Heart Bypass Surgery: Recovery

Heart bypass surgery, also referred to as coronary artery bypass graft (CABG), is a major procedure. The recovery process is not always easy and the recovery timetable varies per person. However, as a general rule of thumb, you may be hospitalized for approximately three to seven days, and many people are discharged in just a few days.

Once your hospital stay is over, your recovery is still far from complete. In fact, it may take several months before you’ll be able to return to the same lifestyle and engage in every activity you enjoyed before your surgery. Two important factors to keep in mind are:

1. Everyone recovers at a different pace, don't set your expectations too high.
2. Always get the approval from your healthcare provider before engaging in any type of activity for the first time after your surgery.

Surgery Follow-Up

After you are discharged from the hospital, it’s important to see your healthcare provider—usually a heart specialist called a cardiologist—on an outpatient basis. You will be scheduled for regular follow-up appointments; it is very important for your recovery and overall health to be sure to keep these appointments. Here is an example of what your follow-up appointments may look like:

• The first appointment: Three to seven days after your discharge. During this visit with your cardiologist you will establish appointments for subsequent visits.
• The second appointment: Six weeks after the initial appointment.
• Yearly follow-ups: Once you're recovered, your cardiologist will probably want to see you on a regular basis, at least once per year.

You will be given a progress report—including facts about your surgery and hospital stay—to take along with you to your cardiologist. Your cardiologist will want to evaluate the progress you are making in your recovery. Your cardiologist will give you instructions on:

• When you can drive
• Go back to work
• Which foods to eat and which ones to avoid
• Blood pressure
• Exercise schedule

The advice you receive from your cardiologist will help prevent future complications such as a heart attack or stroke.

Recovery Timeline

After your heart bypass surgery, you will have limits on what you can do; it’s important to follow the advice of your healthcare team when it comes to when to begin engaging in specific activities, when to start eating solid foods again and so forth. Every person is different when it comes to how long it will take to get back to normal activities and to their pre-surgery lifestyle. Your healthcare team will assess how well your recovery is going and let you know when it’s time to progress to the next level of your recovery. With that in mind, here is a general timeline of how long it takes the average person to get back to a normal routine after bypass surgery:

The First 24 To 48 Hours After Surgery

A heart bypass procedure usually takes approximately four to six hours to complete. After your surgical procedure is complete, you will be transferred to the cardiac intensive care unit (CICU) or intensive care unit (ICU) (depending on the facility). Most people are transferred out of the CICU unit, to a lower level of care (such as a bed in a cardiology unit) in one to three days.

On the day of surgery, most people who have undergone heart bypass surgery:

• Begin drinking clear liquids: You will also start eating easy-to-digest solids once your body can tolerate it. You'll stay away from food that are fried, greasy, processed or spicy. 
• Are asked to sit up: Your healthcare team will encourage you to move your body by sitting up on the side of the bed.
• Are coached to cough and do deep breathing exercises frequently: This is to prevent lung complications such as pneumonia.

The Second Day After Surgery

On the second day after your heart bypass surgery, you may:

• Be expected to get out of bed several times per day: You'll be prompted to walk short distances in the hallway. You should try to walk every day and slowly, gradually, increase the distance that you walked from the day before. Walking helps prevent common post-surgery complications such as pneumonia and constipation.
• Be able to sit up in a chair: You'll be encouraged to eat your meals out of bed.
• Begin eating solid foods and drinking liquids as tolerated: There will be a limit to the amount of fluids you can drink (no more than six to eight cups) over a 24-hour period.
• Be moved to a regular cardiac unit: When you are moved out of the ICU, your heart will continue to be monitored closely via a small portable device called a telemetry unit, which continually transmits your heart's rhythm, heart rate, breathing and blood pressure, remotely. This enables the nurses to monitor your vital signs, even when they are not in the room with you. 

Hospital Discharge

The number of days you will be in the hospital after heart bypass surgery will vary. This timeline can depend on whether you have post-surgical complications as well as other factors. Usually, a person is in the hospital between three to five days after they are moved from the CICU. Once you are discharged to home, your recovery time can vary greatly. It may take anywhere from around four to twelve weeks to fully recover. 

Cardiac Rehabilitation

After heart surgery, many surgeons and cardiologists recommend a program called “cardiac rehabilitation,” which involves:

• A structured exercise program: This will begin while you are still in the hospital and continues during your recovery period
• Instruction on how to increase your physical activity: This will be done while under medical supervision after heart surgery.
• Information on how to work with a dietitian to improve your diet: Your cardiologist may order a heart healthy diet, rich in lean protein, whole fruits and vegetables and low in saturated fats.
• Support in reaching out to get help from other professionals: This may included occupational therapists or psychologists.
• Addressing aspects of implementing a long-term heart healthy lifestyle: This includes incorporating diet and exercise into your daily life.

Note, cardiac rehabilitation (rehab) may begin while a person is still in the hospital, or it may be ordered to start as soon as you return home after hospital discharge. You need an order from your healthcare provider to participate in a cardiac rehab program.

The First Few Weeks at Home

During the first few weeks after hospital discharge, many people who have undergone heart bypass surgery:

• Experience low energy levels and feel fatigued frequently
• Have intermittent post-operative pain
• Need to continue taking pain medication, as ordered by the healthcare provider
• Are not yet able to return to work
• Have strict activity limitations such as a lifting and driving restrictions
• May have insomnia
• May experience sadness and mood swings
• Commonly have symptoms of major depression

Coping During the First Few Weeks at Home

You should rest often and sleep when you feel tired. Sleep will help your body recover and help to replenish your energy level. If you have trouble getting enough sleep at night, there are some things you can do to help, including:

• Be sure to establish a regular pattern of going to bed and getting up at the same time every day.
• If you have frequent insomnia, you may want to eliminate naps to ensure you are tired at night. 
• Take your pain pills before you go to bed
• Be sure to sleep on your back for the first four to six weeks while your breastbone heals.

