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 your body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your doctor attaches one end of the graft above the blockage and the other end below the blockage. Blood 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, your doctor makes a large incision in the chest and temporarily stops the heart. To open the chest, your doctor cuts the breastbone (sternum) in half lengthwise and spreads it apart. Once the heart is exposed, your doctor inserts tubes into the heart so that the blood can be pumped through the body by a heart-lung bypass machine. The bypass machine is necessary to pump blood while the heart is stopped.
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 (done through very small incisions) and robotic procedures (done with the aid of a moving mechanical device), may be used.
Why might I need coronary artery bypass surgery?
Your doctor uses coronary artery bypass graft surgery (CABG) to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to your heart muscle.
Symptoms of coronary artery disease may include:
- Chest pain
- Fatigue (severe tiredness)
- Abnormal heart rhythms
- Shortness of breath
- Swelling in the hands and feet
Unfortunately, you may not have any symptoms in 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 your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. 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 and then the intensive care unit (ICU) to be closely monitored. Machines 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 help 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, your doctor can adjust the breathing machine 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, your doctor will remove the breathing tube. In most cases, the breathing tube is removed soon after the operation, usually the same day or by early the next morning. Your doctor will also remove the stomach tube at this time.
After the breathing tube is out, a nurse will help you cough and take deep breaths every couple of hours. This will be uncomfortable due to soreness, but it is very important that you do this 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 medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
Your doctor may delivery medicines through the IV to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, he or she will gradually decrease and then stop these medicines.
Once your doctor removes the breathing and stomach tubes and you are stable, you may start to drink liquids. You can gradually include more solid foods as you can handle 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. You can gradually increase your activity as you get out of bed and walk around for longer periods. You can eat solid foods as soon as you can tolerate them.
A member of your care team will arrange for you to go home and schedule a follow-up visit with your doctor.
Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. Your doctor will remove the sutures or surgical staples during a follow-up office visit, if they were not removed before leaving the hospital.
Do not drive until your doctor tells you it's OK. You may have other activity restrictions.
Tell your doctor if you have any of the following:
- Fever of 100.4°F (38°C) or higher, or chills
- Redness, swelling, or bleeding or other drainage from any of the incision sites
- Increase in pain around any of the incision sites
- Trouble breathing
- Rapid or irregular pulse
- Swelling in the legs
- Numbness in the arms and legs
- Persistent nausea or vomiting
Your doctor may give you other instructions after the procedure, depending on your situation.