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Coronary Artery Bypass Grafting
all information

Coronary Artery Bypass Grafting

(CABG)

En Español (Spanish Version)

Click here to view an animated version of this procedure.

Definition

Surgery to restore blood flow to the heart muscle. This is done by using blood vessels from other parts of the body to provide a route around obstructed coronary (heart) arteries.

Coronary Artery Bypass Surgery

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Parts of the Body Involved

  • Heart
  • Chest
  • Legs

Reasons for Procedure

Coronary artery bypass grafting (CABG) is done to re-establish blood supply to the heart muscle. It is often recommended in cases of:

  • Severe blockages in the main artery or obstructions in several blood vessels
  • Persistent chest pain (angina) not improved with drug therapy

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

In the days leading up to your surgery:
  • Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor.
  • The night before, eat a light meal and 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.

Description of the Procedure

The surgeon cuts through the skin and breastbone to opens the chest. The heart-lung machine is connected. This machine pulls blood from the heart, adds oxygen, and pumps it back into the body.

The surgeon may take an artery from the chest wall or remove a section of vein from the leg. The harvested vessels are connected (grafted) to the blocked arteries above and below blockages. When the grafts are in place therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected. The breastbone is wired together and the chest closed.

Some are using a less invasive approach, called minimally invasive coronary artery surgery. The purpose of this surgery is the same but the technique and indications 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, over the site of the clogged artery. The surgeon usually uses an artery from inside the chest to bypass. The key difference in this technique is that the surgeon operates while the heart is beating. This way you can avoid the use of the heart-lung machine. This type of surgery is promising, but the benefits and risks need to be weighed for each individual. Talk to your doctor about what is best for you.

After Procedure

You'll have close attention and monitoring in the intensive care unit. You'll be hooked up to various tubes and monitors, including:

  • 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

Will It Hurt?

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

Possible Complications

  • Infection
  • Pneumonia
  • Phlebitis (blood clots in a vein), which can lead to heart attack or stroke
  • High or low blood pressure
  • Excessive bleeding
  • Neurological deficits, stupor, coma, or decreased intellectual function
  • Stroke
  • Kidney dysfunction
  • Irregular heart rate
  • Depression
  • Death

Average Hospital Stay

5-7 days

Postoperative Care

  • Take medications as directed by your doctor. These may include:
    • Blood pressure medication
    • Digitalis—to help your heart pump more strongly
    • Anti-arrhythmics—to keep your heart's rhythms regular
    • Blood thinners—to prevent blood clots from forming
  • 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 legs.
  • The day after surgery, try to walk with help.
  • Dressings will be removed in a day or two; pacing wires and chest tubes will be removed after a few days.
  • Internal stitches will dissolve; staples will be taken out 5-7 days after surgery.
  • Small paper strips on incisions will peel off and can be removed one week after discharge.
  • Once home, only take medications approved by your doctor, check your temperature twice daily, and weigh yourself every morning.
  • Follow activity and cardiac rehabilitation program as recommended by your doctor to speed recovery and improve cardiovascular health.

Outcome

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, and high in fiber, 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.

According to a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using balloon angioplasty or coronary stenting. *

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Gaining more than four pounds within one or two days
  • Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain

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://ww2.heartandstroke.ca/

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.

Updated Outcome section on 11/7/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print]



Last reviewed November 2007 by J. Peter Oettgen, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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