Coronary Artery Bypass Grafting Overview

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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 your body to make a new route for blood to flow around blocked coronary (heart) arteries.

Coronary Artery Bypass Surgery © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Chest x-ray
• Electrocardiogram (ECG, EKG) —a test that records the heart's activity by measuring electrical currents through the heart muscle
• Coronary angiogram —a test to determine the extent and location of blockages in blood vessels in the heart

Talk to you doctor about your medicines. You may need to stop taking aspirin or other anti-inflammatory drugs for one week before surgery. You may also need to stop blood-thinning drugs, like clopidogrel (Plavix) or warfarin (Coumadin).

• The night before, eat a light meal. Do not eat or drink anything after midnight.

• Arrange for a ride to and from the hospital.

• Arrange for help at home after returning from the hospital.

Anesthesia

General anesthesia will be given. You will be asleep.

Description of Procedure

Once you are asleep and no longer feel any pain, a breathing tube will be placed in your throat.

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." Electric 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 operates while the heart is beating. This way, you can avoid the use of the heart-lung machine. This type of surgery is promising. The benefits and risks need to be weighed for each individual. Talk to your doctor about what is best for you.

Immediately After Procedure

You will be monitored closely in the intensive care unit. You will be hooked up to various tubes and monitors, which may include:

• Heart monitor
• Pacing wires to help control heart rate
• Tubes connected to a machine that helps drain excess blood and air from the wound
• Breathing tube until you can breathe independently, then an oxygen mask
• Bladder catheter

How Long Will It Take?

4-5 hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. You may be given medicines 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 and 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 a day or two. Pacing wires and chest tubes will be removed after a few days.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Take medicines as directed by your doctor. These may include:

• Medicine to lower cholesterol
• Pain medicine
• Blood pressure medicine (eg, beta blockers, ACE inhibitors)
• Anti-arrhythmics to keep your heart's rhythms regular
• Blood thinners to prevent blood clots from forming

• Internal stitches will dissolve. Staples will be taken out 5-7 days after surgery.

• Small paper strips on the incisions will peel off. They can be removed one week after discharge.

• Only take medicines approved by your doctor.

• Weigh yourself every morning.

• You will be started on a cardiac rehabilitation program, as recommended by your doctor, to speed recovery and improve cardiovascular health.

• Be sure to follow your doctor's instructions .

Bypass surgery does not cure heart disease. The grafted blood vessels can also become clogged. You will be encouraged to make lifestyle changes to improve your cardiovascular health. These include:

• Exercising regularly
• Not smoking
• Eating a heart-healthy diet—one that is low in saturated fat, simple sugars, and salt. It is important to eat food that is high in fiber, which includes fruits and vegetables.

Ask your doctor for a referral to a registered dietitian if you need help changing your dietary habits. Most patients can return to office-type work in 4-6 weeks.

RESOURCES:

American Heart Association
http://www.americanheart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/

Heart Healthy Kit: Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

References:

What is coronary artery bypass grafting? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov . Accessed July 21, 2008.

Women fare better after bypass surgery without heart-lung machine. American Heart Association website. Available at: http://www.americanheart.org . Accessed July 21, 2008.