Coronary Artery Bypass Surgery - CABG

Coronary artery bypass graft (CABG) surgery, sometimes just called bypass, is a procedure that enables a blocked area of the coronary artery to be bypassed so that blood flow is not hindered. In essence, CABG surgery restores blood flow to heart tissue that has been deprived of blood because of coronary artery disease.

Frequently Asked Questions (FAQ’s)

The information presented below is only for informational purposes. Your surgeon will talk to you about details regarding your specific procedure.

How is the surgery performed?

In the most common type of bypass operation, an incision is made over the breastbone, or sternum (called sternotomy). During bypass surgery, a healthy artery or vein is taken from the leg, arm, or chest and transferred to the outside of the heart. The new healthy artery or vein then carries the oxygenated blood around the blockage in the coronary artery. CABG surgery is usually performed in people with a blocked left main coronary artery, disease in several vessels (arteries or veins), poor function in the heart’s main pumping chamber (the lower chamber or left ventricle), and debilitating chest pain (also called angina). The CABG surgery is done to relieve symptoms of coronary artery disease, alleviate ischemia (lack of blood to the heart muscle), reduce the possibility of more heart problems, and to prolong life. CABG procedures substantially improve symptoms in more than 90% of patients who undergo the treatment.

What are some common methods for bypass surgery?

There are three main types of heart bypass surgery. They are: on-pump, off-pump and clampless bypass surgery.

In the on-pump method, your heart is stopped. A system called cardiopulmonary bypass (CPB) is used. CPB requires the heart to be stopped and filled with a solution to keep it still. Throughout the procedure a pump takes over the function of the heart (cardio) and lungs (pulmonary). The pump performs the function of supplying oxygenated blood to the body. During cardiopulmonary bypass, aortic clamps are also used to restrict blood flow to the area where grafts will be placed. These clamps stay until the grafts are in place. Following placement of the grafts, you are ready to come off CPB. You are technically off-pump when the heart takes over its normal function.

In the off-pump method, the heart is not stopped. During off-pump procedures, the heart continues to beat and supply the body with oxygenated blood, though parts of the aorta are clamped to restrict blood flow temporarily. Off-pump techniques were developed because of the belief that working on-pump puts patients at a higher risk of experiencing certain complications. With the use of off-pump techniques, surgeons provide the same graft results through a less invasive, although technically more complicated, procedure.

Finally, the clampless bypass surgery method Clampless bypass surgery, a type of off-pump surgery, was developed to further reduce the complications associated bypass procedures. The most significant difference from off-pump surgery in the clampless technique is the elimination of the clamps used to restrict blood flow. Mechanical connectors are typically used in clampless bypass surgery to provide a graft connection much like sutures (sewing), but they can be used on the aorta without clamping. You should discuss which method will suit your condition best with the cardiologist.

What can I expect after the procedure?

After the procedure, you will probably spend five to seven days in the hospital. You will be watched closely for the first few hours and your heart will be monitored continuously. In fact, you will probably be in the intensive care unit (ICU) at first. It is not abnormal to spend a day or two in the ICU. You may have a breathing tube to help you temporarily, and there will probably be two to three draining tubes inserted in your chest. These will be removed a couple of days after surgery.

You will be moved from the ICU after a day or so. Your doctor may choose to put you in a normal hospital room or a transitional care unit, where you may begin cardiac rehabilitation. As your incision heals, watch for redness, swelling, or increasing tenderness. Generally, your incision will feel better in a few days.

Recovery from any surgery varies for each patient. Most patients start feeling better and gradually increase their activity in about four to six weeks. It is important in the post-operative phase to follow your doctor’s instructions closely and to report any problems you might have (abnormal pain, signs of infection) to him or her immediately.

What are some of the complication and risks of this procedure?

There are complications and risks associated with CABG procedures, however, just as there are with any surgery. Complications associated with coronary artery bypass grafting may include, but are not limited to, the following: stroke, damage to the aorta, the potential damaging effects of emboli (an abnormal particle, such as air circulating in the blood stream), bleeding, atheroembolism, vein graft occlusion or stenosis, arrhythmias, acute myocardial infarction, angina, or death.