Coronary artery bypass graft

Coronary artery bypass grafting

Also called CABG, coronary artery bypass graft is a type of open-heart surgery in which the rib cage is opened and a section of a blood vessel is grafted from the aorta to the coronary artery to bypass the blocked section of the coronary artery and improve the blood supply to the heart

When is CABG needed?

• atherosclerotic blockage of coronary arteries
• CABG helps reduce the risk of obstructive coronary artery disease, a type of ischemic heart disease.
• CABG may also be used in an emergency, such as a severe heart attack.

How does it work?

• CABG uses one or more blood vessels from another area such as the lower extremity and connects them to blood vessels above and below the narrowed artery, bypassing the narrowed or blocked coronary arteries.
• One or more blood vessels may be used, depending on the severity and number of blockages.
• The blood vessels are usually arteries from the arm or chest, or veins from the legs.

Tests before surgery

Tests and procedures may include the following:

CABG

• Electrocardiogram (ECG or EKG)
• Stress tests to measure how well your heart works
• Echocardiogram to assess heart function including the valves and pumping.
• Coronary angiography to see how blood flows through your arteries which shows how severe the disease is, which arteries are affected, and the location of the affected arteries.
• CT angiography uses an injection of dye in the arm along with computed tomography (CT) imaging. Because it does not involve threading a catheter into the heart as cardiac catheterization does, CT angiography may be safer for some patients.
• Coronary calcium scan to get images of the calcium in the walls of your coronary arteries, which is linked to coronary artery disease. This test uses CT imaging.

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Quadruple Bypass

Traditional CABG

Traditional CABG is the most common type of CABG surgery. This surgery takes about three to six hours, depending on how many arteries need to be bypassed. Learn more about how to prepare before surgery.

You will be given an intravenous (IV) line for fluids and medicines that will make you sleep before the surgery. You will be connected to a ventilator to support your breathing. The surgeon makes a cut down the middle of the chest, through the breastbone. The bone is split and the rib cage separated so the surgeon can reach the heart.

You will receive medicines to temporarily stop your heart from beating. This makes it easier for the surgeon to connect the healthy blood vessels, called grafts, into the coronary arteries. This requires a heart-lung bypass machine, which adds oxygen to your blood and pumps it throughout your body during surgery while your heart is not beating.

CABG 0&30 Stenosis

Off pump CABG

Sometimes CABG can be done without stopping the heart and using a heart-lung bypass machine. This is called off-pump CABG because the heart-lung bypass machine, or pump, is not used. The heart is steadied with a mechanical device. It is more difficult for surgeons because the heart is beating, and surgeons do not have easy access to blood vessels. However, it may be safer for certain people, such as those who have a higher risk of complications from using a heart-lung bypass machine. These include older adults and people who have ventricular dysfunction, diabetes, kidney disease, and chronic lung disease. This type of surgery is also sometimes called beating-heart bypass grafting.

Minimally invasive cardiac surgery

• Minimally invasive direct coronary artery bypass (MIDCAB). MIDCAB is a modified version of CABG where the chest bone is not cut open. Instead, the surgeon makes a smaller cut on the left side of the chest over the artery that needs to be bypassed and enters in between the ribs. It is also usually an off-pump procedure.
• Robotic. Sometimes CABG surgery can be done using a robot to surgically place the graft. This is called robotic-assisted or robotic surgery. The surgeon controls the robot instead of doing the work by hand, and the machinery only needs small openings in the chest. A heart-lung bypass machine is sometimes used.
• Hybrid. During a hybrid bypass surgery, the robotic bypass is done for one of the main arteries, but a stent is used for other blocked arteries. The stent is a rolled-up mesh tube-like structure that goes inside the blocked artery to hold it open. This procedure is typically used only if your doctor is unable to perform the traditional bypass procedure.

Heart saphenous coronary grafts

Complications of CABG

• Arrhythmia, or irregular heartbeat. The most common type is called atrial fibrillation, which may occur after the surgery but usually goes away on its own.
• Bleeding, which may require more surgery to control it
• Confusion or problems thinking clearly, temporary memory loss, vision problems, and slurred speech can occur for a short time right after surgery. This is also known as postoperative cognitive decline (POCD). Delirium, or intense confusion, is rare. The exact cause of POCD is not known. Many factors, including the health of the patient before surgery, likely play a role.
• Heart attack
• Infection, which can occur where the surgical cut was made or inside the chest where the surgery was performed. This may require additional surgeries.
• Kidney failure
• Stroke

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