Coronary artery bypass graft surgery: How to prepare

How do I prepare for CABG surgery?

There are many things that you can and must do in the days and weeks before your coronary artery bypass graft (CABG) surgery. Your surgeon will give you specific instructions on how to prepare for your CABG surgery.

CABG surgery is an invasive procedure that has a fairly long recovery time, so it is important that you prepare carefully for your surgery as well as for the days and weeks following your surgery. Try to make your life simpler during the recovery period by doing things such as paying bills ahead of time and arranging for someone to assist you in the days following your surgery. It is also important to plan for any complications that could arise. A lot of the preparation that you do before your surgery will help you afterward, while you are recovering.

Before surgery

In the 2 or 3 weeks prior to surgery, attend any scheduled appointments with your surgeon. You will need to have several tests done before your surgery. Most of these tests are done so that your doctors can evaluate and compare your health before and after CABG surgery. The tests can also help your doctors anticipate any special needs. To be ready by the day of your surgery, the tests need to be done days or weeks before.

Tests done days or weeks before surgery

• Blood count (hematocrit): This blood test can reveal whether you are anemic (have a low red blood cell count). A very low blood count may need to be increased before or during surgery with a blood transfusion.
• Prothrombin time (PT, also referred to as INR) and thromboplastin time (PTT) values: These blood tests measure your blood's ability to clot. Typically, you will have these tests if you have recently stopped taking blood-thinning drugs, to make sure the drugs are no longer affecting your blood's ability to clot.
• Other blood tests: Other tests may be done to assess your kidney and liver functions and provide information on the health of these organs.
• Chest X-ray: This test provides a picture of the size and shape of your heart and aorta and whether your lungs appear normal.
• Cardiac catheterization: This test allows your doctor to picture your coronary arteries and identify the location of blockages to help plan your CABG surgery.

Drugs and CABG surgery

Compile a complete list of medications, vitamins, and herbal supplements that you take. Bring this list with you when you visit your doctor so that dangerous interactions with medications used during the CABG procedure can be avoided.

Follow your surgeon's instructions about stopping medications. Ask your doctor whether different medications can be substituted for those that you must stop taking.

Certain drugs, especially anticoagulants like warfarin (such as Coumadin), are usually stopped before CABG surgery because they prevent the blood from clotting. If your blood is too thin, you will be at a greater risk for internal bleeding, which is a serious complication of CABG surgery. If you have another condition that makes your blood more likely to clot, you may be given a different medication than the one you usually take.

You may be asked to arrive for your surgery the night before so that doctors can monitor you. Most other medications that you normally take in the mornings should be continued up to the day of your surgery, especially if you are taking them for other medical conditions. Check with your surgeon about all medications and supplements you are currently taking.

On the day of your CABG operation, you should have only a sip of water with any medication so that you keep your stomach empty.

Diabetes

If you have diabetes, your doctors may need to adjust your medications to prepare for your CABG surgery. Since CABG surgery requires you to stop eating several hours before your procedure, your blood glucose level may drop so low that your regular medications (which lower your glucose level) may not be necessary. Talk to your doctors about the type and severity of your diabetes, as well as which medications you are taking.

General arrangements

• Arrange for transportation the day of your surgery, for someone to help you at home during your first week out of the hospital, and for someone to help with chores and errands for 1 to 2 months after your surgery. You may be too physically tired and sore after your surgery to do many things for yourself.
• Prepay any bills that will be due soon after your surgery. You will probably want to concentrate on recovering, not on everyday affairs.
• Arrange your personal matters, including a will, living will, and nursing preferences. Rarely, serious complications of CABG surgery (including death) can happen. Therefore, you should plan for this possibility and make sure that you have made your end-of-life wishes clear.

End-of-life issues

You should discuss complications of CABG surgery a few weeks beforehand with both your surgeon and your family. In particular, you may wish to clarify your desires about matters such as life support (such as a breathing tube or medications to keep you alive) and resuscitation measures (such as chest compressions and electric shock) in case of an emergency.

In addition, you may want to consider becoming an organ and tissue donor. If you are an organ and tissue donor, your liver, lungs, kidneys, and other organs can be donated to another person who needs them in case you die during your surgery. Although only a very small percentage of all CABG surgeries performed result in death, it is important to prepare in case this happens.

The day before your surgery

• Remind the person who will drive you to the hospital what time you need to be there. It is important to arrive on time, as several preoperative tests and administrative tasks must be done.
• Do not eat or drink anything after midnight. There is a possibility that the anesthesia you receive during your procedure will make you nauseated. If you have an empty stomach, your risk of vomiting and inhaling the vomit into your lungs during surgery is lower.
• Relax, but do not drink alcohol. It may dangerously interfere with medications you will be given on the day of your surgery.
• Use disinfecting solution (that your doctor may have given you) to clean your skin. This will minimize the risk of infection near your chest incision.
• Select comfortable clothes to wear to and from the hospital. After the surgery, your wounds and muscles will still be sensitive, and comfortable clothing is less likely to irritate them.
• Pack the bag that you will bring to the hospital. In general, hospital staff recommend that you pack lightly.

What to bring to the hospital

• Identification
• Contact and emergency information
• Insurance information
• Essential items, including glasses, hearing aids, dentures, or other personal items you need to function
• Comfortable clothes that are easy to put on and take off to wear to and from the hospital

What NOT to bring to the hospital

• Anything valuable
• Personal care items

(The hospital will usually provide you with shampoo, conditioner, soap, lotion, toothbrush, toothpaste, and shaving equipment.)

Items you can bring if you want

• Entertainment such as magazines or books to pass the time before and after surgery
• A robe
• Cosmetics

The day of your surgery

Plan to arrive several hours before your CABG surgery begins. Several more tests and administrative tasks must be done before you are ready for surgery. See what to expect when you arrive at the hospital for CABG surgery for more information.

What to think about

When you prepare for your CABG surgery, you can take an active role. By asking questions and educating yourself, you can take control of your experience. In your weeks of recovery after your surgery, you will be glad that you did.