Complications of CABG

Excessive bleeding after surgery:

Usually Occurs in the first day after surgery. About five patients in 100 require a return to the operating room to stop excessive bleeding. Bleeding may occur as result of the effect of the heart lung machine on your platelets and clotting factors that play an important role in stopping bleeding. Another reason is bleeding at the places where the grafts are sutured to your coronary arteries. If you are bleeding too much, you will receive blood transfusion as well as blood products which will help your clotting system to stop bleeding. Some medications might be given which will help also. If bleeding continues despite all medical treatment, you will be taken back to the operating room. All surgical sites will be explored and secured if needed. All the blood clots will be removed and antibiotics may be put inside your wound to prevent infection. After controlling bleeding, you will be taken to the ICU to continue your regular postoperative care.

Myocardial infarction or heart attack can occur immediately after surgery. This can be due to occlusion of one of the grafts. It may also be cause by other causes related to the heart lung machine and the technique of surgery.

Respiratory insufficiency or pneumonia may develop and may require prolonged stays including treatment with a respirator. Patients in which the left internal mammary artery graft is taken might develop fluid collection in their chest (pleural effusion) and sometimes paralysis of the nerve that supplies the main muscle of respiration (diaphragm).

Kidney failure may develop. This is more likely in people who have some degree of preoperative kidney failure and in those with poor heart function for prolonged periods. Kidney failure may require dialysis.

Heart arrhythmias, or irregular heartbeats, are fairly common after heart surgery. Most are not serious. About 20 percent to 30 percent of my patients develop atrial arrhythmias, sometimes atrial fibrillation or atrial flutter. Also, the ventricles may beat faster than normal. Again, these are usually not serious conditions but may require treatment with medicines. Sometimes, the heart even has to be shocked electrically back into a normal rhythm. The likelihood of these irregular rhythms decreases in the first few days after the surgery, and, by about a month after the surgery, most additional medicines prescribed to treat these abnormal heart rhythms can be discontinued.

Infection of the breastbone or the sternum: this is a very serious problem and may lead to instability of the breastbone which may require another operation to stabilize the sternum together with antibiotic therapy.

Infection can affect incisions of the leg or the hands that the grafts are taken from. Infection usually resolves with frequent dressing and antiobiotics and if not severe, can be treated on outpatient clinic basis.

Stroke  may occur in about one or two of every 100 patients. The risk is higher in elderly patients. Sometimes strokes can be very severe. The patient may be in a coma and never wake up after the surgery. Fortunately, most strokes are much less severe, and most patients who have a problem with their speech or a weakness in an arm or a leg either totally recover or recover to some degree. One of the causes of strokes is related to blockages in the arteries that deliver the oxygenated blood to the brain. The two major arteries are called the carotid arteries, and they can develop atherosclerotic disease just as the coronaries can.

Mood swings, loss of concentration and visual disturbances are common. This usually improves during the weeks following surgery.

Over several years, coronary artery disease may progress in grafted or ungrafted arteries, and further treatment may become necessary. This risk can be reduced by taking your medications as instructed and by reducing risk factors linked to coronary artery disease (for example, smoking, sedentary lifestyle, overweight, and so on.)

Persisting pain in the breastbone is another reported problem after CABG