When you have coronary artery disease (CAD), plaque buildup has caused your arteries to become narrow. This makes it hard for your blood vessels to properly bring oxygen-rich blood to your heart. This can cause chest pain, a heart attack, or a stroke.

One treatment for CAD is a coronary artery bypass graft surgery, or CABG (often pronounced “cabbage”). If you have to get this operation, here’s what you can expect from the procedure and the recovery.

What Happens During Surgery?

CABG is open-heart surgery. The doctor will first take a piece of healthy blood vessel from somewhere else in your body such as your leg, chest, or wrist. Then they will use tools to spread apart your sternum, or breastbone, to expose your heart.

The surgeon will attach one end of the healthy, grafted blood vessel above the blockage in your damaged artery, and the other end just below, so that the blood takes an alternate route through the healthy artery.

The surgery usually takes around 3 to 6 hours, and people often need more than one bypass during a single operation -- usually around three or four grafts, says Amit Pawale, MD, a cardiac surgeon at Northwestern Medicine in Chicago.

After Surgery: ICU Stay

After surgery, you will go to the hospital’s intensive care unit (ICU) so that your doctors can watch you closely. The average stay in the ICU is about 3 to 4 days, but it varies greatly.

“If the patient has comorbidities [other conditions] or they’re sicker -- for example, they’ve had a recent heart attack, or history of stroke, COPD, peripheral vascular disease [problems with blood vessels elsewhere in the body], smoking, diabetes, or obesity -- these patients may have a slower recovery,” Pawale says.

Your hospital stay might also be longer if your surgery takes a long time, was done because of an emergency, or if you have complications afterward. You may also need more time if your heart itself does not function as it should.

Usually, though, people stay in the ICU for a night or two and go home within a week.

At first, you will have a tube in your throat attached to a ventilator to help you breathe while you wake up from anesthesia. You may also have a stomach tube to keep you nourished until you can eat again.

As you wake up enough to breathe on your own, your doctor will slowly adjust the ventilator down, and finally take out the breathing tube, usually within 24 hours of your operation, and often much sooner.

“Typically, the breathing tube can come out very soon, like 2 to 3 hours after bypass surgery,” Pawale says. “Sometimes it can come out at the end of the operation, in the OR.”

Your doctor will give you pain relievers to help with your surgical cut (incision), which might be sore or tender for several days. Only take pain relievers prescribed by your doctor and take them exactly as prescribed.

You might also have an IV so that your doctor can give you medicines to keep your blood pressure stable while you adjust. Once your breathing and stomach tubes come out, you can start drinking liquids and gradually start eating solids again.

When you’re ready to leave the ICU, you’ll be moved to a post-surgery unit where nurses will help you gradually get out of bed and walk around until you’re ready to be sent home -- typically by the fifth day after surgery, Pawale says. “By the time patients go home, they are walking in the corridor, they can take showers by themselves, do a flight of stairs, and do self-care.”

Side Effects

It’s normal to feel crummy for several weeks after your surgery. Side effects might include:

  • Loss of appetite
  • Constipation
  • Swelling or pins and needles where healthy blood vessel was taken
  • Muscle or back pain
  • Tiredness or insomnia
  • Mood swings

Tell your doctor if you have:

  • Fever of at least 100.4 F
  • Chills
  • Redness, swelling, bleeding, or drainage from your incision
  • Increased pain at your incision
  • Trouble breathing
  • Fast or irregular pulse
  • Swollen legs
  • Numbness in your limbs
  • Nausea or vomiting that doesn’t go away

Call 911 if you have any of the following:

  • Chest pain
  • Extreme shortness of breath
  • Palpitations along with feeling faint or dizzy
  • Feeling extremely unwell

Recovery

At home, you will need to follow your surgeon’s directions for bathing and keeping your surgical site clean and dry. If you still have sutures or staples, you’ll have a follow-up visit to remove them. Some doctors use stitches that will dissolve on their own. Recovery will probably take roughly 6 to 12 weeks.

Usually you can do light activities like cooking, playing cards, or walking short distances right away. After around 4-8 weeks, with your doctor’s approval, you can likely:

  • Drive
  • Carry children or heavier objects (but not very heavy things, like bags of cement)
  • Vacuum or mow the lawn
  • Have sex
  • Go back to work, unless your job is very strenuous or involves heavy lifting

Like any open-heart surgery, CABG involves sewing your sternum closed with wire after the operation. That means you’ll need to be very cautious with certain activities while you heal.

