1.What is coronary artery bypass grafting The heart needs energy to maintain its daily and nightly beating. The coronary arteries are the blood vessels that carry blood to the heart, bringing oxygen and nutrients to the heart to maintain the heart’s metabolism. Atheroma is the accumulation of fat, cholesterol and other items within the walls of the arteries. When atheroma grows in your coronary arteries it can cause severe narrowing of the coronary arteries, reduced blood perfusion to the heart and angina or myocardial infarction. Coronary artery bypass surgery is a type of heart surgery used to improve the perfusion of blood to the heart. This procedure uses a blood vessel taken from another part of the body as a bypass (bridge) through which blood can bypass the blocked coronary artery to supply the distal end, improving the blood supply to the heart. If more than one coronary artery is blocked, you may need multiple bypasses. A cardiac catheterization or coronary angiogram is a test used by surgeons to understand the location and extent of coronary artery blockage before surgery so that they can monitor the procedure. 2. How to prepare for coronary artery bypass surgery Knowing what is coming can help reduce anxiety for most patients undergoing surgery. Talking to your surgeon or a patient who has already had this surgery may help you feel less nervous and scared before the procedure. You can ask your surgeon to set aside some of your own blood beforehand so that you can use your blood to replenish it after the surgery and avoid transfusing someone else’s blood. Ask your doctor what medications you should take before the surgery. Your doctor may prescribe medication to prevent your blood from clotting. If you are taking aspirin daily, ask your doctor if you need to stop taking it before your surgery. Arrange your post-operative care and recovery plan. Take time off work and find someone to help you with your daily routine. Follow your doctor’s instructions to take a regular shower and wash your hair the night before surgery, eat a light dinner in the evening, and not eat or drink anything after midnight. Follow your surgeon’s instructions and refrain from smoking before and after surgery, as smoking slows a patient’s recovery from surgery. Patients who smoke are also more likely to have breathing problems with their surgery. Therefore, if you smoke, you should quit for at least two weeks, preferably six to eight weeks. To prevent infection, the hair on your legs, groin, and chest (if necessary) will be shaved prior to surgery. A mild dose of sedative will be given to help you relax before the general anesthetic is administered. The general anesthetic medication will relax your muscles so that you feel no pain and allow you to sleep deeply. 3. What happens during coronary artery bypass surgery Coronary artery bypass surgery is done by a team of surgeons. The operation takes two to six hours, depending on how many vessels need to be bridged. Your surgeon will open your chest and separate your sternum. The surgeon will connect your heart to an artificial heart-lung machine, which will take over the work of your heart and lungs during the procedure. If a vein is used as a bridge, one end of it is sewn to the aorta (the large blood vessel from the heart). The other end is sewn to the distal end of the blocked coronary artery. If an internal mammary artery is used, its distal end is cut off and reconnected to the vessel distal to the blockage of the coronary artery. In both cases, blood will be supplied to the distal end of the coronary artery stenosis through the new vessel (vessel bridge) that will loop around the blockage. After the anastomosis is complete, the surgeon will restart your heart, disconnect the heart-lung machine, suture your sternum and chest skin, and close the chest incision. The surgeon will place some drains through the incision to drain blood and fluid from the chest cavity. If the blockage is directly in front of the heart, the surgeon may also perform a coronary artery bypass graft using a small incision in the chest. This approach does not require cutting through the sternum and makes recovery easier, but it is not suitable for most bypass patients. Consult your surgeon to see if this approach can be taken. 4.What happens after coronary artery bypass surgery After surgery, you will be sent to the intensive care unit (ICU). You will stay in the ICU overnight until you no longer need further observation, and then you will be transferred to a general ward. A continuous electrocardiogram monitor will record the rhythm of your heart after surgery, and respiratory therapy will help prevent some lung diseases such as atelectasis, infection or pneumonia. The nurse or therapist will give you respiratory therapy every few hours. If you have pain, you can ask your healthcare provider for pain relief. You will also have some physical therapy, which will include walking and other exercise activities in the hospital. You will learn how to move your upper arm without hurting your sternal wound. Your healthcare provider will tell you what foods to avoid when you return home, such as foods high in fat, cholesterol, and sodium. You should consult with your doctor about your cardiac rehabilitation plan before you leave the hospital. 5. What are the risks of coronary artery bypass surgery Every treatment has risks. Your surgeon will talk to you about the specific risks. There are some risks any time you are under general anesthesia; infection, especially lung infection, is often a problem; heavy bleeding after surgery sometimes means another surgery is needed to stop the bleeding; there is a risk of gradual blockage of the vascular bypass (vascular bridge); postoperative stroke is also a risk; the occurrence of postoperative arrhythmias is quite common, but medication for them is often effective. 6. How to take care of yourself after surgery Follow your doctor’s treatment, take your doctor’s prescribed medication, get enough rest, and rest for at least 2 periods during the day (or more if you still feel tired). Accept help from your side and visits from family and friends, but the visits should not be long enough to ensure that you get some rest. Learn the technique of deep breathing and relaxation. If you are overweight, you need to lose your weight slowly. Follow a healthy, balanced diet that includes low salt, low saturated fat and low cholesterol. Weigh yourself every morning and report to your doctor if your weight suddenly exceeds 2Kg. Implement the exercise program given to you by your doctor. Constipation is a common problem, and many patients in the hospital or at home become constipated after bed rest. If you are constipated, ask your doctor for some stool softening medication or a light laxative. For swelling and circulation problems in the lower extremities after saphenous vein extraction, the doctor will recommend walking more often and elevating the affected extremities while lying down to prevent prolonged standing and sitting, and some doctors will ask you to wear elastic stockings to prevent swelling and circulation problems in the lower extremities. 7.How to avoid problems in recovery after surgery Try to follow the doctor’s advice after surgery. If you still have slight dizziness, you will need help with bathing or showering. For your safety, you may need to use a shower bench; avoid overheated hot showers and tubs because it can affect blood flow and make you feel dizzy. When you first get home, avoid lifting heavy things over 5 kg. Don’t drive, don’t mow the lawn, don’t mop the floor and use the vacuum cleaner, don’t do any upper arm and chest other activities until your your doctor allows you to do so. Avoid sexual intercourse until your doctor tells you that you can recover. Do not drink alcohol without your doctor’s approval. 8.When should you see your doctor after surgery You should see your surgeon in the following cases: fever, feeling shortness of breath and chest tightness, chest pain that gets progressively worse.