Dad needs 5 vessel CABG

  1. Hey everyone. I just found out my 59 year old Dad needs a 5 vessel CABG. Understandably, both as his oldest daughter & an RN, I'm very concerned! Dad's a NIDDM type 2, mostly diet controlled, though his doc just started him on glipzide 5 mg po QD. No hx htn according to Dad, but he has just recently developed some exercise induced angina pain.Cariologist started him on beta blocker (toprol) few days ago after CP induced on stress test. Also was given prn ntg rx. He had heart cath this am (he lives out of state & my step mom tells me the info) & docs say he needs a 5 vessel CABG.

    I don't get many post CABG on my floor, as I work med/tele/renal and we only get post EP study, post heart cath, post pacers, more stable teles. I have floated to step down, and I've seen post CABG, but not really knowing what to expect. My memory is, anyone needing multivessel CABG has some serious cardiac dz & comorbidities.I did some internet searches & it looks grim, with his DM and family hx of cardiac dz (his dad died of MI, older sis had MI x4 and also has DM).

    My husband & I are flying out to be with Dad & family in a day or two.In the meanwhile, I'm feeling mixed emotions. On one hand, glad they caught this before an MI (Dad says his cardiologist states no cardiac muscle damage). Though I don't know any details, getting it all second hand. Don't know if LAD is blocked & how much, don't know ej. fraction.

    Dad used to smoke for 20+ years, but has been compliant w/ diabetic diet & non smoker for 10 years.Blood sugars recently "high" per Dad at 150s (and just started glipizide). Excercises regularly. Not overweight- never has been more than 20 lbs overweight. 5 ft 10, 160 lb now.High stress job, though. Owns his own business & has been working 14 hr days.

    I am going to be supportive, strong & put on a happy face for Dad, but I am very worried! Even with surgery going well w/o complications, I wonder what the post surg. survival rate is for multivessel dz & DM? The internet info I read looked grim. Anybody have any tips or words of hope? He's only 59, and I don't want to lose him.
    Thanks!!!

    ~kona
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  2. 14 Comments

  3. by   lalaxton
    Kona,
    Sorry to hear about your dad! I am a Cardiology NP and although we do not do CABG here at my facility we do send many patients and 'repatriate' those who need more than the standard 5 day recovery.
    First if your dad's Cardiologist says his heart muscle is ok then his ef and left ventricular function should be normal. Yes he is at higher risk because of family hx and DM but having caught this before an MI and thus before damage has been done means that he should recover fine especially if he is in reasonable physical condition, has great support system (he has you!) and has no prior end organ damage (eg renal failure). THis said however there is always a risk of any surgery. No statistic will make you feel any more comfortable because it's your dad. A 1% risk means nothing if you are the 1% that has problems. All you can do now is encourage him to have a positive attitude and be there for him!
    Good luck my thoughts are with you!
  4. by   Dr. Kate
    It's never harder to be a nurse than when it's with your own.

    CV surgery isn't my area of expertise. But, if you have a chance talk to a nurse you know or some suggests to you in the CV surgery unit of your hospital. They'll be able to tell you what questions you will want to ask the doctors and the nurses caring for your dad. When you dad has surgery, let the nurses know you're a nurse and want to understand and help. Let them know you don't want to take over, just be kept informed. You may not be "one of our own" at that particular hospital, but you can "be "one of our own" in the company of the nursing staff.
    It's hard to have to be the strong, knowledgable one, let the nurses know. Just like you'd help a family member, they'll help you, if you give them the opportunity.
    Don't forget to rest and eat while you're there.
    Good luck
  5. by   Love-A-Nurse
    kona, i just wanted you to know i will be thinking of you and yours through this time in your lives. i will say a prayer for your dad.
  6. by   hoolahan
    Kona, I worked CT ICU for 13 years. I saw many pt's have 4 and 5 vessel bypass safely. The key is the surgical expertise. What you need to do is find out what hospitals are available in the area, and ask the nurses, from one professional to another, "If this was your father, which surgeon would you send him to?" It makes the world of difference. Not every great hospital has cardiac surgeons of equal ability. If you were on the East Coast, I would tell you exactly who I would send him to, and this guy did an unheard of 7 vessel bypass on my friends hubby, and he is doing great 10 yrs later.

