Will there be pain and fever after the operation ?

There will be some discomfort in the incision

made to reach the heart it is usually made along the midline

of the chest through the breastbone. The incision may

hurt medication will be given to relieve the pain.

Sometimes it causes heavy perspiration during

the night or even the day. Taking medicines usually brings

after the surgery.


What can be done to help recovery ?

Deep breathing exercises and coughing are important

way to speed recocery. Coughing reduces the chances of

pneumonia and fever and will not harm the incision or

bypass grafta. Most patients will have fear of pain,

discomfort and don't like to cough after an operation, still

coughing is essential. Some patients find it easier to cough

if a pillow supports their chest. You can help our own

recovery by changing position in bed often.



When can you eat and drink ?

Once your breathing tube is removed, you will

be able to swallow liquids. How quickly you will be able

to progress from liquids. To regular diet is an individual


It depends on your digestive system. It is possible you

may have a depressed appetite for some days due to mild

indigestion caused by stress. It will return to normally on

your return to normal activities.


When can you get out of bed ?

Patients may get out of bed and sit in a chair or walk

around the room as soon as they are able-usually within

a day or two. Later they can take short walks in the hall.

Eventually they can climb stairs and take brisk, longer

walks to prepare for going home.


What can you do to help yourself after returning home ?

The booklet has talked about what other people will

do to make sure your operation is successful and that you

have smooth and happy recovery period. There is also a

lot you can do, both before your operation, to help yourself

  • If you smoke, give up smoking.

  • Watch your weight.

  • Watch your cholesterol level.

  • Be positive.

  • Keep physically active.

  • You should only take the medicines perscribed by

    your doctor.


When should routine follow up doctor appointments be

scheduled ?

It depends up on a patient's need and the wishes of your

cardiovascular surgeon. Patients usually are advised

about future surgical appointments when they are

discharged from the hospital. You should see

cardiologist reqularly and have intervals to assess

progress. You should doctor soon after returning home.


How long will you have to wait before returning to

work ?

If you perform a sedentary job, the average is

between three to six weeks. If your job involves heavy

work, the time is six weeks or longer. Your doctor is

the best guide to help you return to work.


What about sexual relations ?

Typically patients may resume sexual relations

when they feel like it. If you have questions, talk to your



Will there be restrictions on driving an automobile ?

You may begin driving any time you feel

physically able to operate the vehicle safely. It is

usually best to wait a few weeks after leaving the

hospital to begin driving a car.



When to do awake bypass surgery ?

  • Specially good for patients with.

  • Severe lung disease.

  • Severe liver disease.

  • Past history of stroke/ unconsciousness.

  • High risk general anesthesia.


When not to do ?

  • Emergency CABG.

  • Bleeding disorders.

  • Large heart.

  • Poor ventricular function ( 25%).

  • Diffuse coronary disease.

  • Spinal deformity.


Benefits for the patients

  • No general anesthesia.

  • Can be performed for high-risk group of

patients who were earlier termed in- operable

because of risk of general anesthesia.

  • No post-operrative ventilator support required which

reduces post-operative intensive care to less than

24 hours.

  • Overall hospitalization can be reduced by 3 days.


Preparing for your surgery typically a patient is admitted

to the hospital with enough time the operation date to

allow diagnostic tests to be done. These routinely include

blood and urine tests, electrocardiograms (ECGs),

chestx-rasy and so on. Cardiac catheterization with coronary

angiograms is done during the preoperative hospital



Who will you before the operation ?

Before the operation, members of the cardiac surgery

team will visit to examine you, discuss the details of the

operation and answer your questions.

The nursing staff will also evaluate your needs; make you

as comfortable as possible. In addition, the anesthesiologist

will evaluate you and discuss plans for the care or vital

body functions during the operation.

Other members of the technical staff may come to draw

blood, instruct you about how to breathe and care for your

lungs after the operation. You will also be told when the

operation will occur.


What is per-donation for blood transfusion?

If you can found to be fit, one or two bottles of your own blood may be drawn before surgery which will be used for blood transfusion, during or after surgery. It is the safest blood transfusion and liminates or reduces the need for donor blood transfusion. This may be done before or after your admission, on the decision of your cardiovascular surgeon.


