Coronary Artery Bypass Grafting (CABG)

Coronary Artery Disease (CAD) is caused by a condition known as atherosclerosis. In this condition, plaque builds-up inside the artery lining. As time progresses, the condition will worsen and thus lead to the narrowing of the coronary arteries. The coronary arteries supply your heart muscle with oxygen-rich blood. As plaque continues to build, the narrowing gets worse. This decreases the blood flow to the heart. In addition, the plaque may rupture, and lead to a blood clot which could then block the blood supply to the heart, causing a heart attack.

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Prior to arriving at this procedure, your doctor will recommend various types of medications and suggest lifestyle changes. However, if these do not improve your health, or if you have a heart attack, your doctor may suggest a PCI (percutaneous coronary intervention) or a CABG. The type of procedure chosen will vary according to your particular health condition.

Coronary Artery Bypass Graft Surgery (CABG), also known as bypass surgery, is the most common type of open-heart surgery. It provides a way to bypass the blocked portion of the coronary artery with a piece of a healthy blood vessel (vein or artery) from elsewhere in your body (veins from leg or artery from chest or forearm).

Types of CABG

• Traditional Coronary Artery Bypass Grafting: The most common type. During the surgery, the breast bone or sternum is cut open and split into two halves. The heart is stopped. A heart-lung bypass machine is used to keep blood and oxygen moving throughout the body during grafting. After graft completion, the heart resumes normal function.
• Off-Pump Coronary Artery Bypass Grafting (Beating Heart): Though similar to traditional CABG, during this procedure your heart isn’t stopped and a heart-lung bypass machine isn’t used. This means the heart continues to provide blood to the rest of the body during the surgery. This method is used in selected cases when the use of the heart-lung machine is not recommended.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Angioplasty
• Blood tests
• Cardiac Catheterization
• X-Rays
• Ultrasound
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress test
• Urinalysis

What to Expect During the Procedure

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A CABG surgery usually takes 4 to 6 hours, but the preparation and recovery may add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make you feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery).

During “Traditional CABG”

• For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will start with the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery beyond the blockage.
• After all the grafts have been completed, the doctor will closely check them as blood runs through them to make sure they are working. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
• If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it.
• Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period.
• Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

During an “Off-Pump CABG”

• Once your doctor has cut your breastbone, he or she will stabilize the area around the artery to be bypassed with a special instrument. The rest of the heart will continue to function and pump blood through the body.
• The bypass machine and the person who runs it may be kept on stand-by just in case the procedure need to be completed on bypass.
• The doctor will do the bypass graft procedure by sewing one end of a section of a vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage.
• Before the chest is closed, the doctor will closely examine the grafts to make sure they are working. Once checked, the doctor will sew your sternum back together by use of sutures or surgical staples.

What to Expect After the Procedure

After the surgery, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. CABG surgery requires a hospital stay of 4 to 6 days. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• If you have pacing wires in your heart, he or she will remove those too.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may also be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.