Coping with Pain

Pain after bypass surgery is common, some things you can do to relieve pain include:

• Continue to take pain pills at home as needed: According to your hospital discharge instructions and your healthcare provider’s orders.
• Take your medication at the first sign of pain: Don't wait until it gets severe.
• Wear loose fitting clothing: This will help promote comfort by reducing friction caused by tight clothes rubbing against your incision.
• Don't sit, or lie, too long in one position: Getting up and walking frequently will help alleviate the muscle stiffness that often accompanies inactivity after surgery.

Important Activity Warning

During an open heart bypass procedure, the surgeon cuts through the chest bone (sternum) to gain access to your thoracic area to perform the surgery. Unlike when a person breaks other bones in the body, the sternum cannot be put into a cast as the edges of the bones grow back together. The surgeon wraps heavy wire around the sternum to keep the edges together, so it can heal properly. You should be very cautious about engaging in strenuous activity during the first four to six weeks of your recovery. Activities that could compromise the healing of your sternum by pulling the edges of the bones apart include:

• Lifting objects that weigh over 10 lbs: This includes children, laundry baskets, trash receptacles and other objects.
• Driving: Even a minor car crash could cause the chest area to slam into the steering wheel.

6 Weeks After Your Heart Bypass Surgery

By week six after a heart bypass procedure, you may be able to perform many of the activities you engaged in before your surgery, but your healthcare provider will instruct you on specific activities you can do and when it’s okay to perform them, examples include:

• When to drive: Most surgeons recommend waiting at least six weeks after surgery to begin driving; even a minor accident could cause you to hit your chest area on the steering wheel which could disturb normal healing of your sternum. 
• When to return to work: Those who perform strenuous physical labor may need to wait longer than people who work at a desk all day.
• When you can begin lifting heavy items: It's important not to push yourself before your weight lifting restriction is eliminated.
• When you can resume engaging in normal sexual activity: Don't neglect to discuss this with your healthcare provider.

Twelve Weeks After Heart Bypass Surgery

For the first three months after heart bypass surgery, you should avoid any type of strenuous exercise that could strain your chest or upper arms, this includes activities such as:

• Pushing a lawn mower
• Mopping the floor
• Swinging a golf club
• Vacuuming
• Playing tennis (swinging the racquet)
• Lifting heavy objects (such as heavy grocery bags, cat liter or dog food bags, a child, etc)
• Other activities that put strain on your chest and upper arms

Most people are fully recovered at the 12-week mark after heart bypass surgery, and able to resume all normal, pre-surgery activities. Be sure to get the okay from your surgeon or cardiologist before resuming any type of exercise or other strenuous activity after your surgery.

Coping with Recovery

Recovery from heart bypass surgery involves both physical and emotional issues linked with well being. Emotional aspects of recovery may be associated with several factors such as fear of pain, fatigue, worry, stress, or being overwhelmed about integrating drastic changes in lifestyle. Common emotions may include:

• Mood swings
• Sadness, including crying frequently
• Frustration
• Irritability
• Difficulty concentrating
• Having fluctuations in how you feel you are recovering. For example, some days you may feel like you are doing better than others.

Depression

According to Cleveland Clinic, 15% of those with heart disease and up to 20% of people who have had bypass surgery experience major depression.

It’s common for people who are recovering from a major surgery, like heart bypass surgery, to experience negative emotions. However, if the feelings of sadness and depression don’t go away, or if they are severe, it’s important to reach out and talk to your healthcare provider. You may want to get involved in a local or online support group. Talking with others who are going through similar experiences can help. If you think you may have signs and symptoms of depression, be sure to talk to your healthcare provider about a possible referral to a licensed counselor or a clinical therapist. 

 There are many options—both online and in-person—for support and recovery groups. There’s even a course specifically designed to help people who have a heart condition and need to address stress reduction. The course is called Mindfulness Based Stress Reduction (MBSR). Learn more about an online MBSR class at U Mass Memorial Medical Center.

Wound Care

After a heart bypass procedure, metal wires holding your breastbone together are permanently placed. There are also stitches at the incision site that function to hold the skin together while it heals. The stitches will dissolve on their own and do not need to be removed. While you are in the hospital, and during your discharge interview, you will be instructed on exactly how to perform wound care to the incision as well as to the graft site. It’s important to:

• Keep the incision clean and dry: It’s okay to shower after your surgery but be sure to pat your incision dry afterward. 
• Avoid direct sun exposure while the incision is healing: Sun exposure can cause the scar to darken.
• Avoid bathing for the first three weeks after surgery: Or until your healthcare provider gives you the okay to bathe).
• Avoid swimming: This will only be for about a month after surgery.

Note, after your incision heals there will be a scar in the chest area—at the surgical site—as well as where the grafted blood vessel was removed from. The scar will appear very reddened when it first heals, but it will fade and become lighter over time.

A Word From Verywell

While recovering from any type of heart surgery may seem insurmountable, keep in mind that there are literally millions of people around the globe who are in the same boat. Reaching out to others who are going through or have gone through similar experiences can help.There is a wealth of educational information and resources available to help yo—such as the American Heart Association's online support network—on your journey to recovery.