Heart Bypass Surgery: Long-Term Care

Heart bypass surgery, also known as coronary artery bypass graft (CABG), is a type of surgery that may be used to treat coronary artery disease (CAD). With CAD, plaque has built up in the arteries to the point that it is blocking the supply of blood to the heart. This blockage is usually the result of an accumulation of inflammatory cells and fatty material (composed of cholesterol, calcium, and fibrin) called plaque.

Heart bypass surgery involves attaching (grafting) a blood vessel taken from elsewhere in the body to the diseased coronary artery. This results in a redirection of the blood flow around the blockage. When a person has a double (or triple) bypass surgery, it means that two or three arterial blockages are rerouted.

Benefits of Surgery

There are several major benefits of having heart bypass surgery, these include:

• Living a pain-free life: According to a 2015 study, people who have bypass surgery can often live long-term without discomfort from chest pain or heart failure. 
• Lowering risks associated with CAD: This includes lowering the risk of future heart attacks.
• Living longer: A 2016 study found that those who had heart bypass surgery in addition to medical therapy lived longer than people who had just medical therapy alone.

It’s important to learn how you can optimize the positive benefits of heart bypass surgery. Quitting smoking, employing a heart-healthy diet, and getting active are a few major ways to make a positive impact in the long term.

Possible Future Surgeries

There are several reasons why someone who has had heart bypass surgery may require another operation (reoperation); these include progression of your disease. Progression of coronary artery disease often results in new arteries that become blocked or in an occlusion in one or more of the grafted arteries. There are several factors linked with the longevity of new graft arteries, including:

• The type of blood vessel used for the graft—a vein or an artery
• Quality of the heart arteries that are being bypassed
• Risk factors linked with heart disease, such as smoking, high cholesterol levels, and inactivity.
• Genetics
• Complications from your first bypass procedure, such as infection at the graft site

Any of these factors could require a person to need a subsequent heart bypass operation.

Note, bypass surgery reoperation is, in many instances, difficult and should only be performed by surgeons who have experience in performing such operations.

Risks Associated With Reoperation

Because of the many advances in medical science today, when it comes to heart surgery, many people are living long enough to require a second heart bypass surgery. But there are many challenges connected with having reoperation for coronary artery disease, these include:

Age: As a person ages, many times they develop more health problems. Depending on your health status, and other factors related to age, reoperation can be harder to recover from than your first heart bypass procedure. Getting older increases the potential for risks during any type of surgery, due to common health problems such as high blood pressure, coronary artery disease, and other factors. According to the American Society of Anesthesiologists, "Just being older sometimes can cause some distressing side effects." 

Surgical adhesions: These are fibrous bands that develop between organs and tissues as a result of injury during a surgical procedure; they are similar to scar tissue, and in the case of heart bypass surgery, they often develop in the chest. These adhesions can cause difficulty for the surgeon, particularly one who is not experienced in reoperations.   

The condition of your arteries: Your best arteries were probably already used for grafting during your first heart bypass surgery. If you are having another procedure performed, the surgeon must harvest part of the artery that is further along the vascular tree and not considered as good as arteries used in your first heart bypass procedure. 

Lifestyle Adjustments

Anyone who has had a heart bypass surgery to correct life-threatening or major artery blockage in the heart, will need to address several aspects of long-term recovery. According to the Centers for Disease Control and Prevention (CDC), approximately 50% of Americans have at least one of these three key risk factors:

• Smoking
• High cholesterol
• High blood pressure

Having these risk factors not only makes a person more prone to having CAD, they also lend themselves to make a person with CAD more prone to long-term complications, such as a heart attack or stroke, even after heart bypass surgery.

Getting your blood pressure under control may involve starting on medication called antihypertensive drugs to lower the blood pressure. But even if your healthcare provider does not feel you need medication, it’s imperative to address lifestyle changes that can adversely impact the blood pressure. These lifestyle changes include management of stress, regular exercise, quitting smoking and controlling alcohol use. 

When it comes to high cholesterol, the same is true; you may be ordered to begin taking statins or other drugs that lower your cholesterol.  But whether or not your healthcare provider orders high cholesterol medication, eating a heart-healthy diet that is low in saturated fats will be part of your long-term recovery plan. 

