Coronary Artery Bypass Grafting

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

Parts of the Body Involved

Heart, chest, legs

Reasons for Procedure

A CABG is performed 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 not improved with drug therapy (angina)

Risk Factors for Complications during the Procedure

  • Pre-existing heart condition
  • Lung disease, especially chronic obstructive pulmonary disease (emphysema)
  • Prior heart attack or bypass surgery
  • Advanced age
  • Surgical urgency
  • Obesity
  • Diabetes
  • Smoking
  • High blood pressure
  • Thyroid disease

What to Expect

Prior to Procedure

Your doctor will likely do the following:
  • Physical exam
  • Chest x-ray
  • Electrocardiogram (ECG, EKG) - a test that records the hearts 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
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
During Procedure:
  • Anesthesia
  • IV fluids
  • Oxygen
  • Catheter placed in your bladder to drain urine
  • A heart-lung machine to maintain blood circulation and cool the blood and body temperature
Anesthesia - General

Description of the Procedure - The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine pulls blood from the heart, adds oxygen to it and pumps it back into the bloodstream while the surgeon is working on the heart and/or lungs.

To harvest a blood vessel to graft into the heart, the surgeon may detach an artery from the chest wall, or make one or several incisions in the leg and remove a section of vein from the leg. Sometimes two surgeons work together, one on the chest and one on the leg to remove a vessel for grafting. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions. When the grafts are in place, the blood (and thus the body temperature) is re-warmed to normal temperature, and therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.

After Procedure - Youll have close attention and monitoring in the intensive care unit. Youll 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
  • 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 experience pain during recovery, but will be given pain medications to relieve the discomfort.

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
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 hearts 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 to 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 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 restores blood flow through the heart but does not cure heart disease; the grafted blood vessels can also become clogged. Therefore, you will be encouraged to make lifestyle changes in order to improve your cardiovascular health. These include exercising regularly, not smoking, and eating a heart healthy diet

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