Coronary artery bypass graft surgery: patient outcomes and rehabilitation

Technical Instructions for Coronary Artery Bypass Graph Surgery

Key Points and Definitions

Because more and more people are living longer, there has been a corresponding increase in age-related heart conditions as well as those that result from the cumulative effects of various environmental factors over the long-term. Besides older people, many others of all age groups are experiencing heart-related problems based on an increasingly sedentary lifestyle that has contributed to the prevalence of obesity in the United States to the point where many authorities are describing the problem in terms of it being an epidemic. For these and other reasons, the number of people who are needing coronary artery bypass graph (CABG) surgery has also increased in recent years so it is important to provide this growing group of patients with the timely information they need to understand what the procedure involves and what they should expect before, during and following the surgery.

While statistics differ somewhat across the country, coronary heart disease remains a profound physical illness as well as one of the primary causes of death across the board in Western society today; as a result, many people are considering a CABG, which the patient should recognize is "a major surgical treatment" (Ben-Zur, Rappaport, Ammar & Uretzky, 2000, p. 201). The procedure is becoming increasingly commonplace, with just over a third of a million CABGs being performed in the United States each year; moreover, healthcare practitioners continue to improve their methods and success rates (Ben-Zur, 2000). While any surgical procedure, especially those involving general anesthesia, carry certain risks, the research to date suggests that the CABG is worth the risk for most people: "This operation prolongs the life of patients in cases of triple-vessel disease. It also improves patients' quality of life thus providing them with the opportunity for successful rehabilitation" (Ben-Zur et al., 2000, p. 201). The chances of patients enjoyed positive clinical outcomes can be improved when they understand what is involved and what they can expect over the course of the procedure. What many patients may not realize, though, is just how much and for how long general anesthesia can affect them, even under the best of circumstances and these issues are discussed further below.

How the CABG Works

Although more expansive and exhaustive presentations are readily available everywhere online, some useful guidance is provided by the U.S. Department of Health and Human Services (DHHS) which reports that, "Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease" (What is coronary artery bypass grafting, 2010, para. 1). Coronary heart disease results when there is an accumulation of plaque within the coronary arteries and some way of circumventing these clogged routes must be found, which is where the term "bypass" originates in the CABG. According to the DHHS, "During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle" (What is coronary artery bypass grafting, 2010, para. 2).

A typical CABG procedure is illustrated in Figure 1 below, with the requisite vein usually being harvested from the patient's chest or leg.

Figure 1. Typical sites for CABG bypass graphs

Source: http://intensivecare.hsnet.nsw.gov.au/five/images/coronary_artery_bypass.jpg

As can clearly be seen in Figure 1 above, the CABG will likely be regarded as a highly invasive procedure from the perspective of the patient and it is important for the healthcare team to provide CABG patients with the information they need to understand what is involved and with the opportunity to have their questions fully answered. Moreover, because the CABG procedure does not address the other healthcare issues that may have contributed to the need for the CABG procedure in the first place, it will be important to provide CABG patients with the long-term follow-up care they will need to help them resume their normal lives as much as possible as quickly as possible while treating the behavioral, dietary and other lifestyle factors such as smoking, drinking and substance abuse that may be comorbid with the CABG patient's overall healthcare status. In this regard, some useful guidelines for CABG patients concerning what takes place and what they can expect before, during and after their procedure is provided at Appendix A.

Finally, the results of a recent study by researchers at the Stanford University School of Medicine published in the Annals of Internal Medicine ("CABG and PCI each have strengths, weaknesses," Ann Intern Med. 2007), patients who elected the CABG procedure were more likely to experience angina relief than those who received the percutaneous coronary intervention (PCI); in addition, CABG patients were also more likely to avoid having to undergo subsequent revascularization procedures compared to the PCI (CABG and PCI each have strengths, weaknesses, 2007). Nevertheless, the procedure is not without its risk and patients considering this alternative should ensure that they understand what is involved, what they should expect before, during and after the procedure. Indeed, ensuring that CABG patients manage their post-operative condition to avoid depressive episodes and harmful behaviors was shown to be an essential part of the rehabilitation process.

Summary

People who are considering a coronary artery bypass graft surgical procedure should recognize that it is major surgery which carries certain concomitant risks, including death. For the overwhelming majority of patients who survive the experience, though, their chances of regaining their psychosocial skills and an improved quality of life will be enhanced if they know what to expect and what is involved at the technical level so that there will be on surprises and the patient can become mentally prepared for what is to come so that what happens afterwards can be dealt with in an effective fashion. Because patients need between 6 months and a full year -- or more -- to completely recover from a CABG, they must recognize that the recovery and rehabilitation process takes time and to avoid becoming frustrated and depressed at any seeming lack in progress. Indeed, "time heals all wounds," even those resulting from open heart surgery, and the payoff was shown to be clearly worth the risks involved for most of the people who electively seek out the CABG procedure for their coronary heart disease.