Open-heart surgery is not available in Bermuda. Many dozens of patients undergo the surgery abroad every year, shortly after which they come back home and start the road to recovery.

The ultimate goal is to resume a normal and healthy lifestyle.

While open-heart surgery could be carried out for valve problems or congenital cardiac conditions, its most common indication remains coronary artery bypass in the setting of advanced coronary artery disease.

It is very important to know, and as the name implies, that coronary artery bypass grafting surgery does not reverse the blockages in the coronary vessels; those blockages are being bypassed by grafts harvested from the chest wall and/or legs.

This means that unless risk factors that lead to coronary artery disease in the first place are aggressively controlled, new blockages will continue to develop in both the native vessels and the new grafts, and will lead to future adverse cardiac events [angina, heart attacks, heart failure and death].

How do I take care of the wound in my chest wall?

Usually, and by the time you leave hospital, the wound has partially healed and does not require any further dressing, as long as it is kept dry and clear.

It is important to watch for signs of an infection, especially during the first two weeks after your surgery. The same applies to the leg wounds where the graft veins were harvested from. Inform your care provider if you have any of the following:

• Fever higher than 100.4°F

• Severe or worsening pain around your chest wound; a mild pain is very common

• A wound that is bleeding, draining pus, or has redness around it.

Do I need to take medication?

Yes. Most people need to take two major sets of medicines: one set aimed at treating residual coronary disease usually includes aspirin and a beta-blocker.

Another set is aimed at controlling continuing CAD risk factors, mainly diabetes (with pills or insulin), hypertension (with at least one preparation such as an ACE inhibitor), and high cholesterol (a “statin”).

These medicines have been extensively studied, and have proven to help one live longer and prevent coronary blockages from progressing.

Other drugs may be prescribed, too, on a case-by-case basis.

It is important to take your medicines exactly as prescribed. Let your doctor or nurse know if you have any side-effects or problems with the medicines. You should also let him or her know if you cannot afford your pills as there are often ways used to solve this issue.

What is cardiac rehabilitation?

Cardiac rehab is an integrated programme that your doctor might recommend.

At cardiac rehab, doctors, nurses, exercise physiologists, nutritionists and other health professionals teach you how to keep your heart healthy. This includes:

• Healthcare professionals will work with you to formulate an exercise programme that is safe for you.

Originally, they would supervise and guide your performance and tell you how often and how hard to exercise.

Then after you learnt the routines, you could continue them through an extended stay in the programme, in a community gym, or at home. Typically, an exercise programme includes five to ten minutes of warm-up, followed by aerobic exercises (walking, swimming, and/or jogging) for at least 20 minutes, then a cool-down phase of five to ten minutes.

• You will receive help to improve your diet. Fruits, vegetables and foods with fibre can help to prevent heart disease and stroke.

Avoid eating trans-fats, which are found in many fast foods, and saturated fats, which are found in red meats and cheeses. In addition, calorie-intake restriction and portion control are of paramount importance.

• Lose weight if you are overweight, by reinforcing the above lifestyle measures.

• Quit smoking if you smoke. Stopping cigarettes significantly lowers your chance of getting, or dying from, heart disease. To quit, you can try nicotine patches, gums, or nasal sprays. You can also try a prescription medicine to help stop the craving.

• Many people feel depressed or anxious after coronary artery bypass grafting surgery. Your doctor or counsellor can help you with these feelings and, if necessary, treat your mood disorder.

When can I have sex again?

As a general rule, sexual activity could be resumed at the same time cardiac rehab is started or shortly after. After coronary artery bypass grafting surgery, though, some people are less interested in sex or do not enjoy it as much. This can be a side-effect of certain heart medications, or from depression, apprehension, or fear of having a cardiac complication during sex. If you have such a problem, let your doctor or nurse know.

When can I drive again?

Check with your doctor. He or she may not want you to drive again until your chest incision has well healed, about six weeks.

• Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article