Coronary artery bypass grafting (CABG): The surgical process for combating Atherosclerosis

A coronary artery bypass graft (CABG) is an open-heart surgery to restore blood flow to the heart muscle. Part of a blood vessel from another part of the body, usually the chest wall or leg, is attached to a blocked artery of the heart. The attached blood vessel creates a new path for blood to flow around the blockage.

Why CABG surgery is performed

Atherosclerosis is a common disease of the arteries. It occurs when cholesterol and fat collects on the walls of blood vessels and forms a plaque. As the plaque expands, it decreases the amount of space for blood to pass through and slows blood flow to the heart muscle. This low blood flow can lead to chest pain, called angina. Eventually, plaque causes the blood vessel to tear and form a blood clot, which can completely block blood flow and lead to a heart attack or death.

A CABG procedure is performed if there are blockages in the arteries of the heart that cause problems with the function of the heart. CABG may be an option if other treatments are ineffective or not a good option, including:

• After or during a heart attack
• To treat angina that is not responding to other treatment

What to expect from coronary artery bypass grafting surgery

Prior to the procedure

To prepare for your CABG surgery, your doctor may perform 1 or more of the following:

• Physical exam
• Chest x-ray
• Electrocardiogram (ECG)—shows heart's electrical activity
• Cardiac catheterization—a procedure to determine the amount of blockage

Talk to your doctor about any medications or supplements you are taking. You may need to stop certain medications for 1 week before surgery. In addition, your doctor may 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 administered so that you are asleep during the entire procedure.

During the procedure

An incision is made through the skin and the breastbone is split to open the chest. In traditional CABG surgery, a heart-lung machine is connected to the major blood vessels of the heart. The machine acts as the heart and lungs during surgery so that blood and oxygen continue to flow through the body while the heart is repaired.

An artery is taken from the chest wall or a section of a vein is removed from the leg. The new vessel section is connected near the blocked arteries. One end of the new vessel is attached just above the blockage and the other end is attached just below the blockage. When the new vessel is in place, the heart is allowed to wake up. Electrical shocks may be needed to make sure the heart is beating with the right rhythm. Once the doctor is sure that blood is flowing well, the heart-lung machine is disconnected. Temporary tubes are placed in your chest to help drain any fluid and the breastbone is wired together. The chest is then closed with stitches or staples.

There is a less invasive approach, called minimally invasive coronary artery surgery. The purpose of the surgery is the same, but the technique and condition of the patient are different. Patients who only have 1 or 2 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 and the heart-lung machine is not needed. If you need CABG, your doctor will determine the best technique for you.

Immediately after procedure

After the CABG surgery, you will be taken to the intensive care unit (ICU) to receive monitoring and support. Care may include:

• Heart monitoring
• 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 to drain the bladder

How long is the procedure and hospital stay?

A typical CABG surgery takes 4 to 5 hours. Most patients spend 5 to 7 days in the hospital following the procedure.

Does it hurt?

Anesthesia prevents pain during CABG surgery. There will be pain for a few weeks after the procedure because of the chest opening. You will be given medication and support tips to help manage pain during recovery.

Post-procedure care

At the Hospital:

Dressings will be removed in 1 to 2 days. Pacing wires and chest tubes will be removed after a few days. Your medical team will encourage movement and other steps to help prevent complications after surgery, including:

• Frequent deep breathing and coughing exercise to prevent fluid build up in the lungs.
• Walking as soon as possible after surgery to prevent blood clots in legs.

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

• Washing their hands
• Wearing gloves or masks
• Keeping your incisions covered

There also are steps you can take to reduce your chances of infection during recovery, including:

• Washing your hands often and reminding visitors and healthcare providers to do the same
• Reminding your healthcare providers to wear gloves or masks
• Not allowing others to touch your incisions

At Home:

You will have reduced activities during your recovery and a cardiac rehabilitation program will be arranged. You may need to work with a dietitian for a special diet. Recovery may include:

• Medications to control pain and heart disease
• Wound care to prevent infection
• Checking your weight every morning

Bypass surgery does not cure heart disease and the grafted blood vessels or other heart vessels can become clogged. You will be encouraged to make healthy lifestyle changes to prevent future complications.

Potential complications of CABG surgery

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential issues, such as:

• Post-surgical infection
• Blood clots
• High blood pressure or low blood pressure
• Bleeding
• Stroke
• Damage to other organs, like the kidneys
• Irregular heart rate
• Death

Factors that may increase the risk of complications include:

• Lung disease, especially chronic obstructive pulmonary disease (COPD) or emphysema
• Prior heart attack or bypass surgery
• Advanced age
• Severe condition (the need to have emergency surgery)
• Obesity
• Diabetes
• Smoking
• High blood pressure
• Thyroid disease
• Depression

When to call the doctor

It is important to monitor your recovery after you leave the hospital and alert your doctor to any problems. If any of the following occur, call your doctor right away:

• Pain that you cannot control with the medication you were given
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
• Persistent nausea or vomiting
• Cough, shortness of breath, or chest pain
• Pain, burning, urgency, frequency of urination, or persistent blood in the urine
• Gaining more than 4 pounds within 1-2 days
• Pain or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain

If you think you have an emergency, call for emergency medical services right away.