• Your Care Team During Coronary Bypass Surgery

     
     
     
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    Coronary artery bypass graft surgery requires the coordinated efforts of a team of medical professionals who will not only perform the operation and monitor your vital signs, but who will also prepare you before the procedure and look after your comfort and well-being when the surgery is complete.

    Read on to learn more about your care team before, during, and after bypass surgery.


    Cardiac surgeon. The lead person on your team will be your cardiac, or cardiothoracic, surgeon, who will perform the actual coronary artery bypass graft surgery. These surgeons specialize in treatment of the heart, lungs, esophagus, and chest. A cardiothoracic surgeon will have completed medical school, followed most often by a five-year residency in general surgery. After the general surgery residency, the physician will have completed a two- or three-year residency specifically in cardiothoracic surgery. Additionally, a board-certifiedcardiothoracic surgeon will have a valid license, be in good ethical standing in the profession, have passed tests demonstrating knowledge, and will demonstrate lifelong learning.

    The cardiac surgeon is responsible for opening the patient’s chest, chooses which blood vessel will be harvested from elsewhere in the body to use for the graft, and sews that blood vessel to the aorta and then the heart artery after the blockage to allow blood to flow around the blockage to the heart muscle. The surgeon will also wire the breastbone back together and close the incision with stitches.

    Before, during, and after your procedure, your cardiac surgeon will be assisted by other care team members, including the following:

    An anesthesiologist. An anesthesiologist is a medical doctor trained to administer the drugs that will take you "under" and block any feeling of pain or unpleasant sensations. Your anesthesiologist is involved in your care before, during, and after your surgery. He or she may do a medical evaluation before your surgery to determine an anesthesia plan tailored for you. During surgery, the anesthesiologist oversees life support and pain control. And after the surgery, he or she also provides pain management during your recovery. If time allows before surgery, you should discuss the anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques, with the anesthesiologist.

    A perfusionist.  During the bypass surgery, the heart is stopped while the surgeon grafts (sews) a blood vessel (a “graft”) to the clogged artery to create a bypass around a blockage. The perfusionist on the care team operates the heart-lung bypass machine -- the machine that takes over the responsibilities of the heart (to pump blood to the body) and the lungs (to exchange carbon dioxide in the blood for oxygen) during bypass surgery. The perfusionist may be a specially trained nurse or technician who has been certified by the American Board of Cardiovascular Perfusion. Those who are not certified should have at least two years of supervised experience working in an operating room during open heart surgeries. Some bypass surgeries called “off-pump” bypasses will take place with the heart beating and no heart-lung bypass machine.

    Operating room nurses and technicians. Operating room nurses and technicians support the cardiac surgeon as he or she performs the procedure. They also monitor your condition and work to make you as comfortable as possible.

    An intensivist. An intensivist (or ICU doctor) is a medical doctor who specializes in the care of critically ill patients, usually in an intensive care unit (ICU). An intensivist may be trained in internal medicine, anesthesiology, or another medical specialty. In addition, the ICU doctor will have completed a fellowship of one or more years' duration in critical care medicine. Depending on your hospital, you may be under the care of an intensivist while in the ICU or the cardiac surgery ICU.

    Intensive care nurses. If you are moved into the hospital's intensive care unit following bypass surgery, you will be cared for by intensive care (or critical care) nurses. These nurses have special training in caring for patients facing life-threatening problems, including cardiac and respiratory emergencies.

    Cardiac care nurses.Cardiac care nurses are specially trained to work with heart disease patients and their families. They may have an additional specialty –that of critical care nurse – that prepares them to work with patients in the hospital. Otherwise, you may be visited by a cardiac care nurse in your home following bypass surgery.

    Physical therapists/occupational therapists/rehab nurses. Both while you are in the hospital and after you are discharged, these medical professionals work with you to help you build up your strength, restore function, and regain your ability to move.

    Cardiac rehabilitation team. A team of health care professionals, including nurses, exercise physiologists, physical therapists, occupational therapists, dieticians and nutritionists, counselors and others, will provide education and coaching to speed your rehabilitation. During cardiac rehab, the team will support you as you learn and adopt a heart-healthy lifestyle, such as eating a healthy diet, becoming physically active, and managing stress.

    Cardiologist and primary care physician. Your cardiologist and primary care physician will continue to be an integral part of your care. Your cardiologist will be closely involved with your case while you are under the care of the cardiac surgeon. He or she, in turn, should also provide reports and updates to your primary care physician in order to ensure your continued coordinated care.