Heart Bypass (CORONARY ARTERY BYPASS GRAFT )

surgery involves the bypass of a blockage in one or more of the coronary arteries using the saphenous vein , mammary artery or radial artery as conduits or replacement of vessels. This surgery is usually performed with the heart stopped (Cardioplegia) using a solution of iced saline containing potassium, necessitating the usage of cardiopulmonary bypass (CPB) Performed to relieve angina and reduce the risk of death from coronary artery disease Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle) diverts blood around narrowed or clogged parts of the major arteries (blood vessels), to improve blood flow and oxygen supply to the heart a type of surgery called REVASCULARIZATION, used to improve blood flow to the heart in people with severe coronary artery disease (CAD)

Other Names for Coronary Artery Bypass Grafting

Bypass surgery Coronary artery bypass surgery Heart bypass surgery

3 Types of Less Invasive CABG:

1)OFF BYPASS CABG --performed through median sternotomy with a smaller incision 2)MINIMALLY INVASIVE DIRECT CABG (MIDCABG) --performed through a left anterior thoracotomy without cardiopulmonary bypass 3)PORT ACCESS CABG

--with femoral-to-femoaral bypass and cardioplegia with a limited incsion

Saphenous Vein
distal end of the vein is sutured to the aorta, and the proximal end is sewn to the coronary vessel distal blockage

Internal Mammary Artery

more routinely used to revascularize the portion of the myocardium supplied by LAD artery but more time is required to remove it and mammary artery is shorter

Radial Artery
Has excellent patency rates Indication: ~ Severe narrowing of the left main coronary artery (because this major artery branches into several others, putting too much of the heart at risk if the angioplasty were to fail) ~ Severe narrowing of any three arteries in a person who also has a weakly pumping heart ~ Severe narrowing of the left anterior descending artery and at least one other coronary artery, plus either diabetes or a weakly pumping heart ~ Disease of the left main coronary artery (LMCA). ~ Disease of all three coronary vessels (LAD, LCX and RCA) ~ Following failed coronary angioplasty COMPLICATIONS Too much bleeding, requiring more surgery Dysrhythmias Decreased Cardiac output Infection of the wound Stroke, the sudden death of brain cells due to lack of oxygen caused by a blockage Blood clots

Organ failure (liver, kidney, lung) Heart attacks occur in 5% to 10% of patents, and are the main cause of death Infection at incision sites or sepsis Deep vein thrombosis (DVT) Anesthetic complications such as malignant hyperthermia Keloid scarring Chronic pain at incision sites Chronic stress related illnesses MATERIALS IV line Oral or IV sedative General anesthesia Breathing tube Catheter placed in bladder PREPARATION Describe surgical procedure: all steps, including heart lung machine Review anatomy and physiology of heart Length of time of surgery Describe ICU environment and monitoring equipment: cardiac monitor, and alarm ET tube Mechanical ventilator/alarm suctioning procedure, arterial line and automatic BP cuff Describe preoperative preparation: showering with antimicrobial soap shaving of chest , abdomen, neck groin Specail cardiac studies (ECG, electrocardiogram, ccatheterization cardiac) Describe comfort measures:

Pain reduction Turning Range of motion execises Out of bed next morning Medication for sleep if needed

Before the Procedure

Always tell the doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include: Aspirin,ibuprofen (such as Advil and Motrin) , naproxen (such as Aleve and Naprosyn) For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. Ask your doctor which drugs you should still take on the day of the surgery. .If you smoke, try to stop Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness. Prepare home so you can move around easily when you return from the hospital.

The day before your surgery:

Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic to guard against infection.

On the day of the surgery:

You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow. Take your drugs your doctor told you to take with a small sip of water.

After the Procedure

You may be able to leave the hospital 2 or 3 days after your surgery. You may also be able to return to normal activities after 2 or 3 weeks. <span class=" fbUnderline">Sternal Precautions</span> To avoid certain things for eight to 12 weeks to reduce the risk of opening the incision. 1.First, patients need to avoid using their arms excessively, such as pushing themselves out of a chair or reaching back before sitting down To avoid this, patients are encouraged to build up momentum by rocking several times in their chair before standing up. 2.Second, patients should avoid lifting anything in excess of 510 pounds. A gallon (U.S.) of milk weighs approximately 8.5 pounds, and is a good reference point for weight limitations 3. Finally, patients should avoid overhead activities with their hands, such as reaching for sweaters from the top shelf of a closet or reaching for plates or cups from the cupboard. Nursing Responsibilities: 1.Monitor cardiac output and or cardiac index 2.Monitor heart rhythm continuously 3.Monitor weight daily and compare previous weight 4.Monitor peripheral edema every 4 hours 5.Auscultate heart sounds every 4 hours 6.Auscultate lung sounds for crackles every 4 hours 7. Monitor intake and output, urine output hourly 8. Monitor potassium and calcium levels 9. Maintain fluid balance by administering IV fluids , packed RBC, or colloids 10. Administer prescribed vasodilators 11. Administer positive inotropic/ contractility meds. As prescribed

12. Monitor ECG and arterial BP to verify timing and effect of balloon counter pulsation 13. Protect external pacemaker wires from water and accidental expossure to electricity by placing them in a rubber glove