood clotting. Blood clots form in the grafts usually because of small arteries beyond the insertion site of the graft causing sluggish blood run off. Another 10% of vein grafts close off between two weeks and one year after CABG surgery. Use of aspirin to thin the blood has been shown to reduce these later closings by 50%. Grafts become narrowed after the first five years as cells stick to the inner lining and multiply, causing formation of scar tissue (intimal fibrosis) and actual atherosclerosis. After 10 years, only 2/3 of vein grafts are open and 1/2 of these have at least moderate narrowings. Internal mammary grafts have a much higher (90%) 10 year rate of remaining open. This difference in longevity has caused a shift in surgical practices toward greater use of internal mammary and other arteries as opposed to veins for bypasses.(Arterial bypass grafting ).

  It has been shown that in CABG patients with elevated LDL cholesterol (bad cholesterol) levels, use of cholesterol-lowering medications (particularly the statin family of drugs) to lower LDL levels to below 80 will significantly improve long-term graft patency as well as improve survival benefit and heart attack risk. Patients are also advised about the importance of lifestyle changes to lower their chance of developing further atherosclerosis in their coronary arteries. These include stopping smoking, exercise, reducing weight and dietary fat, as well as controlling blood pressure and diabetes. Frequent monitoring of CABG patients with physiologic testing can identify early problems in grafts. PTCA (angioplasty) with stenting, in addition to aggressive risk factor modification, may significantly limit the need for repeat CABG years later. Repeat CABG surgery is occasionally necessary, but may have a higher risk of complication.

• How do CABG surgery and angioplasty (PTCA) compare?

  Ongoing studies are comparing the treatment results of angioplasty (PTCA) versus bypass (CABG surgery) in patients who are candidates for either procedure. Both procedures are very effective in reducing angina symptoms, preventing heart attacks, and reducing death. Many studies have either shown similar benefits or slight advantage to CABG (primarily in severe diabetics). The best choice for an individual patient is best made by their cardiologist, surgeon, and primary doctor.

VALVE SURGERY

• How does my doctor determine the best treatment for me?

  the type of valve disease treatment that is recommended will depend on several factors,including the type of valve disease you have, how badly the valve damage is, your age andmedical history. Your health care team will talk to you about your best treatment options.

• Is surgery better for me than medication alone?

  Medications often help during the first stages of valve disease, but they don't work as well as the disease gets worse. You do not need to wait until your symptoms become unbearable before you have surgery. In some cases, it is best to have surgery before symptoms begin. the decision to have surgery is a major one that is based on your individual needs. It involves input from you, your cardiologist and your surgeon.

• How will I feel after surgery?

  The way you feel after surgery depends on your overall health, how the surgery went and how well you take care of yourself after surgery. Most patients feel better after they recover. To some extent, how you feel will depend on how you felt before surgery. Patients with more severe symptoms before surgery may have a greater sense of relief after surgery. Call your doctor if you are concerned about your symptoms or the speed of your recovery.

• How long will my valve last?

  The amount of time your valve repair or replacement lasts depends on several things - your health at the time of surgery, the type of surgical treatment you have and how well you take care of yourself after the surgery.

  Mechanical valves rarely wear out, but they may need to replaced if a blood clot, infection or tissue growth keeps them from working properly. Biological valves may need to be replaced. This is especially true for younger patients who have valve replacement surgery.

• Are there any risks of major complications from the surgery?

  All surgery involves risks. these risks are related to your age, other medical conditions you have and how many procedures are done in a single operation. Your cardiologist and surgeon will talk to you about these risks before your surgery. Please ask questions to make sure you understand all the potential risks and why the procedure is recommended.

• Will I need to take blood-thinning medication (anticoagulants) after surgery?

  The need for anticoagulant medication (blood thinners) after surgery depends on the type of surgery you have. The medication is used to prevent blood clots from forming and causing problems with your heart valve.

• If you have a mechanical heart valve, you will need to take this medication for
  the rest of your life.

  If you have valve repair or a biological valve replacement, you may need to take this medication for several weeks after surgery, or maybe not at all. It is possible that you may need to take an anticoagulant for a condition not related to your heart valves. This medication is also used as a treatment for an irregular heartbeat, an enlarged hear,t, a weakened heart and in patients with a history of blood clots.

• What if I choose not to have surgery?

  Depending on the type and extent of valve disease you have, you may be able to be treated with medications. You may also be able to have a non-surgical procedure. Valve disease does not go away and gets worse with time. As the disease gets worse, you will have more symptoms and your overall health will suffer. these changes often happen slowly, but they can also occur very quickly.

  If you decide to not have surgery, it is recommended that you stay in close contact with your doctor. Surgery usually remains a treatment option, even for patients with advanced valve disease, and it may be the only effective treatment.

TESTIMONIAL

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