    Of course you are right to be concerned about the diabetes, but it seems that he has been keeping it under control. As long as sugars are under control, and managed aggressively post-op, the risks are about the same. Even more important after the surgery to keep DM under good control. Does he have a glucometer? If not, he needs one to monitor his sugars. The fact tha he no longer smokes is very much in his favor as well.

    I would say your best hopes are to thoroughly investigate the surgeon. do NOT worry if you seem obnoxious, this is your dad, and you love him, so you advocate for him, as aggressively as you have to. Do not accept vague answers to your questions, be persistent. Anyone who isn't upfront with you about what to expect, I would be leary of. Find out how many pt's the surgeon has done on people w diabetes and 5 vessle disease and how their outcomes are.

    I will keep you in my thoughts. If you have any questions, feel free to pm me.
  7. by   MollyMo
    Hey, Kona. I've been doing CV nursing since I graduated almost 12 years ago. I don't know what Internet site you were on and got those stats, but don't go back. Your dad's chances are 50/50. Plain and simple, he'll live or he won't. WHEN he comes off the table and goes to ICU, he will be restrained for his protection. He will have an ET,NG, swan, art line, chest tube and foley. If the hospital is typical he'll have a ton of IV'S and should have one or two nurses assigned only to him who are bypass certified. They will try to extubate around 12 hours post op. If all goes well he'll be in the chair by 18 hours and to the stepdown unit 24 to 48 hours. They should tell you all this before surgery. Ask at the hospital if they will allow you to see a post op cabg in the unit to give you an idea what to expect. What your dad needs to do is make sure he takes his pain medicine around the clock the first couple of days. Make sure he uses his incentive spirometer. Make sure he splints his chest when he coughs and deep breathes. Where I work, the patients are only in the bed when they are asleep. Otherwise they are up walking or sitting in the recliner. Keep track of whether or not he has a bowel movement. He should by the second or third day. If not let the staff know. The nurses should push him to do even if he doesn't want to and you guys need to reinforce the staff's instructions. I've seen plenty of diabetics do well with the surgery. Some require less medication once their heart is back to proper function. One common complication is going into atrial fibrillation, sometimes rapid sometimes controlled. A surgeon explained to me that it happens because the heart hasn't adjusted to having increased blood flow and doesn't realize that it doesn't have to work hard anymore. It's easily fixed. Be strong. Be positive. DON'T hover, give him space. You want to get him to doing things for himself. Assist as needed, but don't do it for him. Don't take any crap from him. Men in that age group tend to get angry or depressed. He should nap during the day if possible. If he can't sleep, they should have a sleeping pill ordered. If not ask for one. Keep us posted. You and your family are in my prayers. Be Blessed. :kiss
  8. by   SmilingBluEyes
    Kona best wishes and prayers your way. I hope your father does well and makes a speedy recovery. Good luck and keep us up-to-date!
  9. by   live4today
    Kona.....((((hugs)))) I will be praying for your father as well.
    My own father is on a daily pill for diabetes, and he was about your father's age when he underwent a quadruple CABG procedure. He also had previous surgery before that where they replaced his mitral valve. He has had to wear those 24 hour heart monitors that record how his heart is or isn't doing. Today, he is 72 years old, and still playing golf. I hope your dad does as well in the surgery to correct his heart problems, too. :kiss
  10. by   ERNurse752
    I did an internship in a cardiovascular recovery room...I saw a lot of similar pts do very well after CABG. Most of the pts I saw who did not do well were older, smokers, out of control diabetics, renal insufficiency/failure, and pts who had sick hears from prior cardiac damage.
    Your dad sounds like he should do well...he's pretty young, no cardiac muscle damage, non-smoker for 10 years, sugars decently under control, and compliant.
    At my facility, the goal is to wean from the vent within the first 8 hours, and up in the chair the same evening...the sooner he can get up, the better. It is scary when they come back, b/c they have ETT, OG, swan, art line, central line, chest tubes...
    But, those will all come out as he continues to be stable.
    The nurses in CVRR (at least where I work) will let you know when it's ok to visit, and you'll be allowed a few minutes at a time, if he's stable enough. Some pts who are more unstable will drop their bp/heart rate with any kind of extra stimulation. We've had to have security remove family before, b/c they insisted on hovering in the room talking to their loved one, not understanding that we're not being mean, we're trying to keep them alive!
    It's good that he's been compliant...that will be very important for diet, and rehab after surgery.
    I'll be praying for him...keep us posted!
  11. by   fedupnurse
    Kona, best to you and your dad!! I couldn't agree with Hot Lips more about getting the right doc! Our facility boasts great stats but I wouldn't stay here if you paid me a million bucks. Stats are worthless. Ask the nurses in the area where your dad lives "who would you go to if this was your dad?" I'd hit NYC or Philly as I live in Jersey. Don't be shocked if he ends up on Insulin for a while as they like to keep their sugars on the lower side. They may also want to check his hemoglobin A1C to see how his sugras have trended over the past couple of months. Don't want it above 6 or 6.5 depending on the lab.
    And may I be so bold as to say to take care of yourself. Your dad's history can directly impact your future health. SO please, when all this settles down, find a cardiologist you trust and get a workup done. Try to head off problems at the pass!
    Please let us know how the surgery goes. Best to all of you and hang in there!
  12. by   e-nurse
    I've been doing cardio-thoracic step-down for 2 years and I agree w/ everything Mollymo says except the 50/50 chance. His chances of geting through the surgery and doing well are probably in the 90%'s. Everything about the incentive spirometer, pain meds, walking, atrial fibrilation, and depression are all accurate. The only thing I would add is that you shouldn't waste too much energy looking after him while he's in the hospital, he'll need you or someone more once he goes home and doesn't have nurses looking after him 24/7. Make sure he has someone @ home to look after him24/7 the first week or two after discharge, making sure he's continuing w/ his IS and walking to keep his lungs healthy and get his strength back. Best of luck to you and your dad.
  13. by   Genista
    Thank you for the wonderful advice & prayers! I talked to Dad today & surgery is set for Monday morning at 6 am. He got the "inside scoop" from some RNs in the area (he has his connections, hee hee) and his CV surgeon is supposedly "the one" to go to. Hubby & I are flying out there Monday afternoon after I do my weekend charge nurse duty at work (we'll be flying out of state). All of your thoughtful comments were much appreciated. Thank you so much for responding to my worried post!

