Coronary Bypass Graft (CABG) Surgery

An open surgical procedure used to treat moderate to severe coronary artery disease. Clogged arteries are bypassed with grafts to provide alternate routes of blood flow to the heart. Although other grafts may be used, this surgical procedure most commonly involves a saphenous vein graft from the leg to route blood around areas of vessel blockage in the heart.

Sternal Precautions after Surgery

Sometimes after the chest is closed and sutured, the underlying tissues are not fully healed. Most surgeons will recommend their patient's follow sternal precautions.

• No pushing, pulling, lifting more than 10 pounds for 6 weeks post-operative.

• No pulling or pushing up in bed with the arms.

• Walk with hand held assistance rather than using canes or other assistive devices.

• Take small steps when turning in standing, avoid twisting the body.

• No driving for 4 weeks post-operative.

• If a sternectomy is involved and a skin or muscle flap is present, shoulder elevation may be limited to 90 degrees.

• Avoid holding hands/arms overhead for long periods of time.

Care of the Operative Leg (the limb from which the bypass graft is taken):

Sitting with legs crossed should be avoided as it impairs circulation. The involved leg should be elevated when sitting or lying to manage swelling. Swelling in the operative leg is common, but should improve as the collateral circulation develops. Leg stockings are usually worn 2 weeks post-operative to prevent swelling and blood clots.

Returning to Activities

• Bathing: Showering is usually permitted 2 days post-operative. Tub baths and use of extremely hot water should be avoided until incision is well healed. It is recommended that one sits while drying off. Soaking in the tub is usually permitted after the incision is well healed at about 6 weeks post-operative.

• Dressing: Sit as much as possible when putting on/taking off shirt and pants to conserve energy. Wear comfortable, loose fitting clothes.

• Walking: Frequent short walks are usually recommended initially. Pacing of activities and energy conservation are important. Monitoring heart rate, perceived rate of exertion and blood pressure with walking activity is recommended.

• Stair climbing: Usually permitted unless physician states otherwise.

• Sexual Relations: Resumed when patient feels comfortable, usually 2-4 weeks after discharge from acute care.

• Driving: Usually allowed after 3-4 weeks post-operative, but may vary pending Physician's discretion.

• Housework/Yardwork: Task such as vacuuming, mopping mowing the lawn, using light hand tools, taking out the garbage and carrying wet laundry basket are resumed after 2 months post-operative.

• Recreation: Swimming, Fishing, Tennis, Lifting greater than 10 pounds, Biking, and Treadmill walking are usually safe to resume after 3 months post-operative. Physician approval may be necessary for return to bowling, diving and golf.

• Return to work: Usually allowed after 4-6 weeks post-operative pending type of work (physical vs. sedentary).

Rest

Exercise and rest should be well balanced for a successful recovery from open heart surgery. Sitting quietly 20-30 minutes and/or short naps between activities is usually encouraged. It takes time to regain stamina, endurance and to re-establish a normal blood count after open heart surgery. Some individuals find it takes 6-12 weeks post-operative to begin to feel their energy level rise.

When to Contact the Doctor

Stop any activity if you are having shortness of breath, heart palpitations, chest pain/discomfort, dizziness and or fainting. If these symptoms to do not clear within 20 minutes of rest, contact your physician.

If edema (swelling) in operative leg gets progressively worse.
If you experience excessive sweating or intolerance to activity.
If you note any signs of infection (fever of 101 degrees Fahrenheit or more, chills, increased or unusual pain, swelling/redness at or around incision site(s), drainage from incision site(s)).

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