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Coronary Artery Bypass

Coronary bypass

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. 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.

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.

Conditions Treated

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.

What to Expect

Coronary artery bypass graft surgery (CABG) requires a hospital stay. The patient receives a sedative medication through an IV and is in a deep sleep for the procedure. He or she has a breathing tube and is connected to a ventilator.

Once all the tubes and monitors are in place, incisions are made in one or both legs or one of the wrists to access the blood vessels to be used for the grafts. The surgeon makes an incision down the center of the chest, separates the two halves of the breastbone and spreads them apart to expose the heart.

For the On-Pump Procedure, the heart must be temporarily stopped. Tubes are put into the heart so that blood can be pumped through the body by a cardiopulmonary bypass machine. Once the blood has been diverted into the bypass machine for pumping, the heart is stopped by injecting it with a cold solution.

For the Off-Pump Procedure, the area around the artery to be bypassed is stabilized with a special instrument. The rest of the heart continues to function and pump blood through the body.

The surgeon then performs the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. More than one bypass graft may be performed, depending on how many blockages the patient has and where they are located. After all the grafts have been completed, the doctor will closely check them as blood runs through them to make sure they are working.

The sternum is sewn together with small wires and the incision is closed. Tubes are put into the chest to drain blood and other fluids from around the heart, and a tube is put through the mouth or nose into the stomach to drain stomach fluids.

After surgery, the patient is typically taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored. CABG requires an in-hospital stay of at least several days.

The patient has a breathing tube until they are stable enough to breathe on their own, usually the same day or by early next morning. The stomach tube is also removed early. A nurse will help the patient cough and take deep breaths every two hours to keep mucus from collecting in the lungs and possibly causing pneumonia. The patient will also start with a liquid diet and gradually advance to more solid foods as they are deemed fit to tolerate them.

When the doctor determines the patient is ready, he or she is moved from the ICU to a post-surgical nursing unit. Recovery continues there: activity is gradually increased and diet expanded. When appropriate, arrangements are made for the patient to go home and a follow-up visit with the doctor is scheduled.

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