Cardiac Diagnostic Treatments
Coronary Artery Bypass Graft Surgery
Coronary heart disease, or CHD, is an accumulation of plaque inside one or more coronary arteries that can cause a reduction in blood flow to the heart muscle. Coronary artery bypass graft surgery, or CABG, is a procedure that improves blood flow to the heart muscle by rerouting blood around the blocked or narrowed portion of a coronary artery. To reroute blood around a blocked section of a coronary artery, surgeons use a piece of an artery or vein from another part of a person’s body, called a graft vessel. Coronary artery bypass graft surgery also referred to as bypass surgery and CABG, is the most frequently performed cardiac surgery in the United States.
Bypass surgery is done to restore blood flow to the heart by bypassing arteries narrowed or blocked by atherosclerosis, a process caused by the buildup of fats and cells called plaque. Bypass surgery restores an adequate supply of oxygenated blood to the heart, thus allowing it to work more effectively and efficiently. This operation is usually performed after drug therapies have failed to improve blood flow.
Preparation for coronary artery bypass surgery consists of preoperative testing that may include:
- Cardiac catheterization
- Chest x-ray
- Lab tests
What to Expect
Preparation for heart surgery begins with the shaving and disinfecting of the chest. A narrow, soft tube called an intravenous catheter, or IV will be placed in one or both of the patient’s arms to provide fluids and medication during and after surgery. Another catheter will be placed in the side of the patient’s neck.
During the bypass operation, surgeons take a blood vessel from another part of the patient’s body and construct a detour around the blocked portion of the coronary artery. One vein that is commonly used to create this detour a greater saphenous vein from the leg. Often, arteries in the chest, such as the left internal mammary artery, or LIMA, are used for grafts. Another vessel used for grafts in coronary artery bypass surgery is the radial artery from the wrist and the forearm, which feeds blood to the hand. Typically, the saphenous vein is removed by endoscopic vein harvesting.
Almost all coronary bypass surgeries use a heart-lung machine, which enables a surgeon to stop the heart from beating while he or she sews tiny arteries and veins together to form grafts. The heart-lung machine performs the pumping and oxygenation functions of the heart. When the grafts have been completed, the heart is stimulated to begin pumping blood again and the heart-lung machine is removed.
Some surgeons now perform minimally invasive coronary artery bypass or keyhole surgery. The same techniques are used as in beating-heart surgery, but instead of performing a full sternotomy, or opening the patient’s chest by cutting through and separating the breastbone, surgeons make small incisions-or keyholes-between the ribs to access the heart.
Coronary bypass surgery usually takes 2 to 5 hours. After the surgery is completed, the patient typically spends about 24 to 72 hours in the intensive care unit of the hospital. The patient is then moved to the cardiac care discharge in 3 to 7 days. Recovery takes 1 to 2 months.
To reduce the chances of needing another coronary bypass surgery in the future, the physician will advise the patient to stop smoking and reduce intake of fat and cholesterol. The physician will also recommend that the patient walk or do another form of physical activity to help regain lost strength. Sexual activity may be resumed in 3 to 4 weeks after surgery. People with sedentary jobs can return to work in 4 to 6 weeks; those with physically demanding jobs will have to wait longer.
There is a small risk of the following complications:
- Breathing problems
- Blood clots
- Brain damage
There is a 2 percent risk of dying from a scheduled coronary artery bypass graft surgery. The risk increases to 8 percent if it is an emergency procedure.