“In terms of doing heavy upper body activity, like lifting heavy weights, swimming, riding a bike using your hands, hiking, or golf swings, we recommend you wait for 2 to 3 months after surgery,” Pawale says.

Cardiac Rehab

You may start cardiac rehabilitation while in the hospital. This is a personalized program, covered by most insurance plans, that helps you get on track for a heart-healthy lifestyle.

You’ll meet with a care team that includes doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and mental health specialists. You’ll get tests, practice day-to-day things like walking and climbing stairs, and learn how to exercise safely. Your team will work with you to design a program that meets your needs and gives you the tools to successfully make heart-healthy changes.

Cardiac rehab usually involves up to about 12 weeks of supervised sessions at an outpatient clinic, but this varies.

Long-Term Changes

CABG surgery is not a cure for heart disease. Your doctor will likely give you medication to lower your blood pressure and cholesterol. But it’s also critical to directly tackle any lifestyle habits that will continue to cause plaque buildup in your arteries unless you change them.

This means you need to:

  • Quit smoking.
  • Limit how much alcohol you drink.
  • Make heart-healthy diet changes.
  • Add physical activity to your routine.

These lifestyle changes are a must to keep your new healthy grafts from becoming blocked the same way the old ones did, Pawale says. “You can make a big difference.” Your doctor can give you specific instructions on what changes to make.

It’s also important to manage your stress, which can put you at risk for further damage. There are many ways to do this. Start by ensuring your basic needs are met including sleep, nutrition, and exercise. Then you can start to spot your triggers for stress, build good stress management skills, and remind yourself that you are able to get through stressful situations.

Keep watch of your emotions, too. Many people feel depressed, anxious, or both when they’re dealing with a serious health problem like coronary artery disease. Taking care of your mental and emotional health is important. Don’t hesitate to talk with a professional who can help you manage your emotions as you move forward. If you need a referral, start with your doctor or cardiac rehab team.

Show Sources

SOURCES:

Alyssa M. Vela, PhD, assistant professor of cardiac surgery and psychiatry and behavioral sciences, Northwestern Medicine; cardiac behavioral health specialist, Cardiac Behavioral Medicine, Northwestern Medicine Bluhm Cardiovascular Institute in Illinois.

American Heart Association: “Ejection Fraction Heart Failure Measurement,” “Heart Procedures and Surgeries,” “What Is Coronary Bypass Surgery?”

Amit Pawale, MD, cardiac surgeon, Northwestern Medicine Bluhm Cardiovascular Institute, Chicago.

Annals of Thoracic Surgery: “Hospital Variability in Length of Stay After Coronary Artery Bypass Surgery: Results from the Society of Thoracic Surgeon’s National Cardiac Database.”

Brazilian Journal of Cardiovascular Surgery: “Risk Factors for Prolonged Hospital Stay After Isolated Coronary Artery Bypass Grafting.”

Cleveland Clinic: “Left Ventricular Assist Devices (Mechanical Circulatory Support MCS).”

Interactive Cardiovascular and Thoracic Surgery: “Length of Intensive Care Unit Stay Following Cardiac Surgery: Is It Impossible To Find a Universal Prediction Model?”

Johns Hopkins Medicine: “Coronary Artery Bypass Graft Surgery,” “Peripheral Vascular Disease.”

Journal of the Formosan Medical Association: “Risk Factors Associated With Longer Stays In Cardiovascular Surgical Intensive Care Unit After CABG.”

Kim L. Feingold, PhD, assistant professor of cardiac surgery and psychiatry and behavioral sciences, Northwestern Medicine; director, Cardiac Behavioral Medicine, Northwestern Medicine Bluhm Cardiovascular Institute in Illinois.

Mayo Clinic: “Coronary Bypass Surgery.”

National Heart, Lung, and Blood Institute: “Cardiac Rehabilitation.”

NHS: “Coronary Artery Bypass Graft.”

Nigerian Postgraduate Medical Journal: “Prolonged Intensive Care Unit Stay After Coronary Artery Bypass Graft Surgery: Role Of Perioperative Factors.”

UCSF Department of Surgery: “Coronary Artery Disease.”

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