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Coronary Artery Bypass Surgery  
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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.

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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. 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
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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:

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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