Coronary Artery Bypass Grafting (CABG)
When coronary artery disease is treated there are usually four major alternatives that are not always exclusive. The first is modifying risk factors. This includes changing dietary habits, discontinuation of smoking, limitation of sedentary lifestyle, and tight blood sugar control for diabetics.
The second approach is medical intervention with beta-blockers, lipid lowering agents, and antihypertensives. The next step is cardiac catheterization. Through injection of dye directly into the coronary arteries and special xray equipment high quality pictures of the vessels supplying blood to the heart may be visualized. Then the blockages may be opened with balloon dilatation and kept open with stents. The risks of this procedure include stroke, restenosis (blockage of the vessels again), and possible death. If these options fail or are not able to be applied then surgery may be required.
Surgery is traditionally done through an incision in the front part of the chest and then the breast bone is divided and later repaired with wire. Conduits or materials for the actual bypasses are then harvested. These may include arteries from inside the chest (internal thoracic or mammary arteries), arteries from the arms (radial arteries), or veins from the legs. These are then used to carry the blood around the blockage to the heart muscle that needs more blood and oxygen. This may be done with or without the use of the heart-lung machine.
CABG is very common and safe. It has stood the test of time. This procedure has been studied for decades. It remains the longest lasting intervention that can be completed for coronary artery disease. There are complications, however, that may occur. These include, but are not limited to, atrial fibrillation (irregular heart beat), infection, myocardial infarction (heart attack), stroke, bleeding, and possible death.
Note: It is standard of care in coronary bypass surgery to use at least one internal mammary artery. Upstate surgeons use at least one if not both in the appropriate surgical candidate.
Click here to view an animated version of this procedure.
A coronary artery bypass graft (CABG) is an open-heart surgery to restore blood flow to the heart muscle. A part of a blood vessel from another part of the body is attached to a blocked artery of the heart. The attached blood vessel creates a new path for blood to flow around the blockage.
|Coronary Artery Bypass Surgery|
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Reasons for Procedure
Atherosclerosis is a common disease of the arteries. Over time cholesterol and fats collect on the walls of blood vessels and form a plaque. As the plaque grows, it decrease the amount of space that blood has to pass through and slows blood flow to the heart muscle. This low blood flow can lead to chest pain called, angina . Eventually, plaque can cause the blood vessel to tear and form a blood clot which can completely block blood flow and lead to a heart attack or death.
CABG is done if there are severe blockages in arteries of the heart that are causing problems with the function of the heart. CABG may be an option if other treatment are ineffective or not a good option. It may be done:
- After or during a heart attack
- To treat angina that is not responding to other treatment
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Post-surgical infection
- Blood clots
- High blood pressure or low blood pressure
- Damage to other organs such as the kidneys
- Irregular heart rate
Some factors that may increase the risk of complications include:
- Lung disease, especially chronic obstructive pulmonary disease (COPD) or emphysema
- Prior heart attack or bypass surgery
- Advanced age
- Severe condition (the need to have emergency surgery)
- High blood pressure
- Thyroid disease
What to Expect
Prior to Procedure
To prepare for surgery, your doctor may need some of the following:
- Physical exam
- Chest x-ray
- ECG —shows heart's electrical activity
- Cardiac catheterization —procedure to determine amount of blockage
Talk to your doctor about your medication. You may need to stop taking certain medication for one week before surgery.
Your doctor may also ask you to:
- Eat a light meal the night before. Do not eat or drink anything after midnight.
- Arrange for a ride to and from the hospital.
- Arrange for help at home after the procedure.
General anesthesia will be given. You will be asleep during the procedure.
Description of Procedure
An incision will be made through the skin. The breastbone will be split to open the chest. For traditional CABG, a heart-lung machine will be connected to major blood vessels of the heart. The machine will act as the heart and lungs during the surgery so that blood and oxygen will continue to flow through the body while the heart is repaired.
An artery will be taken from the chest wall or a section of a vein will be removed from the leg. The new vessel section will be connected by the blocked arteries. One end of the new vessel will be attached just above the blockage. The other end will be attached just below the blockage. When the new vessel is in place, the heart will be allowed to wake up. Electrical shocks may be needed in some cases to make sure the heart is beating with the right rhythm. Once the doctor is sure that blood is flowing well, the heart-lung machine will be disconnected. Temporary tubes may be placed in your chest to help drain any fluid. The breastbone will be wired together. The chest will be closed with stitches or staples.
There is a less invasive approach, called minimally invasive coronary artery surgery. The purpose of this surgery is the same, but the technique and condition of the patient are different. Patients who have only one or two clogged arteries may be candidates for this approach. In this technique, a small incision is made in the chest. The doctor usually uses an artery from inside the chest for the bypass. The key difference in this technique is that the doctor performs the surgery while the heart is beating. With this technique, the heart-lung machine is not needed. If you need CABG, your doctor will carefully evaluate you to determine the best technique for you.
Immediately After Procedure
Recovery will happen in the intensive care unit, to provide monitoring and support if needed. Care may include:
- Heart monitor
- Pacing wires to control heart rate
- Tubes connected to a machine to drain fluids from the wound
- Breathing tube or an oxygen mask
- Catheter inserted to drain the bladder
How Long Will It Take?
How Much Will It Hurt?
Anesthesia prevents pain during surgery. There will be pain for a few weeks after the surgery because of the chest opening. You will be given medication and support tips to help manage pain during recovery.
Average Hospital Stay
Dressings will be removed in 1-2 days. Pacing wires and chest tubes will be removed after a few days. Your medical team will encourage movement and other steps to help prevent complications after surgery. Step may include:
- Frequent deep breathing and coughing exercise to prevent fluid build up in the lungs.
- Walking as soon as possible after surgery to prevent blood clots in legs.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection during recovery such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
You will have reduced activities during your recovery. A cardiac rehabilitation program will be arranged. You may need to work with a dietitian for a special diet. Recovery may include:
- Medications to control pain and heart disease
- Wound care to prevent infection
- Checking your weight every morning
Bypass surgery does not cure heart disease. The grafted blood vessels or other heart vessels can become clogged later on. You will be encouraged to make healthy lifestyle changes to prevent future complications.
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Pain that you cannot control with the medication you were given
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
- Persistent nausea or vomiting
- Cough, shortness of breath, or chest pain
- Pain, burning, urgency, frequency of urination, or persistent blood in the urine
- Gaining more than 4 pounds within 1-2 days
- Pain or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
If you think you have an emergency, call for emergency medical services right away.
- Coronary artery bypass graft (CABG) surgery. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113960/Coronary-artery-bypass-graft-CABG-surgery . Updated November 29, 2017. Accessed November 30, 2017.
- Coronary artery bypass graft surgery. Cardio Smart website. Available at: https://www.cardiosmart.org/Healthwise/hw10/1095/hw101095. Accessed November 30, 2017.
- Explore coronary artery bypass grafting. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cabg. Updated February 23, 2012. Accessed November 30, 2017.
- 12/3/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113960/Coronary-artery-bypass-graft-CABG-surgery : Morone NE, Weiner DK, Belnap BH, et al. The impact of pain and depression on recovery after coronary artery bypass grafting. Psychosom Med. 2010;72(7):620-625.