Coronary Artery Bypass Graft (CABG): What is it and How is it Done?

A coronary artery bypass graft (CABG) improves blood circulation to the heart. A surgeon takes blood vessels from another area of the body and uses them to bypass the damaged arteries.

A surgeon recommends this surgery when the coronary arteries get blocked or damaged. Coronary arteries are blood vessels that supply oxygenated blood to the heart muscles. When these arteries get blocked, damaged, or narrowed, the blood flow is restricted causing the heart to not function properly. This causes heart failure.

The health experts recommend the type of CABG depending on the damaged arteries. A surgeon may suggest the following bypass surgeries:

• Quadruple Bypass: When there’s a blockage in four arteries
• Triple Bypass: When there’s a blockage in three arteries
• Double Bypass: When there’s a blockage in two arteries
• Single Bypass: When there’s a blockage in one artery

A doctor may suggest CABG if a patient has severe blockages in the large coronary arteries that supply blood to a major part of the heart muscle. Additionally, a doctor may suggest this surgery if a person has blockages in the heart that can’t be treated with angioplasty. It may be done even in emergency situations like a heart attack not responding to other treatments. 

A doctor will suggest undergoing coronary artery bypass graft based on the below-mentioned factors:

• Quality of life
• Presence and severity of coronary heart disease (CHD) symptoms
• Any medical problems
• Location and severity of blockages in coronary arteries
• Response to other treatments

Risks

There are a few risks and complications after CABG. The complications and risks include:

• Heart stroke or attack
• Kidney failure
• Bleeding
• Arrhythmia
• Infection 
• Chest pain
• Blood clots
• Death, rarely

How to Prepare for Coronary Artery Bypass Graft

A doctor will evaluate your entire medical history. Also, the doctor will suggest a few physical examinations and blood tests to look at your health or detect any underlying health condition. 

If it is a planned surgery, the patient should avoid eating or drinking for 8 hours before the surgery. Also, hospital staff will ask the patient to take a bath with an antiseptic soap or special cleanser the night before the surgery or in the morning. 

The patient then needs to inform the doctor about the list of prescribed and non-prescribed (OTC) medicines, drugs, and herbal usage before the surgery. Also, he or she is required to tell if he or she is allergic or sensitive to any medicine, anesthesia, latex, iodine, tape, or drug.

A patient should inform the doctor if he or she is using any blood-thinning medicines or have a history of bleeding disorders. A doctor may ask to stop those medicines a few days before the surgery.

What  Happens During the Surgery

Before the surgery, the health professionals will give certain medication, fluids, and general anesthesia through an IV. General anesthesia makes a person go into a deep and painless sleep. 

The first step that the surgeon will start with is an incision in the middle of the chest. After that, the surgeon will expose the heart by spreading the rib cage. A surgeon may opt for a minimally invasive surgery which involves smaller incisions and special miniaturized instruments and robotic procedures.

Once the heart is exposed, the doctor will insert a few tubes in different areas that will be connected to a cardiopulmonary bypass machine. This machine helps circulate oxygenated blood throughout the body while the surgeon treats the heart. However, certain procedures are performed “off-pumped” that means the person isn’t connected to a cardiopulmonary bypass machine.

Once the body is on the cardiopulmonary bypass machine, the surgeon will remove healthy vessels from the leg to bypass the damaged or blocked portion of the artery. One end of the graft is attached above the blockage and other below the blockage.

Once the surgery is done, the surgeon checks the function of the bypass. Once the bypass starts working properly, the surgeon will start the heart to pump with a shock. After the heart starts to pump, the tubes attached to the cardiopulmonary bypass machine are removed. The rib cage is then attached together with a few stitches and the wound is bandaged. 

After the surgery, the patient is brought to the intensive care unit (ICU) for monitoring and extra care.

Recovery Period

Doctors usually advise patients who underwent CABG to remain under observation until they are stable enough for regular activities. For the first few days post-op, the hospital will admit the patient in the intensive care unit (ICU). Once discharged, the person will have regular follow-up checkups for about 6 – 8 weeks post-surgery.

The recovery duration varies from person to person. Most commonly, the person should be able to sit on the chair after 1 day, walk carefully after 3 days, and walk, climb up and down the stairs after 5 to 6 days.

Once home, a person needs to take things easy for a few weeks. Generally, the person can return to normal activities and routine after about 6 weeks.

According to health experts, a person can make a full recovery within 12 weeks.

Post-Surgical Care

After the surgery, patients should make it a point to keep the surgical area clean and dry. A doctor will provide special bathing instructions that should be followed properly. 

A doctor will remove the stitches or surgical staples during a follow-up meeting if he or she did not remove them during the discharge from the hospital.

Do not perform any physical activities before consulting a doctor or until the doctor tells you to. Also, in case of any following things, call the doctor or visit the health center immediately:

• Persistent vomiting or nausea
• Legs and arms numbness
• Legs swelling
• Irregular or rapid pulse
• Breathing issues
• Pain around the incision area
• Bleeding, swelling, redness or any discharge from the incision sites
• Chills or fever of and above 100.4 degrees F (38 degrees C)