Coronary Artery Bypass Surgery
Coronary Artery Bypass Surgery (CABG)
What is it?
Arteries can become clogged over time by the buildup of fatty plaque, arteriosclerosis. Bypass surgery improves the blood flow and oxygen to the heart by rerouting, or "bypassing," blood around a section of clogged or diseased artery.
How does it work?
Surgeons take a segment of a healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly.
During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other forms of heart surgery, the chambers of the heart are not opened during the operation.
If possible, minimally invasive coronary artery bypass surgery is done through smaller incisions. It may involve using the mammary artery as a graft. Saphenous veins may also be used. This procedure may be done without stopping the heart, and some patients can even leave the hospital within 48 hours. This operation is only used for patients whose blockages can be bypassed through this smaller incision and whose risk of complications is low.
Reasons for Coronary Artery Bypass Surgery
Because medicines cannot clear blocked arteries, a severely narrowed coronary artery may need more treatment to relieve chest pain and reduce the risk of a heart attack. If percutaneous or transcatheter interventions (such as angioplasty and stenting) don’t clear the arteries, a patient may require coronary artery bypass surgery. Increasing blood flow to the heart muscle can relieve chest pain and reduces the risk of a heart attack.
What to expect
The procedure can take from two to six hours, depending on the number of bypasses needed. A hospital stay is required. One week is the usual hospital stay with the first one to three days being in the Intensive Care Unit (ICU).
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. After being admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A mild tranquilizer, to relax the patient, will be given before entering the operating room. Small metal disks (electrodes) will be attached to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the heart's rhythm and electrical activity. The patient will then receive a local anesthetic to numb the area where a plastic tube (line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in the vein. The IV line will be used to give the anesthesia during the operation to make the patient sleep during the operation.
After the patient is completely asleep, a tube (ventilator) will be inserted down the windpipe and connected to a machine (respirator), which will take over breathing. Another tube will be inserted through the nose and down the throat, into the stomach. This tube will stop liquid and air from collecting in the stomach, so you the patient will not feel sick and bloated after surgery. A thin tube (catheter) will be inserted into the bladder to collect any urine produced during the operation.
A heart-lung machine is used for most bypass operations. Before being hooked up to this machine, a blood-thinning medicine (anticoagulant) will be given to prevent your blood from clotting. Once the heart-lunch machine is hooked up, the heart is stopped and cooled.
An incision about 6 to 8 inches long and is made down the middle of the chest and the breastbone is sawed open to gain access to the heart.
A long piece of vein (graft) from the leg (the saphenous vein) may be removed. One end of the graft will be attached to the ascending aorta, the large artery that carries oxygen-rich blood out of the top of the heart to the body. The other end of the graft will be attached to a coronary artery below the blocked area. The surgeon may also choose to use an artery from the inside of the chest wall (the internal mammary artery). Or the surgeon may use both the vein and artery.
After surgery, the remaining hospital stay is for testing and monitoring the patient’s condition. Once discharged, a patient will be advised to enroll in a physician-supervised cardiac rehabilitation program. This program teaches lifestyle changes and helps rebuild strength and confidence.