What is coronary bypass graft surgery?
Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease. Coronary artery disease (CAD) is the narrowing of the coronary arteries – the blood vessels that supply oxygen and nutrients to the heart muscle. CAD is caused by a build-up of fatty material within the walls of the arteries. This build-up narrows the inside of the arteries, 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 a piece of a healthy blood vessel from elsewhere in the body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from the legs or an artery in the chest. 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. Blood is routed around, or bypasses, the blockage by going through the new graft to reach the heart muscle. This is called coronary artery bypass surgery.
Traditionally, to bypass the blocked coronary artery, a large incision is made in the chest and the heart is temporarily stopped so that the surgeon can perform the delicate procedure. 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 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 commonly done and often preferred in many situations, 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 keyhole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), may be used.
Why might I need coronary artery bypass surgery?
Coronary artery bypass graft surgery (CABG) is used to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to the heart muscle.
Symptoms of coronary artery disease may include, but are not limited to:
- Chest pain
- Fatigue (severe tiredness)
- Abnormal heart rhythms
- Shortness of breath
- Swelling in the hands and feet
Unfortunately, there may be no symptoms of early coronary artery disease, yet the disease will continue to progress until there’s enough artery blockage 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 heart attack may occur. If the blood flow can’t be restored to the particular area of the heart muscle affected, the tissue dies.
There may be other reasons for your doctor to recommend CABG surgery.
What happens after coronary artery bypass surgery?
In the hospital
After the surgery, you may be taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored. Or, you may be taken directly to the ICU from the operating room. You will be connected to machines that will constantly display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Coronary artery bypass surgery (CABG) requires an in-hospital stay of at least several days.
You will most likely have a tube in your throat to assist with breathing through a ventilator (breathing machine) until you are stable enough to breathe on your own. As you continue to wake up from the anesthesia and start to breathe on your own, the breathing machine will be adjusted to allow you to take over more of the breathing. When you are awake enough to breathe completely on your own and you are able to cough, the breathing tube will be removed. In most cases, the breathing tube is removed soon 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, a nurse will help you cough and take deep breaths every two hours. This will be uncomfortable due to soreness, but it is extremely important that you do this in order to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
The surgical incision may be tender or sore for several days after a CABG procedure. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
You may be on special IV drips to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these drips will be gradually decreased and turned off.
Once the breathing and stomach tubes have been removed and you are stable, you may start to drink liquids. Your diet may be gradually advanced to more solid foods as you are able to tolerate them.
When your doctor determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue there. Your activity will be gradually increased as you get out of bed and walk around for longer periods. You can eat solid foods as soon as you can tolerate them.
Arrangements will be made for you to go home and a follow-up visit with your doctor will be scheduled.
Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they were not removed before leaving the hospital.
You should not drive until your doctor tells you to. Other activity restrictions may apply.
Notify your doctor if you have any of the following:
- Fever and/or chills
- Redness, swelling, or bleeding or other drainage from any of the incision sites
- Increase in pain around any of the incision sites
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.