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Surgery to restore blood flow to the heart muscle. This is done by moving blood vessels from other parts of the body into the heart, to provide a route around obstructed coronary (heart) arteries.
Reasons for Procedure
A CABG is performed to re-establish blood supply to the heart muscle. It is often recommended in cases of:
• Persistent chest pain not improved with drug therapy (angina)
• Severe blockages in the main artery or obstructions in several blood vessels
What to Expect Prior to Procedure
Your doctor will likely do the following:
• Chest x-ray
• Coronary angiogram - a test to determine the extent and location of blockages in blood vessels in the heart
• Electrocardiogram (ECG, EKG) - a test that records the heart's activity by measuring electrical currents through the heart muscle
• Physical exam
Risk Factors for Complications During the Procedure
• Advanced age
• High blood pressure
• Lung disease, especially chronic obstructive pulmonary disease (emphysema)
• Pre-existing heart condition
• Prior heart attack or bypass surgery
• Surgical urgency
• Thyroid disease
What to Expect Prior to Procedure:
In the days leading up to your procedure:
• Arrange for a ride to and from the hospital
• Arrange for help at home after returning from the hospital
• Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor
• The night before, eat a light meal and do not eat or drink anything after midnight
• A heart-lung machine to maintain blood circulation and cool the blood and body temperature
• Catheter placed in your bladder to drain urine
• IV fluids
Description of the Procedure:
The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine pulls blood from the heart, adds oxygen to it and pumps it back into the bloodstream while the surgeon is working on the heart and/or lungs.
To harvest a blood vessel to graft into the heart, the surgeon may detach an artery from the chest wall, or make one or several incisions in the leg and remove a section of vein from the leg. Sometimes two surgeons work together, one on the chest and one on the leg to remove a vessel for grafting. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions. When the grafts are in place, the blood (and thus the body temperature) is re-warmed to normal temperature, and therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.
Several medical centers are evaluating a less invasive approach to coronary artery bypass grafting, called minimally invasive coronary artery surgery. The purpose of this surgery is the same, to bypass the clogged arteries, but the technique and indications are different. Patients who have only one or two clogged arteries may be candidates for this approach. In this technique, a small incision is made in the chest, over the site of the clogged artery. The surgeon usually uses an artery from inside the chest wall to bypass the obstruction. The key difference in this technique is that the surgeon operates while the heart is beating, thus avoiding the use of the heart-lung machine. This type of surgery is promising, but needs more study.
Talk to your doctor about what is best for you.
You'll have close attention and monitoring in the intensive care unit. You'll be hooked up to various tubes and monitors, including:
• Bladder catheter
• Breathing tube until you can breathe independently; then an oxygen mask
• Heart monitor
• Pacing wires to help control heart rate
• Tubes connected to a machine that helps drain excess blood and air
How Long Will It Take? 4-5 hours
Will It Hurt? - Anesthesia prevents pain during surgery. You may experience pain during recovery, but will be given pain medications to relieve the discomfort.
• Excessive bleeding
• High or low blood pressure
• Irregular heart rate
• Kidney dysfunction
• Neurological deficits, stupor, coma, or decreased intellectual function
• Phlebitis (blood clots in a vein), which can lead to heart attack or stroke
Average Hospital Stay: 5-7 days
• Dressings will be removed in a day or two; pacing wires and chest tubes after a few days
• Follow activity and cardiac rehabilitation program as recommended by your doctor to speed recovery and improve cardiovascular health
• If a leg vein was removed, elevate your legs above your heart while sitting and do not cross legs
• Internal stitches will dissolve; staples will be taken out 5-7 days after surgery
• Once home, only take medications approved by your doctor, check your temperature twice daily, and weigh yourself every morning
• Small paper strips on incisions will peel off and can be removed one week after discharge
• Take medications as directed by your doctor.
These may include:
• Anti-arrhythmics, to keep your heart's rhythms regular
• Blood pressure medication
• Blood thinners, to prevent blood clots from forming
• Digitalis, to help your heart pump more strongly
• The day after surgery, try to walk with help
• To reduce the risk of fluid buildup in your lungs, breathe deeply and cough 10 to 20 times every hour
Bypass surgery restores blood flow through the heart but does not cure heart disease; the grafted blood vessels can also become clogged. Therefore, you will be encouraged to make lifestyle changes in order to improve your cardiovascular health. These include exercising regularly, not smoking, and eating a heart healthy diet—one that is low in saturated fat, simple sugars, and salt; and high in fiber, fruits, and vegetables. Ask your doctor for a referral to a registered dietitian if you need help changing your dietary habits. Most patients can return to office-type work in 4-6 weeks.
Call Your Doctor If Any of the Following Occurs
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Gaining more than four pounds within one or two days
• Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
• Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
• Signs of infection, including fever and chills