Coronary Artery Bypass Graft (CABG- pronounced as “cabbage”) surgery is the most common type of heart surgery, according to the American Heart Association. Coronary artery bypass graft surgeries are recommended to patients who are at risk of a heart attack (also known as myocardial
infarction), due to significant narrowing or blockages of the heart vessels. These narrowing or blockages of the heart blood vessels, also known as coronary artery disease, can cause a lack of blood flow to the heart muscle. When the narrowing of the blood vessel is more than 50 to 70 percent, there is not
enough blood flow to the heart during exercise/activity. Blood carries oxygen throughout our body, including our heart, and when our heart is starved of this oxygen-rich blood (ischemia) it can cause chest pain (also referred to as angina pectoris), which can then lead to a heart attack. Coronary artery bypass
graft surgery reestablishes sufficient blood flow to deliver oxygen-rich blood and nutrients to the heart, by taking a healthy blood vessel from another part of the body (called a graft) and bypassing the blocked artery to create a new path for blood flow.
Diagnostic tests for coronary artery disease
Benefits of coronary artery bypass graft surgery (CABG)
Coronary artery bypass surgery will improve blood flow to the heart. CABG surgery will relieve chest pain, fatigue, and other symptoms of coronary artery disease. The grafting procedure that surgeons perform results in an increase in blood flow, decreasing the
probability of a heart attack. The procedure can also enable a patient to manage risk factors of their coronary artery disease and prevent future blockages.
Possible surgical complications
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Preparing for coronary artery bypass graft (CABG)surgery
The surgeons who will perform your procedure will give you detailed instructions on how to prepare for your surgery. Here are some basic guidelines:
The day of your coronary artery bypass graft (CABG)
Once at the facility, a nurse will start an IV line in your arm or your hand which will provide access for fluids and medications required during the heart surgery. If needed, hair will be removed from your chest and any other incision sites for a sterile field.
Anesthesia will be given before the surgery starts and this will keep you free from any pain during the procedure. Anesthesia will put you into a deep sleep state, and a tube will be placed in your mouth down your throat to take over your breathing during the surgery.
How a coronary artery bypass graft (CABG) surgery is performed
The blood vessels most commonly used for the bypass are the saphenous vein from the leg and the internal mammary artery located on the left side of the chest wall. Another option is the radial arterylocated in the arm.
The cardiac surgeon makes an incision down the middle of the chest and divides the sternum (breastbone). This procedure is called a median (middle) sternotomy.
A heart-lung machine (Cardiopulmonary bypass) must be established before attaching the grafted artery can take place. Plastic tubes are placed into the right side of the heart to channel non-oxygenated blood out of the body and into the heart-lung machine. Once the carbon dioxide is extracted from the blood and
the blood is oxygenated, it can be returned to the body throughout the surgery.
“Off-pump CABG” is a coronary artery bypass graft surgery performed without the use of a heart-lung machine. Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument. The rest of the heart will continue to function and pump blood
through the body. The heart-lung bypass machine and the person who runs it may be kept on stand-by just in case the procedure needs to be completed on bypass.
The grafting portion of the surgery can now begin by attaching a grafted blood vessel beginning at the aorta to beyond the narrowing or blockage, also known as an aortocoronary bypass. Once the graft is prepared it will be sewn into place. You may have heard the words single bypass, double
bypass, triple bypass or quadruple bypass surgeries. These refer to the number of arteries that are bypassed, and it does not necessarily indicate how severe the heart disease is. Once the graft has been attached, blood will start flowing in this new pathway, bypassing the blockage.
Finishing the coronary artery bypass graft surgery
After the coronary artery bypass graft surgery
Helping You Breathe
The cardiac surgeon and nurse navigator will prepare you for the next steps upon discharge from the hospital. New medications and adjustments will be discussed, and directions will be given on how and when to take them. Daily activities like driving, sexual activity,
and work will all be discussed, but it typically takes several weeks before patients are able to resume these activities. If needed, arrangements can be made for those who need to be at a skilled nursing facility to help them recover.
Cardiac rehab can take place in the hospital, clinic, or doctor’s office. A team of specialists (doctors, nurses, exercise specialists, dietitians, and counselors) will work with you to educate and instruct you about life after heart surgery. You will learn safe
ways to strengthen your heart through exercise and the best ways to shop and eat for a healthy heart. The cardiac rehabilitation team will help you manage risk factors for coronary artery disease which includes high blood pressure, high cholesterol, diabetes, and smoking. Counseling is also available to help
you deal with the emotional aspects of open heart surgery. Your family is encouraged to be involved so they can be educated as well.
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