CABG, VADs, TAHs, Heart Transplant

CABG (Coronary Artery Bypass Graft)

A type of heart bypass surgery that uses a healthy blood vessel graft to bypass a blocked portion of a coronary artery.

Purpose of CABG

Improve blood flow to the heart by bypassing blocked coronary arteries.

CABG graft sources

Healthy blood vessels taken from the arms, chest, or legs.

Open-heart CABG

A procedure that requires the heart to be stopped while a heart-lung bypass machine pumps blood through the body.

Minimally invasive CABG

A type of coronary artery bypass surgery performed using a less invasive surgical approach.

Nutrition goals after cardiac surgery

Decrease tissue catabolism, reduce postoperative complications, improve wound healing, and maintain adequate hydration and glycemic control.

Tissue catabolism after cardiac surgery

The breakdown of body tissues, including muscle, that nutrition therapy aims to minimize.

Wound healing after cardiac surgery

Adequate nutrition, hydration, and blood glucose control support recovery and wound healing.

VAD (Ventricular Assist Device)

A mechanical circulatory support device that helps the heart pump blood in patients with heart failure.

Purpose of a VAD

Support circulation when the heart cannot pump enough blood to meet the body's needs.

VAD as a bridge to transplant

A VAD may support a patient with heart failure while they wait for a heart transplant.

VAD as permanent treatment

A VAD may be used as long-term treatment for patients who are not candidates for heart transplantation.

VAD as a bridge to recovery

A VAD may temporarily support circulation while a damaged heart recovers.

How a VAD works

Pumps blood from the heart's ventricles to the rest of the body.

LVAD (Left Ventricular Assist Device)

A VAD placed to assist the left ventricle; it is the most frequently used type of VAD.

VAD placement

Often requires open-heart surgery.

Nutrition concerns in VAD patients

Many patients experience malnutrition, making nutritional assessment and medical nutrition therapy important.

RDN role in VAD care

Assess for malnutrition and provide individualized medical nutrition therapy.

VAD nutrition therapy

Generally follows heart failure medical nutrition therapy recommendations, individualized to the patient's needs.

TAH (Total Artificial Heart)

A mechanical pump placed in the chest to replace the function of a damaged heart.

TAH driver

An external machine that controls the artificial heart pump.

Purpose of a TAH

Replace heart function when the heart is severely damaged by heart failure.

TAH as a bridge to final therapy

A total artificial heart is intended to support the patient until they can receive definitive treatment, such as a heart transplant.

Heart transplant

A surgical procedure that replaces a damaged heart with a donor heart.

Heart transplant indication

The only cure for refractory, end-stage heart failure.

Phases of heart transplant care

Pretransplant, immediate posttransplant, and long-term posttransplant.

Pretransplant nutrition and lifestyle recommendations

Restrict alcohol, lose weight if appropriate, exercise, quit smoking, follow a low-sodium diet, and manage hypertension and hyperlipidemia.

Enteral feeding before heart transplant

May be needed when oral intake is inadequate to meet nutritional needs.

Immediate post-heart transplant energy needs

Approximately 30–35 kcal/kg/day or energy needs measured using resting energy expenditure (REE).

Immediate post-heart transplant protein needs

Approximately 1.3–2.0 g/kg/day.

Immediate post-heart transplant carbohydrate recommendation

Approximately 50% of total calories from carbohydrates; limit simple sugars if blood glucose is elevated.

Immediate post-heart transplant fat recommendation

Approximately 30% of total calories from fat, or higher if severe hyperglycemia requires an individualized plan.

Immediate post-heart transplant sodium recommendation

Approximately 2 g of sodium per day.

Magnesium and phosphorus after heart transplant

Encourage foods rich in magnesium and phosphorus.

Potassium management after heart transplant

Supplement or restrict potassium based on serum potassium levels.

Calcium recommendation immediately after heart transplant

Approximately 1,200 mg/day.

Other vitamins and minerals immediately after heart transplant

Meet recommended dietary intake (RDI) levels and provide additional supplements when deficiencies are suspected or confirmed.

Complementary and alternative products after heart transplant

Avoid products without established safety and effectiveness in transplant patients.

Food safety after heart transplant

Provide food safety education to reduce the risk of foodborne illness, especially during immunosuppression.

Long-term post-heart transplant energy needs

Approximately 20–30 kcal/kg/day, depending on activity level.

Long-term post-heart transplant protein needs

Approximately 1 g/kg/day.

Long-term post-heart transplant carbohydrate recommendation

Approximately 50% of total calories from carbohydrates, emphasizing complex carbohydrates and fiber while limiting simple sugars.

Long-term post-heart transplant fat recommendation

No more than 30% of total calories from fat.

Long-term post-heart transplant saturated fat recommendation

No more than 10% of total calories from saturated fat.

Long-term post-heart transplant calcium recommendation

Approximately 1,200–1,500 mg/day; vitamin D supplementation may also be needed.

Long-term post-heart transplant sodium recommendation

Approximately 2 g of sodium per day.

Magnesium and phosphorus during long-term transplant care

Encourage foods rich in magnesium and phosphorus.

Potassium management during long-term transplant care

Supplement or restrict potassium based on serum potassium levels.

Long-term post-heart transplant vitamins and minerals

Meet recommended dietary intake levels and supplement as needed to correct deficiencies.

Complementary and alternative products during long-term transplant care

Avoid products without proven safety and effectiveness in transplant patients.

Long-term food safety after heart transplant

Continue food safety practices to reduce the risk of foodborne illness.