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

Reasons for Procedure

Atherosclerosis is a disease of the arteries. Cholesterol and fatty deposits build up on the walls of the arteries. This restricts blood flow. When the buildup happens in the heart, it may lead to chest pain, called angina, or heart attack. Lifestyle changes and medicines 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

If you are planning to have a CABG, your doctor will review a list of possible complications, which may include:

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:

Lung disease, especially chronic obstructive pulmonary disease (COPD) (emphysema)
Prior heart attack or bypass surgery
Advanced age
Severe condition (the need to have emergency surgery)
Obesity
Diabetes
Smoking
High blood pressure
Thyroid disease
Depression

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, such as:

Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
Blood-thinning drugs, such as warfarin (Coumadin)
Anti-platelet drugs, such as clopidogrel (Plavix)

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

A breathing tube will be placed in your throat. Next, 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 into 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 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:

Ask your doctor about when it is safe to shower, bathe, or soak in water.
Take medicines as directed by your doctor, such as:
- Antiarrhythmics
- Blood thinners
- Cholesterol-lowering medicine
- Blood pressure medicine
- Pain medicine
Follow your doctor's guidelines for caring for your stitches and staples. For example, 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.
Weigh yourself every morning.
Follow the cardiac rehabilitation program that was created for you.
If recommended by your doctor, work with a registered dietician.
Make lifestyle changes, like exercising regularly, not smoking, and eating a healthy diet.
Ask your doctor when you can drive and return to work.
Be sure to follow all of your doctor's instructions.

Note: 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

Pain that you cannot control with the medication you have been given
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
Nausea and/or vomiting that you cannot control with the medication you were given after surgery or that lasts longer than expected
Cough, shortness of breath, or chest pain
Pain, burning, urgency, frequency of urination, or persistent blood 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

In case of an emergency, call for medical help right away.

RESOURCES

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

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

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/

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

References

Coronary artery bypass graft surgery (CABG). Cardio Smart website. Available at: http://cardiosmart.org/heartdisease/ctt.aspx?id=900. Accessed September 17, 2012.

What is coronary artery bypass grafting? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/. Updated February 23, 2012. Accessed September 17, 2012.

12/3/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Morone NE, Weiner DK, Belnap BH, et al. The impact of pain and depression on recovery after coronary artery bypass grafting. Psychosom Med. 2010;72:620-625.

Revision Information

Reviewer: Michael J. Fucci, DO
Review Date: 09/2012 -
Update Date: 00/92/2012 -

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