Coronary Artery Bypass Grafting

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Definition

A coronary artery bypass graft (CABG) is a surgery to restore blood flow to the heart muscle. This is done by using blood vessels from other parts of the body to make a new route for blood to flow around blocked coronary (heart) arteries.

Coronary Artery Bypass Surgery
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Reasons for Procedure

Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries and restricts blood flow. When the buildup happens in the heart, it may lead to chest pain, called angina , or a heart attack . Lifestyle changes and medications can be used to treat atherosclerosis. When the blockage gets too severe, CABG is done to re-establish blood supply to the heart muscle. It is often recommended in cases of:

  • Severe blockage in the main artery or in several blood vessels that supply blood to the heart
  • Persistent angina that does not improve with other treatments

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infections
  • Blood clots
  • High blood pressure or low blood pressure
  • Bleeding
  • Stroke
  • Damage to other organs, such as the kidneys
  • Irregular heart rate
  • Death

Some factors that may increase the risk of complications include:

What to Expect

Prior to Procedure

Your doctor will likely do the following:

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.

Anesthesia

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. A heart-lung machine will be connected. Since the heart needs to be stopped for the surgery, this machine will act as the heart and lungs.

An artery will be taken from the chest wall. Or, a section of vein will be removed from the leg. This section will be used as the bypass. Once the heart is stopped, the new vessels will be connected (grafted) to the blocked arteries. One end will be attached just above the blockage. The other end will be attached just below the blockage. When the grafts are in place, the heart will be allowed to "wake up." Electrical shocks may be needed in some cases to regulate the heart’s rhythm. 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

You will be monitored in the intensive care unit, where you will have the following interventions:

  • 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?

4-5 hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. You may be given medication for any pain during recovery.

Average Hospital Stay

5-7 days

Post-procedure Care

At the Hospital

  • To reduce the risk of fluid buildup in your lungs, breathe deeply and cough 10-20 times every hour.
  • If a leg vein was removed, elevate your legs above your heart while sitting. Do not cross your legs.
  • Efforts will be made to get you out of bed and walking as soon as possible.
  • Dressings will be removed in 1-2 days. Pacing wires and chest tubes will be removed after a few days.

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 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

At Home

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 can also become clogged. You will be encouraged to make healthy lifestyle changes.

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've been given
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
  • Persistent nausea and/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 and/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 medical help right away.

Revisions

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