Coronary Artery Bypass Graft Surgery

What is coronary bypass graft surgery?

Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease. Coronary artery disease (CAD) is the narrowing of the coronary arteries. These are the blood vessels that supply oxygen and nutrients to the heart muscle. CAD is caused by a build-up of fatty material within the walls of the arteries. This buildup narrows the inside of the arteries, limiting the supply of oxygen-rich blood to the heart muscle.

One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in your body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your healthcare provider attaches 1 end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle. This is called coronary artery bypass surgery.

Traditionally, to bypass the blocked coronary artery, your provider makes a large cut (incision) in the chest and briefly stops the heart. To open the chest, your provider cuts the breastbone (sternum) in half lengthwise and spreads it apart. Once the heart is exposed, your provider inserts tubes into the heart. This lets the blood be pumped through the body by a heart-lung bypass machine. The bypass machine is needed to pump blood while the heart is stopped. 

The traditional open heart procedure is still commonly done. In many cases it may be preferred. But less invasive methods have been developed to bypass blocked coronary arteries. Off-pump procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other minimally invasive procedures, such as keyhole surgery (done through very small incisions) and robotic procedures (done with the aid of a moving mechanical device), may be used.

Why might I need coronary artery bypass surgery?

Coronary artery bypass graft surgery (CABG) is done to treat a blockage or narrowing of 1 or more of the coronary arteries. It can restore the blood supply to your heart muscle when nonsurgical procedures are not a choice.

Symptoms of coronary artery disease may include:

• Chest pain

• Fatigue (severe tiredness)

• Palpitations

• Abnormal heart rhythms

• Shortness of breath

• Swelling in the hands and feet

• Indigestion

You may not have any symptoms in early coronary artery disease. But the disease will continue to progress until there’s enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow can’t be restored to the part of the heart muscle affected, the tissue dies.

There may be other reasons for your provider to advise CABG surgery.

What are the risks of coronary artery bypass surgery?

Possible risks of coronary artery bypass graft surgery (CABG) include:

• Bleeding during or after the surgery

• Blood clots that can cause heart attack, stroke, or lung problems

• Infection at the incision site

• Pneumonia

• Breathing problems

• Pancreatitis

• Kidney failure

• Abnormal heart rhythms

• Failure of the graft

• Death

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your provider before the procedure.

How do I get ready for coronary artery bypass surgery?

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is unclear.

• Along with a review of your health history, your provider may do a complete physical exam to make sure you are in otherwise good health before having the procedure. You may need blood tests or other diagnostic tests.

• You will be asked to not eat or drink for 8 hours before the procedure, generally after midnight.

• You may be asked to shower with a soap or special cleanser the night before and the morning of surgery.

• Tell your provider if you are pregnant or think you could be.

• Tell your provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic medicines (local and general).

• Tell your provider about all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.

• Tell your provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines, aspirin, or other medicines that affect blood clotting. You may be told to stop some of these medicines before the procedure. Ask which medicines to take, and which to stop, and when you should stop taking them.

• You may need blood tests before the procedure to find out how long it takes your blood to clot.

• Tell your provider if you have a pacemaker, another implanted cardiac device, or any other implants.

• If you smoke, stop smoking as soon as possible. This may improve your chances for a successful recovery from surgery and benefit your overall health.

• Based on your medical condition, your provider may ask you to do other things to get ready.

What happens during coronary artery bypass?

Coronary artery bypass graft surgery (CABG) requires a stay in a hospital. Procedure may vary depending on your condition and your healthcare provider's practices.

Generally, CABG follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

2. You will change into a hospital gown and empty your bladder.

3. A healthcare professional will insert an IV (intravenous) line in your arm or hand. Other catheters will be put in your neck and wrist to monitor your heart and blood pressure, as well as to take blood samples. 

4. You will lie on your back on an operating table.

5. The anesthesiologist will continuously keep track of your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you are sedated (put into a deep sleep), a breathing tube will be put into your throat and you will be connected to a ventilator, which will breathe for you during the surgery.

6. A catheter will be put into your bladder to drain urine.

7. The skin over the surgical site will be cleaned with an antiseptic solution.

8. Once all the tubes and monitors are in place, your provider will make cuts in 1 or both of your legs or 1 of your wrists. This is to access the blood vessel(s) to be used for the grafts. They will remove the vessel(s) and close those incision(s).

9. The provider will make a cut down the center of your chest from just above the breastbone to just below where the chest ends.

10. The provider will cut the sternum (breastbone) in half lengthwise. They will separate the halves of the breastbone and spread them apart to expose your heart.

What happens after coronary artery bypass surgery?

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure