What is a coronary artery bypass graft?
Coronary artery bypass graft (also called CABG) surgery is a procedure that restores normal blood flow to the heart muscle. The surgeon takes a healthy blood vessel from another part of your body and connects it to the diseased coronary artery on your heart, just past where the blockage is located. This creates a bypass around the diseased artery. Coronary artery bypass graft is a treatment for coronary artery disease.
This procedure is also called coronary bypass surgery, coronary artery surgery, heart bypass and bypass surgery.
Coronary artery bypass graft is a major surgery that, in most cases, involves stopping the heart. Sometimes, the bypass surgery can be performed with the heart still beating. This procedure, called off-pump coronary artery bypass grafts (OPCABG), is believed to reduce some of the risks of surgery and can shorten the amount of time you have to stay in the hospital after surgery. During OPCABG, your sternum, or breastbone, is split to reveal the heart and the surgery is performed while the heart continues to beat.
For patients with certain patterns of coronary artery disease, we can perform minimally invasive bypass surgery with small incisions. The surgeon makes a smaller incision in your chest, without having to open the breastbone, and uses robotic instrumentation to bypass the diseased artery. Recovery from minimally invasive surgery is generally quicker than with traditional open surgery.
Robotic surgery is also beneficial for minimally invasive coronary artery bypass surgery, a procedure that reroutes blood around clogged arteries to improve blood flow and oxygen to the heart. The surgeon may only have to make small one-centimeter incisions through the left chest for the robot ports.
Your physician may recommend a coronary artery bypass graft if you have heart disease symptoms, such as angina or chest pain, or a dangerous blockage and other less invasive treatments have not succeeded or are not options for you. You might need coronary artery bypass graft if you have narrowing in multiple coronary arteries or a narrowing in the left main coronary artery, which supplies the majority of the blood to the left ventricle. You also might require bypass surgery if you are not a candidate for coronary angioplasty or a stent procedure.
Typically, the worse or more extensive your coronary artery disease, the more you will benefit from surgery. This is particularly true if you have many of the medical problems that can be associated with coronary artery disease, including diabetes.
What to expect during a coronary artery bypass graft
Preparing for your procedure
Prior to your coronary artery bypass graft, you meet with your physician to discuss your medical history, the medications you take and any questions you have.
Tests you may have before coronary artery bypass graft include:
- Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine
- Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart
- Cardiac catherization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
- Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.The valves are checked for stenosis (too tight) and regurgitation (leakage). These conditions may be able to be fixed during your surgery.
The diseases that cause coronary artery disease – atherosclerosis and arteriosclerosis – often affect other arteries in the body. If your heart disease is particularly severe or if you have had a stroke (or a mini-stroke, transient ischemic attack [TIA]) or if your physicians hear signs of abnormal blood flow in your carotid arteries (the arteries in your neck that bring blood to your brain), then an echocardiogram or CT angiogram of these arteries may be performed.
If you have a lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema, you may need a pulmonary function test to determine your risks of surgery. This test also can help determine if your symptoms are related to your lung disease or to your heart disease.
During your procedure
Coronary artery bypass graft typically takes three to six hours. You receive general anesthesia, which means you are asleep during the procedure. Prior to going to sleep, you receive an intravenous line in your wrist to continuously measure your blood pressure during surgery. Another intravenous line also is placed in your neck to provide medications during the procedure and measure the pressures inside of your heart during and after the procedure.
In most cases, you have a large incision in your chest, and your rib cage is spread open to give the surgeon access to your heart. Your heart may have to be stopped during surgery and you are connected to a heart-lung machine, which functions for your heart until your heart can resume normal function. If your surgery will be performed off-pump, the bypass grafts will be completed while the heart continues to beat.
Your surgeon will gather a blood vessel from somewhere else in your body (arm, leg or the inside of your chest) and connect it to the normal portion of the coronary artery, bypassing the diseased portion of the artery. You may need more than one bypass in a single surgery (single bypass, double bypass, triple bypass and quadruple bypass), depending on how many of your arteries are blocked.
When we can, we almost always use cameras to remove the veins through very small incisions. In most cases, patients barely even notice the incisions or scars in the legs after surgery. These minimally invasive small incisions have dramatically reduced the pain and risks of infection associated with taking the veins from the legs.
If you are a candidate for robotic heart surgery, a minimally invasive procedure, the surgeon makes a smaller incision in your chest and guides the robot to perform the bypass. Recovery from minimally invasive surgery is generally quicker than with traditional open surgery.
After your procedure
After surgery, you require intensive nursing care for the first 24 hours. Your family can visit but may be asked to leave the room at times.
You may be on a machine called a ventilator to help you breathe. You are on the ventilator until you wake up from anesthesia and are breathing well on your own. Most patients are on the ventilator for only a few hours after surgery, until they wake up and are alert and strong enough to breathe on their own. If you are awakening and the breathing tube is not yet ready to come out, you receive pain medication and additional sedation to keep you comfortable. Nurses are at your bedside constantly as you awaken to monitor your comfort and to administer medications.
You are connected to monitors and tubes after surgery including a heart monitor, blood pressure monitor and catheter in your bladder to drain your urine.
After the ventilator is removed, your healthcare team helps you use a breathing exercise device every hour while you are awake. It is important to cough and breathe deeply to prevent congestion and lung problems. It is important to tell a member of your healthcare team if you have pain. Your comfort is important, and it affects your breathing. The better your breathing, the quicker you recover.
The day after surgery
You continue to be on a heart monitor and oxygen monitor. Your healthcare team helps you sit in a chair. Increasing activity helps your lungs and bowels regain normal function. As soon as the breathing tube is out, you are encouraged to drink and eat as soon as possible. It is a normal side effect of the anesthesia wearing off to feel nauseated or to not want to eat. Narcotic pain medication also can upset your stomach.
Two days after surgery
You begin to walk short distances in the room and out in the hall, assisted by members of your healthcare team. Walking is one of the most important things you can do to help in your recovery. It helps expand your lungs and prevent congestion. You should walk at least two to three times each day.
During days three, four and five after surgery
You continue to walk in the hallways several times a day, gradually increasing the distance you walk.
It is not uncommon to feel a little swollen or bloated with fluid after heart surgery. Your surgeon may prescribe a water pill to help your body get rid of the extra fluid.
Continue walking in the hall at least two to three times each day. Try to extend the distance you walk each time you are out of bed.
Typically, you stay in the hospital for four to six days after surgery. You are discharged when you can eat regular foods, have had a bowel movement, can walk in the hallways, have a normal temperature and tubes and monitors have been removed. If you do not feel strong enough to go home or feel that you need more time for recovery, then you may need a short stay in a rehabilitation facility. Your healthcare team can help decide if this is recommended in your case.