Text for the Coronary Artery Bypass Brochure
(the first part of this file is the text designed to support the medical art in the first two columns of the brochure's "outside")
What is Coronary Artery Bypass Surgery?
The coronary arteries are the blood vessels that feed and sustain the heart muscle. As you know, your coronary arteries have blockages that are keeping the heart muscle from being properly nourished. Your doctor has tried medications, and you may have had one or more angioplasties. Unfortunately, you're still having trouble getting blood to your heart muscle. The good news is that you're a candidate for bypass surgery. Although bypass surgery is major surgery, and has risks that you need to consider carefully, it also means that you may add years to your life, and be more comfortable than you are now.
Bypass surgery is just what it sounds like - a bypass, or secondary road, is built, so that the blood can get around the blocked road. Sometimes only one blockage needs to be bypassed, sometimes two, three, four, or more blockages will be bypassed during your surgery.
A bypass is a new road for your blood to travel through, to reach the heart muscle. Since science has not come up with a material that is as good as your own blood vessels, blood vessels you already have that are "extra" will be moved to make the new roads your heart needs.
Every person has two mammary arteries. Each takes blood from just above your heart, and brings it to your torso. Since other arteries are also supplying blood to this same area, the lower part of one of your mammary arteries can be moved, and reattached to the outside of your heart, just below one of your blockages. Doctors like to use the mammary artery because this blood vessel is sturdy and because the upper end is already attached to a great source of blood. If you are having a single bypass, we will probably use the mammary artery. The drawing below, on the left, shows what a bypass, connecting the mammary, to the "LAD," or left anterior descending coronary artery looks like.
Another excellent source of bypass material is your legs. Just as the mammary arteries are "extra," so too are the saphenous veins, which help bring blood back to your heart from your legs. If more than one blockage is being bypassed, or if for some reason we don't want to use your mammary artery, we'll take this extra vein from your leg, and use it to make the bypasses you need. The drawing on the lower right shows two bypasses using saphenous grafts. Often times we will use both a mammary graft and saphenous grafts.
[drawing of the different grafts at
the bottom of the second column]
(the following is the text designed to help you complete the inside spread)
Before Your Surgery:
Bypass surgery is a major undertaking. In order to make the procedure more manageable, we will try to take care of as many details as possible before you actually check-in for surgery.
The day before your procedure, we will have you come in to complete paperwork, have a blood sample taken, be weighed, and have a chest x-ray. We will give you special soap to take home with you. Wash carefully with this soap, the evening before your procedure. Do not eat or drink anything after midnight.
The Morning of Your Procedure
When you make up, do take your regular heart / blood pressure medications, but limit yourself to just a small sip of water to wash them down. If you're on insulin, call us for specific instructions, since you won't be eating. Take a shower or bath again, washing carefully again, with the soap we gave you.
At the hospital, you will change into a gown. Infection control is very important, and we will use a clipper to remove most of your body hair. You will receive an IV, and when it's time to go to the operating room, medications will be added that will make you drowsy.
The surgery suite will be crowded during your bypass. The anesthesiologist will be keeping you asleep. One surgery team will be preparing the graft from your leg and another surgery team will be working on your chest, moving aside your ribs to access your heart. When the grafts are ready to be attached, your heart will actually be stopped, and your blood circulated by a heart-lung machine.
Once the bypasses are in place, your breastbone is joined back together. Your incisions are closed and bandaged, and you're wheeled to ICU, the Intensive Care Unit.
Within a few hours your family can visit. They need to be prepared to see tubes and monitors everywhere! You'll still be groggy, and you may not be awake enough to recognize them.
When you do wake up, you'll still be on oxygen, with a tube down your throat. As you're feeling stronger, we'll remove the tube. Just a few hours after your surgery we'll be asking you to do breathing and coughing exercises. You'll be tired and sore, but these exercises are important to keep your lungs clear.
Expect to be in ICU for one or two days. As you get stronger, the rest of the tubes will be removed. As your recovery continues, we will transfer you to our Telemetry Unit, sometimes referred to as Step Down. Now that you're getting stronger, we'll have you moving about, and eating solid food. Breathing exercises are still important, and will be an important part of your recovery. After three or four days in Telemetry, you'll be ready to head home.
Going home can create mixed feelings. On the one hand, it's great to be leaving the hospital. On the other hand it can be scary to be away from the safety associated with so many doctors and nurses. We will let you go home when we feel you're ready.
You've just had major surgery, so expect to be tired and weak. The day you get home, plan to rest. But your recovery program requires you to become more and more active each day.
Beginning with your first full day home, you should be getting out of bed, showering or bathing, and getting dressed. Move carefully, and ask for help when you need it. Each day you should feel a bit stronger. Soon you should be able to walk around, and even help with light chores. Even if you're feeling well, however, you need to be very careful with your chest. Enjoy walks around the house, and the neighborhood. But don't lift anything that might cause you to strain your chest, and be careful with pushing and pulling as well.
The Road to Recovery
Your life is different now - heart surgery is perhaps the ultimate wake-up call. You're probably pretty motivated right now to stay out of the hospital, so use this energy to begin tackling the risk factors that are responsible for so much heart disease: smoking, poor eating habits, and lack of exercise. Strongly consider joining our cardiac rehab program. For yourself and your family.