    I'm feeling a little calmer now that I've talked to Dad, have travel arrangements, etc. Your kind advice & support was wonderful! Thank you all! I'm hopeful it will go smooth. Dad has a lot in his favor, including family who loves him.
  14. by   Dazedgiggle
    Hi Kona....I'm sorry to hear about your Dad, but I do agree with MollyMo on pretty much everything. You really should get pre-op teaching so you know what to expect. I work on a CV surgical unit, and we have MANY diabetic patients who go through bypass surgery! Makes sense, since being a diabetic does put a person at higher risk for cardiovascular problems. These patients do absolutely wonderful after surgery. What is absolutely key is keeping those blood sugars under control. High blood sugars put a person at higher risk for infection and they won't heal as well as a non-diabetic, which I'm sure you and you're Dad are both aware of. In my facility diabetic patients are put on insulin drips for 3 days minimum, both IDDM and NIDDM, in order to keep very tight control of their blood glucose levels. Our goal is to keep them under 130, believe it or not! I just wanted to let you know that our small hospital performs 1000 cardiac surgeries a year, I see MANY diabetics go through this who have had more risk factors than your Dad (i.e. previous MI, low EF, etc.) and have really done wonderfully. Research the hospital and the surgeons if you can, and take care of yourself! Good luck and I'll be thinking of you and your Dad. :kiss

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