Coronary Artery Bypass Graft (Heart Bypass)

About the Procedure

Coronary Artery Bypass Graft Surgery, also known as CABG, is a procedure allowing the flow of blood through a coronary artery to circumvent a constricted area by using an artery or vein from a different site to bypass it. When one or more coronary arteries are narrowed due to plaque build up (fatty deposits), the doctor may recommend bypassing the blocked area with a vessel taken from another area of the body, commonly, the chest, leg, or forearm. By attaching the vessel below the blockage and linking it to the aorta, oxygenated blood flows freely from the heart to the rest of the body. A CABG may also be performed as emergency surgery during or following a heart attack or when a cardiac catheterization indicates severe blockage. New, minimally-invasive techniques, such as robotic heart bypass surgery and video-assisted (or keyhole) procedures are being performed, but traditional open-chest surgery is preferred as most surgeons have been trained in that procedure.

A cardiothoracic surgeon performs a CABG which takes between three to six hours. The patient is unconscious during the procedure and their respiration is managed by a ventilation system. The surgeon opens the chest through an incision in the sternum and the heart is examined to make a final determination as to the number of arteries requiring bypass. Once the vessels to be used as grafts are obtained, the patient's cardiopulmonary function is taken over by a heart-lung machine. Each graft is attached on one side to the coronary artery before the blocked section and connected to the aorta on the other side. The heart is restarted and stabilized, plastic tubes are placed in the chest cavity for external drainage, the sternum is closed with wires, and the chest is sutured. The patient is then moved to an Intensive Care Unit for recovery.

What to Know Before the Procedure

The risks for any surgical procedure, e.g., blood clots, breathing issues, infections, and blood loss are especially applicable in CABG surgery. Specific risks are numerous and include: heart attack or stroke, heart rhythm abnormalities, poorly healed sternum, embolisms, deep vein thrombosis, and acute renal failure, and post-surgical bleeding which may require a second surgery. Depending on the overall health status of the CABG patient, other serious but infrequent complications may occur. A neurocognitive impairment involving loss of mental clarity and memory defects are common among CABG patients.

Pre-admission tests will be performed the week before surgery and the doctor's office will provide instructions about specific preparations prior to admission. All medications taken by the patient must be reviewed by the surgeon and hospital medical personnel to avoid serious blood clotting issues. The patient should discuss with the surgeon which medications may be taken on the day of surgery.

What to Know After the Procedure

For the first 24 hours, patients are continuously monitored in ICU after which they are moved to a regular room on a cardiac floor. On the day after surgery, the tubes for urine, fluids, and drainage will be removed and patients usually get out of bed and encouraged to resume some activities. Chest sutures are removed prior to discharge and the patient is informed of restrictions in movement to avoid opening the incision and to allow healing of the sternum. Discharge is commonly in three to four days, sometimes sooner with younger patients. Driving is to be avoided for the first month and a return to work generally occurs in six or fewer weeks. Sexual activity can be resumed when the patient wishes as long as putting weight on the chest or arms is avoided. Complete recovery from surgery may take as long as six months. At around four weeks post-surgery, the doctor will counsel the patient as to a cardiac rehabilitation program, medications, and lifestyle changes.

If you Need to Travel Outside of your Local Hospital

Elective coronary artery bypass surgery allows the patient flexibility in identifying a surgeon and facility for the procedure, as well as planning for recuperation. A young patient or one without other significant health factors is less likely to experience complications or a difficult recovery, which is ideal when considering options for the location of the surgery. In light of the risks associated with a CABG, especially for elderly or patients with other health problems, the benefits of having the procedure performed in another state or country may be less important than being near to home, family and local physicians. With such a complex surgery there needs to be an open and active discussion between you and your doctors about the best way to proceed.