Learn what causes the risk of severe complications of CAD—such as heart attacks or strokes—and what you can do to lower these risks. The primary lifestyle and dietary changes you will need to make as part of your long-term recovery include:

Quitting Smoking

If you do smoke, quitting is of utmost importance, because smoking directly contributes to the process that blocks the arteries in the heart in those with CAD. There are many tools and resources available to help you quit.

The American Heart Association offers resources including a network of toll-free hotlines and groups aimed at helping people quit. When it comes to heart disease, there are some things that are out of your hands—such as your age and genetics—but quitting smoking is one thing you can take control of, to help you feel that you are in the driver’s seat, empowering your long-term recovery process.

Eating a Heart-Healthy Diet

When it comes to exactly which diet you should eat after heart bypass surgery, your healthcare provider will likely order a special diet for you. Everyone has different ideas on the best meal plan for heart health, but, according to the American Heart Association, one example of a heart-healthy diet is the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension, and it’s had some very encouraging medical research study results. The DASH diet includes:

• Whole grains
• A variety of whole, fresh (not canned or processed) fruits and vegetables
• Low-fat dairy products
• Skinless poultry and fish
• Legumes, including beans and lentils
• A small number of nuts and seeds, several times per week
• A controlled, small amount of red meat, sweets or fats
• Limited sodium levels
• Limited amounts of lean red meat
• Low in trans fat, saturated fat, and total fat

Eating a low fat, heart-healthy diet also lends itself to helping people who are in need of managing their weight. Keeping obesity at bay and maintaining a healthy weight is important during long-term recovery from heart bypass surgery.

Note, a diet that is low in cholesterol and saturated fats is aimed at slowing down the process of plaque build-up on the arteries. If you have not consulted with a nutritionist, ask your healthcare provider for a referral to get help planning and transitioning to a heart-healthy, low-cholesterol diet.

Exercise

This is a vital lifestyle change for people with heart disease. Many people who have had heart bypass surgery worry about how much activity and what level of intensity in a workout is okay after surgery. That’s the reason that there is a structured program called “cardiac rehab,” short for cardiac (heart) rehabilitation. The program involves:

• Medical support
• Help with employing a heart-healthy lifestyle
• A structured, monitored exercise program (designed specifically for people with heart disease)
• Nutrition counseling
• Psychological counseling

According to a 2010 study, those with heart disease who completed cardiac rehab have a higher likeliness of living longer than those who did not finish the program. Cardiac rehab is paid for by some insurance providers, such as Medicare. You must have an order from your healthcare provider to participate in a cardiac rehab program.

Blood Pressure Management

Keeping blood pressure under control is vital to long-term recovery, after heart bypass surgery. It’s important to take your antihypertensive medication (drugs that lower blood pressure) ordered by your healthcare provider, exactly as instructed. Adhering to a precise medication regime (by taking antihypertensive drugs at a specific time each day) is important. If you go off the recommended schedule and miss dosages or take medication too early or too late, it could cause fluctuations in your blood pressure. 

Managing Stress

This is another important lifestyle change for those with heart disease. Chronic (long-term) stress is a risk factor for heart disease, and it can potentiate hypertension. There is a structured stress management program, designed specifically for those with heart disease, called Mindfulness-Based Stress Reduction (MBSR). You can find out more about an online MBSR course at UMass Memorial Medical Center.

Processing Emotions

It’s normal to feel a range of emotions when recovering from a major operation such as heart bypass surgery, but if you have symptoms that don’t go away or are severe, you could have a medical condition called major depression. According to Cleveland Clinic, approximately 20% of those who have undergone heart bypass surgery have clinical depression afterward. 

Being depressed can interfere with other aspects of long-term recovery from heart bypass surgery, such as causing you to lose motivation to exercise or stay on your diet. If you are severely depressed every day and have other symptoms—such as insomnia, lack of interest in hobbies and other signs of clinical depression) lasting more than two weeks—you should consult with your healthcare provider.

You may be interested to know that studies have discovered depression lends itself to an increase in all causes of death in people with CAD; in fact a 2018 study found that depression may have an adverse effect on the overall outcome of cardiac patients.

A Word From Verywell

If you are struggling with motivation and/or other aspects of the emotional aspects of recovery from heart bypass surgery, it's important to reach out and get help. Not only is it vital to talk to a healthcare professional, it's also important to reach out to friends and family members and share what you are going through. Many people find that getting involved in a support group of others who are going through similar experiences can be a game changer. There are many online and in person support groups for people dealing with recovery from heart surgery, such as the American Heart Association.