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UNDERSTANDING YOUR HEART
Introduction
Your doctor has recommended heart surgery, which may be a new experience for you. This text is designed to help you understand the MIDCAB procedure and answer any questions you may have. Your understanding can play an important role in helping you prepare for surgery, as well as helping you feel more confident when you resume your normal daily activities.

If you have questions after reading this text, please write them down so that your doctor or nurse can answer them for you. Reading this should not take the place of an informed discussion with your doctor and other members of your healthcare team.

WHAT IS MIDCAB ™?
Minimally invasive direct coronary artery bypass (MIDCAB) is a new procedure for certain types of coronary artery blockages. In many ways, MIDCAB is similar to traditional coronary bypass surgery. However, two advantages of MIDCAB are that the heart does not stop beating and the incisions are smaller.

Most candidates for the innovative MIDCAB procedure receive one or more coronary bypass grafts. The MIDCAB procedure may be used for patients who:

  • Are not candidates for angioplasty or whose previous angioplasty was not successful
  • May have undergone a previous conventional bypass surgery and now have blockages in one or two grafts
  • Have medical problems such as decreased heart function, poor physical anatomy, or a history of stroke or pulmonary disease
  • Require a less invasive form of surgery
Here are some important facts about your MIDCAB procedure:
  • The procedure may be preceded by, or followed by, angioplasty. To find out if you will be receiving angioplasty, ask your doctor.
  • Most MIDCAB procedures do not require a cardiopulmonary bypass machine (heart-lung machine), but one will be available if needed.
  • During the procedure, medications may be used to slow down your heart. Special instruments will then keep selected areas of your heart very still while the rest of your heart functions normally. This will enable your surgeon to operate on your heart while it continues beating.

WHAT TO EXPECT
Every patient who receives the MIDCAB procedure requires individual evaluation and care. The following is a general overview of what you may expect during your hospitalization and recovery period.

PRE SURGERY
Your pre-operative preparation will begin prior to your admission to the hospital. Since your family members will play an important role in your care and recovery, their presence during this time is strongly encouraged. Your pre-operative preparation may include:

  • Blood sampling
  • Chest x-ray
  • EKG
  • Meeting with your clinical nurse specialist
  • Meeting with your surgeon
  • Patient and family instructions

DAY OF SURGERY
On the day of your surgery, you will be admitted to the hospital and your family will be able to spend time with you prior to your MIDCAB procedure.

During what is usually a 2 to 3 hour procedure, your family will wait in a special room and will be informed when your surgery is completed.

MORE ABOUT MIDCAB™ PROCEDURE
Your surgeon will determine what type of surgical incision to use, depending on the location of your blockage. In a common procedure, an 8 to 10 centimeter (3 to 4 inch) incision is made under the left breast, in order to connect the left mammary artery to bypass a blockage in the left anterior descending coronary artery. Other procedures require a small incision under the right breast, or a vertical incision at the lower end of the breast bone.

Your specific surgery will be explained to you by your surgeon.

In the operating room, you will receive general anesthesia and a breathing tube will be inserted. A ventilator (respirator) will provide oxygen and assist your breathing. The breathing tube will be removed in the operating room following surgery, or in the recovery room a short time later.

AFTER SURGERY

  • From the operating room, you will go to the cardiac surgery recovery room, where your family will be allowed to visit you. You may stay here overnight or be transferred to another unit.
  • Several activities will be initiated in the recovery room, such as breathing exercises, turning and dangling your legs over the side of the bed, and sitting in a chair.
  • You may have multiple intravenous lines and drainage tubes. Within 12 to 24 hours, these will probably be removed and you will be transferred to a regular hospital room.
  • After you have been transferred to a regular hospital room, nurses and physical therapists may help you start walking while wearing a small, portable cardiac monitor.
  • Oral medications will be resumed and you will be able to eat solid food under the direction of your nurse.
  • You will be encouraged to take pain medication to make activity easier.
  • If your recovery is routine, you will be discharged from the hospital on the morning of your third day (the second day after surgery).
GOING HOME
  • On the day of your discharge, a nurse will remove the dressings over your incisions and assist you with a shower.
  • Your incisions will be covered with small strips of tape (which will eventually curl up and fall off). The nurse will cover the incisions with a dry, sterile dressing and instruct you on the care of the incisions at home.
  • Walking is the recommended exercise for the next four weeks. You should increase your distance as tolerated.
  • Take a daily shower with warm water.
  • Observe the incision daily.
  • Avoid lifting or pulling anything greater than 10 pounds for the first four to five days after surgery, especially on the side of your incision. Resume your previous activities based on how you feel.
  • Contact your cardiologist once you are discharged from the hospital. Report any symptoms of angina or breathing difficulties.
  • Eat nutritious foods to help regain strength.
  • Your normal bowel routine should return within three to four days after surgery. You may need the assistance of an over-the-counter laxative.
AFTER RECOVERY
After the initial recovery period, you should resume a low fat/low cholesterol diet and return to regular exercise. Coronary artery disease prevention should become an integral part of your lifestyle.

Your cardiologist can refer you to an outpatient cardiac rehabilitation program in your area to improve your cardiac function.

  • Your nurse will instruct you on your medications and the use of special breathing exercises at home.
  • You may have a physical therapy session.



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