Post Operative Care After CABG

Dateline: 06/21/98

Often I've been asked the question "What happens after open heart surgery ?"

In this article, I will focus on the surgical aspects of post-operative care after open heart surgery.

The post-operative patient
For illustrative purposes, let's consider a patient recovering from the commonest open heart operation performed today, Coronary Artery Bypass Grafting (CABG). The course is similar after other kinds of open heart procedures too, but each operation has its own special variations and nuances of care.

An average patient - let's call him John Doe - is in his mid-fifties, a smoker, maybe diabetic, with high serum cholesterol, low levels of physical activity and maybe a family history of heart attacks. How can John make his post-operative period least unpleasant ?

An ounce of prevention is better than a pound of cure
Post-operative care begins well before surgery. John should stop smoking for atleast six weeks before operation. If diabetic, his blood sugar levels must be measured and brought under control by adjusting medication dosage. John must be taught deep breathing exercises which will prevent lung collapse (atelectasis) later on. Walking for atleast short distances, and learning calf muscle exercises can help reduce the risk of post-operative pulmonary embolism.

What happens in the ICU ?
John Doe would most likely have had two or more bypass grafts inserted, one of which is an internal mammary artery (IMA) graft. In most centers, a post-CABG patient would be put on an artificial ventilator to allow some time for recovery from the stress of the operation. Special medication would include

• drugs to improve the heart's function (like Dopamine, Dobutamine and Amrinone)
• medicines to maintain the heart's normal regular rhythm (anti-arrhythmics)
• insulin to control blood sugar levels
• pain killers to dull the pain of surgery

John's vital signs - heart rate, blood pressure, temperature, respiration - would be closely monitored. In addition, sophisticated monitoring of parameters like cardiac index or left atrial pressure are occasionally needed.