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Patient Instructions

You had minimally invasive coronary artery bypass surgery on 1 or more of your coronary arteries. Your doctor used an artery from your chest to create a detour, or bypass, around arteries that were blocked and could not bring blood to your heart. A 3- to 5-inch-long incision (cut) was made in the left part of your chest between your ribs. This allowed your doctor to reach your heart.

You may be able to leave the hospital 2 or 3 days after surgery. You may also be able to return to normal activities after 2 or 3 weeks.

After surgery, it is normal to:

• Feel tired
• Have some shortness of breath. This may be worse if you also have lung problems. Some patients may use oxygen when they go home.
• Have pain in the chest area around the wound

You may want to have someone stay with you in your home for the first week.

Learn how to check your pulse, and check it every day. Do the breathing exercises you learned in the hospital for the first 1 to 2 weeks.

Weigh yourself every day. Shower every day, washing your incision gently with soap and water. Do NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Follow a heart-healthy diet.

If you are feeling depressed, talk with your family and friends. Ask your doctor about getting help from a counselor.

Continue to take all your medicines for your heart, diabetes, high blood pressure, or any other conditions you have.

• Do not stop taking any medicine without talking with your doctor or nurse first.
• Your doctor may recommend antiplatelet drugs (blood thinners), such as aspirin or clopidogrel (Plavix), to help keep your artery graft open.
• If you are taking a blood thinner, such as warfarin (Coumadin), you may have extra blood tests to make sure your dose is correct.

Know how to respond to angina symptoms.

See also:

• Angina - when you have chest pain
• Aspirin and heart disease
• Clopidogrel (Plavix)

Stay active during your recovery, but be sure to start slowly.

• Walking is a good exercise after surgery. Don't be concerned about how fast you are walking. Take it slow.
• Climbing stairs is okay, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.
• Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be okay.
• Slowly increase the amount and intensity of your activities over the first 3 months.
• Do not exercise outside when it is too cold or too hot.
• Stop if you feel short of breath, dizzy, or any pain in your chest. You should avoid any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
• Keep your incision area protected from the sun to avoid sunburn.

Be careful how you use your arms and upper body when you move around for the first 2 or 3 weeks after your surgery. Ask your doctor when you may return to work. For the first week after surgery:

• Do NOT reach backwards
• Do NOT let anyone pull on your arms for any reason -- for instance, if they are helping you move around or get out of bed.
• Do NOT lift anything heavier than about 10 pounds (a little more than a gallon of milk).
• Avoid other activities in which you need to keep your arms above your shoulders for any period of time.
• Do NOT drive. The twisting involved in turning the steering wheel may pull on your incision.

Call your doctor if:

• You have chest pain or shortness of breath does not go away when you rest.
• Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
• You have dizziness, fainting, or you are very tired.
• You have a severe headache that does not go away.
• You have a cough that does not go away.
• You are coughing up blood or yellow or green mucus.
• You have problems taking any of your heart medicines.
• Your weight goes up by more than 2 pounds in a day for 2 days in a row.
• Your wound is red or swelling, it has opened, or there is more drainage coming from it.
• You have chills or a fever over 101 °.

Minimally invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole heart surgery - discharge

Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ. 2007;334:617.

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.