What preparations need to be done for the operation?

Before the operations,most of your body hair will be shaved off, especially from your chest and legs, you will probably be asked to shower and wash with to remove bacteria from the skin to reduce the chance of infection.


You should remove personal items such as glasses or contact lenses, dentures or detachable bridge work, watches and jewellery and give it to your family members for sate keeping.


Usually medicines are taken on schedule, but consult your doctor before taking any medicines. Medications that will make you relaxed and drowsy will be given about an hour before the operation.


Attendants will wheel you to the operating room on a rolling bed. After you are in the operating room, the anesthesiologist will give you an anesthetic that brings sleep and freedom from pain during the operation. Then the operation will be performed. Your family can wait in front of the operation theatre during the surgery or at the reception. Be sure surgeon knows where your family will be waiting.


After the operation patient is taken to recovery area or an intensive care unit(ICU). Amember of the family may visit briefly in the recovery or intensive care unit after a few hours of the operation when the patient is awake.


How long is the convalescent period in the hospital ?

The usual hospital stay after an operation is from normally 5 to 7 days. However patients who undergo the minimally invasive coronary bypass surgery (MICAS) can return home within 3-4 days. During that period and beyond, most patients have “good days” and “bad days” with overall progress and gain in strength.



What is coronary artery disease ?

Ageing and other complex factors cause the blood vessels to become hard . In addition,

cholesterol and minerals from the inner deposited on the coronary arteries. When this

material builds up, they from a plaque. A raised plaque may restrict the blood flow

through the coronary artery.



A rasied plaque may also change the surface of the artery from smooth to rough, and

these roughsurfaces may stimulate the formation of a blood clot, which may lead to

narrowed artery. A blood clot can also build up quickly and abruptly close of the artery.


What is coronary artery bypass graft (CABG) surgery ?


Coronary artery bypass graft surgery is an open-heart operation in which arteries or

veins are taken from another part of the body to channel needed blood flow to the

coronary arteries or veins are connected directly to the coronary arteries on the surface

of the heart beyond the blockages. This way blood can flow through them to bypass

the narrowed or closed points.

Coronary artery bypass graft operations usually last from there to six hours, their

duration depending on the number of vessels to be grafted. Each operation varies

in complexity, so its duration can only be estimated.


What is conscious off-pump coronary artery bypass surgery (awake bypass surgery)?

Awake bypass surgery is a break through step in “Fast-track care “of bypass surgery patients.

The 1990's witnessed significant advances in bypass surgery like

  • Elimination of heart lung machine

  • Smaller incision

    Endoscopic approaches

    Arterial grafts

    Awake bypass surgery is the latest advancement where a patient undergoes bypass

    while actually awake and can converse with the operation surgeon and his team.


How is the performed ?

Anew type of beating heart surgery which is performed with apidural anesthesia,

eliminating the need and risks of general anesthesia. The technique is a highly precision- based

methodology, Which involves injection of micro doses of local anesthesia which anesthetizes only

the chest region while the rest of the system is fully awake. This enable a painless bypass surgery and

makes the surgery sage for patients who are at high risk for general anesthesia.


How is a awake bypass different ?

High thoracic eqidural anesthesia given instead of general anesthesia.

  • Which works like cardiac sympatheactomy.

  • Causes vasodilatation of internal mammary arteries and coronary arthritis.

  • Produces severe heart rate without hemodynamic compromise.

  • Leads to attenuation of stress response.

  • Gives favorable blood / oxygen supply/ demand ratio for myocardium

  • Provides effective pain control.


patient selection for awake CAB & procedure thoracic epidural anesthesia eliminates the

needs & risk of general anesthesia . With this technique anesthetic medicine is steadily

delivered to the pidural space of the spine. The patient medication is given to reduce anxiety and

the patient remains awake the entire surgery.


  • Avoidance of tracheal intubation.

  • Avoidance of Ventilation .

  • Avoidance of cardiac depression due to general anesthesia and premedication drugs.

  • Avoidance of ischemic events related to intubation .

  • No ventilator related problems.

  • No hoarness of voice due to intubation.

  • No dizziness.

  • No nausea.

  • Reduced ICU stay.

  • Reduced Hospital stay.