[Postoperative care of coronary surgery patients]

Coronary bypass surgery is a palliative procedure and medical management after surgery is best provided by the private physician in cooperation with the surgical center. Whereas digitalis is rarely indicated in patients after bypass surgery, several prospective and randomized studies have shown that the early use of anticoagulants or platelet inhibiting agents improves graft patency after surgery. This medication should be given for about one year. Complex ventricular arrhythmias (Lown III-V) are 2-3 times as frequent 6-8 weeks after aortocoronary bypass surgery as before the operation. However, they are of less prognostic importance than similar arrhythmias occurring one year after surgery. Exercise-induced angina with ST segment depression occurs in 3% of patients per year with complete revascularization, as compared to 6-10% of patients/year with less than complete revascularization. Repeat angiography after surgery is performed if limiting angina recurs. In some instances coronary angioplasty may reestablish successful bypass surgery. Mortality and morbidity of reoperation are slightly higher and the success rate is slightly lower than with a first operation. Postoperative complications, such as post-pericardiotomy syndrome, left ventricular dysfunction and hepatitis, are briefly discussed.