Open heart surgery, also known as coronary artery bypass graft or CABG, saves the lives of millions of Americans annually. Not without risk, this life-saving surgery can lead to post-surgical complications such as congestive heart failure, or CHF. CHF occurs when the heart can no longer effectively pump the blood and a pooling, or congestion, of blood occurs in the lungs and extremities.
Chronic Ischemia
Ischemia is the medical term relating to the state of decreased oxygenation that the heart suffers before, during and after open heart surgery. Dr. John Butterworth of the Wake Forest University School of Medicine discusses the correlation between ischemia and coronary health, stating that the lack of oxygen is the framework for developing congestive heart failure. Those who suffer years of angina and coronary artery disease prior to their heart surgery have suffered ischemia.
Decreased Coronary Blood Flow
The heart is placed in a frozen state during open heart surgery. Typically, a perfusionist will maintain the blood and oxygen flow through the rest of the body with a bypass machine. Once the coronary artery bypass graft is complete, blood flow resumes through the new coronary grafts, but the first days after surgery are tenuous. According to Dr. Butterworth, this decreased coronary blood flow during the open heart surgery sets up the heart for failure in the recovery period.
Increased Pulse Pressure
Pulse pressure is a number measurement reflecting the difference between systolic and diastolic blood pressures with a normal range from 30 to 40 mmhg. An increased pulse pressure prior to CABG has been directly correlated to a 52 percent increased risk of developing CHF post surgery. When an increased pulse pressure is viewed prior to surgical intervention, actions can be taken to decrease the risk of CHF after open-heart surgery.
Pre-Operative Lifestyle
Coronary surgery only fixes the blocked arteries; it does not alter the lifestyle of the one undergoing surgery. If the coronary disease stemmed from lifestyle choices such as smoking, poor eating choices and a sedentary lifestyle, these habits may continue after open heart surgery. When excessive fat and sodium intake, as well as nicotine and alcohol use resume after surgery, this will predispose the post-surgical patient to heart failure.
