Bypass to the future: A CABG success story

Sumithra1, Loganayaki2

1Staff Nurse, Kauvery Hospital, Hosur, Tamil Nadu

2Assistant nursing Superintendent, Kauvery hospital, Hosur, Tamil Nadu

Introduction

Coronary artery bypass grafting (CABG) is a major surgical operation where atheromatous blockages in the coronary arteries are bypassed with harvested venous or arterial conduits. The bypass restores blood flow to the iischemic myocardium thatal in turn restores function viability, and relieves anginal symptoms

Almost 400,000 CABG surgeries are performed each year making it the most performed major surgical procedure. but numbers have decreased as the use of alternative options such as medical treatment and percutaneous coronary intervention (PCI) have increased.

Definition

CABG is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Artery or Vein from else where in the patient’s body are harvested and used as conduits. Grafted internal mammary arteries or radial arteries, and saphenous vein grafts to the coronary arteries bypass atherosclerotic narrowing in the native arteries and improve the blood supply to the coronary circulation supplying the myocardium. This surgery is usually performed with the heart stopped. (cardioplegia)

Types

  • Double bypass – It means two coronaries are bypassed, eg: Left anterior descending (LAD) coronary artery and Right Coronary Artery (RCA)
  • Triple Bypass- It means three arteries are bypassed. (LAD, RCA, LCX)
  • Quadruple – It means four vessels are bypassed (LAD, RCA, LCX, first diagonal artery of the LAD)
  • Bypass of more than four coronary arteries is uncommon.

Case presentation

A 51-years-old male patient presented with complaints of chest pain, and left upper limb radiating pain. He had a past history of zygomatic fracture and ORIF was done.

Signs and symptoms

The patient presented with chest pain radiating to the Lt upper limb.

Diagnostic evaluations

ECG – ECG showed ST elevation in V1 V2 and V3

Echo

  • Heart rate- 112 beats per minute
  • CAD
  • RWMA+
  • Severe LV dysfunction noted LVEF – 30%
  • Mild mitral Regurgitation, Trivial Tricuspid Regurgitation
  • No pulmonary Artery Hypertension
  • RV function good
  • IVC normal
  • No pericardial effusion/clot / vegetation

Coronary Angiogram

  • CAD –TVD
  • Calcific coronaries

Nursing diagnosis

  • Acute pain related to surgical procedure and chest tube placement
  • Decreased cardiac output related to fluid balances
  • Impaired gas exchange related to altered pulmonary blood flow
  • Activity in tolerance related to surgery
  • Risk for ineffective breathing patterns related to decreased lung expansion

Management

Patient underwent successful CABG with L I M A, Radial Artery and SVG (: L I M A to LAD, \RA to OM1/OM2 and SVGto-RCA on 3/10/2025. The procedure was performed under general anesthesia, and the patient was monitored in the intensive care unit (ICU) in post procedure.

Respiratory Management

  • Maintain Airway Monitor for signs of respiratory distress, ensure effective ventilation, and encourage breathing exercises.
  • Promote deep breathing and coughing exercises:Assist the patient with deep breathing and coughing exercises. Provide a sputum cup for secretion clearance.
  • Incentive Spirometry:Encourage regular use of the incentive spirometer as taught pre- and post-operatively, ideally every hour.
  • Mobilization:Begin ambulating the patient from post-operative day 1 and encourage sitting in a chair.
  • Monitor Oxygenation:Assess oxygen saturation and breathing patterns, reporting any signs of pulmonary congestion or decreased oxygenation.

Hemodynamic and Cardiac Monitoring

  • Monitor Vital Signs:Regularly check and record vital signs, including heart rate, blood pressure, and temperature.
  • Cardiac Status:Observe for central venous pressure changes, low or high cardiac output, chest pain, arrhythmias like atrial fibrillation or ventricular fibrillation.
  • Fluid and Electrolyte Balance:Monitor intake and output, urine color, clarity, and note fluid balance.
  • Medication Management:Administer prescribed IV and oral medications to support blood pressure, heart function, and manage pain or bleeding.

Neurological Function

  • Monitor Neurological Status:Assess the patient’s level of consciousness and overall neurological function.
  • Incision and Pain Management:Administer pain medications as prescribed, provide psychological support, and encourage position changes.
  • Prevent Bleeding:Regularly monitor for excessive bleeding from incision or drainage sites, checking drain output hourly.

Pharmacological Management

Medications administered include

  • Tab Clopitab A (150/75 mg)
  • Tab Rosuvas (20 mg)
  • Tab Ivabrad (5 mg)
  • Tab Pan (40 mg)
  • Tab Lasilactone (50 mg)

Gastrointestinal Management

  • Assess for Complications:Monitor for nausea, vomiting, bowel sounds, and movements.
  • Diet Advancement:Gradually advance the diet starting with liquids once the patient is stable and tubes are removed.

Patient and Family Education

  • Self-Care Behaviors:Educate the patient on the importance of breathing, coughing exercises, and early mobilization.
  • Lifestyle Changes:Discuss smoking cessation, healthy diet, regular exercise, and medication management after discharge.

Health Education

Wound Care

  • Keep the surgical site clean and dry as per doctor’s instructions.
  • Gently wash the incision site with soap and water during daily showers; avoid soaking in hot tubs or bathtubs.
  • Avoid scented soaps, powders, or creams on the surgical site.
  • Contact the doctor if signs of infection appear, such as redness, swelling, drainage, or fever.

Activity and Rest

  • Ensure adequate rest with gentle movements and gradually increase activity as strength improves.
  • Avoid standing or sitting in one position for extended periods.
  • Refrain from activities straining chest muscles.

Diet

  • Follow a heart-healthy diet rich in fruits, vegetables, whole grains, proteins, and healthy fats.
  • Avoid processed foods, sugary snacks, fried foods, and foods high in saturated and trans fats. Reduce salt and red meat intake.

Medication and Monitoring

  • Take all prescribed medications, including blood thinners, as directed by the doctor.
  • Do not stop medications without consulting the doctor.

Conclusion

This study highlights successful management of a 51-year-old male patient with CAD with triple vessel disease using CABG. The patient received comprehensive care from the health care team His symptoms improved and he maintained stable hemodynamics, which gained patient satisfaction. The patient was discharged successfully and has returned to duty in a healthy condition.

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