Coronary Artery Bypass Graft surgery (CABG) is a procedure used to treat coronary artery disease in certain circumstances.
Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a build-up of fatty material within the walls of the arteries. This build-up causes the inside of the arteries to become narrowed, 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 another piece of blood vessel. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein taken from the legs or an artery in the chest. At times, an artery from the wrist may also be used. One end of the graft is attached above the blockage and the other end is attached below the blockage. Thus, the blood is rerouted around, or bypasses, the blockage through the new graft to reach the heart muscle. This bypass of the blocked coronary artery can be done by performing coronary artery bypass surgery.
Traditionally, in order to bypass the blocked coronary artery in this manner, the chest is opened in the operating room and the heart is stopped for a time so that the surgeon can perform the bypass. In order to open the chest, the breastbone (sternum) is cut in half and spread apart. Once the heart is exposed, tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine (heart-lung machine). The bypass machine is necessary to pump blood while the heart is stopped and kept still in order for the surgeon to perform the bypass operation.
While the traditional “open heart” procedure is still performed and often preferred in many situations, newer, less invasive techniques 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 key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), increasingly are being used.
Two other surgical improvements for persons undergoing CABG are endoscopic vein harvesting and endoscopic radial artery harvesting. In both of these procedures surgeons use an endoscope (thin surgical tube with a light and camera on the end) to locate blood vessels that will be used for bypassing the blocked coronary arteries. Veins are generally harvested from the inner thigh and calf areas of the legs, while the radial artery is harvested from the wrist.
Traditional (open) approaches involve making long surgical incisions down the inner thigh and/or calf. Research comparing traditional approaches with endoscopic methods indicates that patients generally have fewer complications, less leg pain, and shorter hospital stays with the endoscopic harvesting methods. Some persons, however, may not be eligible for these methods because of other health conditions.
Coronary artery bypass surgery is performed to treat a blockage or narrowing of one or more of the coronary arteries, thus restoring the blood supply to the heart muscle.
Symptoms of coronary artery disease may include, but are not limited to, the following:
Unfortunately, there may be no symptoms of early coronary artery disease, yet the disease will continue to progress until sufficient artery blockage exists to cause symptoms and problems. If the blood supply to the heart muscle continues to decrease as a result of increasing obstruction of a coronary artery, a myocardial infarction, or heart attack, may occur. If the blood flow cannot be restored to the particular area of the heart muscle affected, the tissue dies.
Before the Surgery
During the Surgery
Coronary artery bypass graft surgery requires a few days’ stay in a hospital.
Generally, a coronary artery bypass surgery follows this process:
Coronary artery bypass graft surgery – On-pump procedure
Coronary artery bypass surgery – Off-pump procedure
Procedure completion, both methods
After the Surgery
After the surgery the patient may be taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored. Alternatively, the patient may be taken directly to the ICU from the operating room. The patient will be connected to monitors that will constantly display the electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and oxygen level. Coronary artery bypass surgery requires an in-hospital stay of several days or longer.
The patient will most likely have a tube in the throat so that breathing can be assisted with a ventilator (breathing machine) until he/she is stable enough to breathe on their own. As the patient continues to wake up from the anaesthesia and start to breathe on their own, the breathing machine will be adjusted to allow them to take over more of the breathing. When the patient is awake enough to breathe completely on his/her own and is able to cough, the breathing tube will be removed. In general, the breathing tube will be removed quickly after the operation, usually the same day or by early the next morning. The stomach tube will also be removed at this time.
After the breathing tube is out, the nurse will assist the patient to cough and take deep breaths every two hours. This will be uncomfortable due to soreness, but it is extremely important that this id done in order to keep mucus from collecting in the lungs and possibly causing pneumonia. The nurse will show how to hug a pillow tightly against the chest while coughing to help ease the discomfort.
The surgical incision may be tender or sore for several days after a CABG procedure. Pain relievers can be taken for soreness as recommended by the physician. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.
The patient may be on special IV drips to help stabilize the blood pressure and the heart, and to control any problems with bleeding. As the patient’s condition stabilizes, these drips will be gradually decreased and turned off.
Once the breathing and stomach tubes have been removed and the patients condition has stabilized, he/she may start liquids to drink. Diet may be gradually advanced to more solid foods as and when the patient is able to tolerate them.
When the doctor determines that the patient is ready, he/she will be moved from the ICU to a postsurgical nursing unit. Patients recovery will continue to progress. Physical activity will be gradually increased as he/she gets out of bed and walks around for longer periods of time. The patient will then be discharged.
Once the patient is home, it will be important to keep the surgical area clean and dry. The doctor will give specific bathing instructions. The sutures or surgical staples will be removed during a follow-up visit, in the event they were not removed before leaving the hospital. The patient should not drive until the doctor permits him/her to drive. Other activity restrictions may apply.
Notify the doctor to report any of the following:
The doctor may give additional or alternate instructions after the procedure, depending on the patient’s particular situation.
Physical aspects of recovery
The pace of physical recovery will depend significantly on the patients health before the bypass surgery. For example, if the patient had coronary artery disease (CAD) but no other medical conditions, it will probably take less time to resume a normal activity level than if the patient is older or has other medical conditions.
Recovery will take at least 4 to 6 weeks. During recovery from CABG surgery, life will probably be quite different from how it was before surgery. The table below lists “normal” physical conditions after CABG surgery.
|During CABG surgery recovery|
|It is normal to:||Why?||For how long?||What can I do?|
|Not have much of an appetite.||The thought of food makes you feel nauseated, or you cannot taste anything.||A few weeks to months||
|Have swelling in your arm or leg where blood vessels were removed.||You have incisions there as well as missing blood vessels that your surgeon used to bypass your coronary arteries.||A few weeks||
|Have difficulty sleeping.||You are in pain and/or are not very physically active.||A few weeks||
|Have sore or tight muscles in your shoulders and upper back.||You were in the same position during your surgery and early recovery.||A few weeks||
|Have a lump over your incision.||Your skin and muscle are healing.||About 6 weeks||
|Be constipated.||It is a side effect of some medications, and/or you are not very physically active.||Depends||
Emotional aspects of recovery
Recovering from CABG surgery means not only getting back physical strength but also emotional and mental well-being. The fatigue and pain experienced by the patient may make them feel depressed. The patient may:
Also, limitations on physical activity can leave the patient with few options to get out of the house for some recreation.
The patient should be aware that these feelings of depression are common for people who have had major heart surgery. The patient may also feel lonely and envious of other people who are living their lives without the discomfort and pain that they are experiencing right now.
It can be important to keep family and friends around during recovery. They can go on walks with the patient or just sit and chat.
In most instances, ischemic heart disease, i.e., coronary artery disease and/or coronary heart disease, is a result or consequence of arteriosclerosis (hardening of the arteries) and atherosclerosis (fatty deposits within the arteries). When the coronary artery becomes affected by arteriosclerosis or atherosclerosis, it may become occluded, causing impaired blood supply to the myocardium. Ischemic heart disease is frequently a forerunner of atrial fibrillation.
A person’s coronary anatomy (i.e., location of blockages in the coronary arteries) is the primary criteria for considering one’s suitability for the surgery. Symptoms of coronary artery disease may include, but are not limited to, the following:
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