Coronary Artery Bypass Graft

What is CABG?

Coronary artery bypass grafting (CABG) is an open-heart surgery to restore blood flow to areas of your heart. You need this when your heart can’t get enough blood from arteries that wrap around it. When blood supply is low due to artery blockages, heart muscle cells start to die.

CABG creates a bypass for blood to reach areas of your heart that need more blood. A bypass is like a detour for your blood to get around an obstacle. Surgeons take a blood vessel from your leg, arm or chest. They use it to make the detour around the blockage.

You may need multiple bypasses if you have more than one blocked artery. These are double (2), triple (3) and quadruple (4) bypasses.

Bypass surgery can improve your heart function and how you feel. It’s for people who have coronary artery disease. This can mean you’ve had a heart attack or you’re at risk for one. CABG also treats chest pain (angina) or silent myocardial ischemia. This is a lack of blood flow to your heart muscle, but with no symptoms.

These problems happen because of a buildup of fatty residue called plaque in arteries. Plaque (atheroma) makes arteries in your heart narrow and stiff. If plaque breaks open, blood clots can form there and make blockages in those arteries. Those blockages cause ischemia in parts of your heart. This can lead to a heart attack.

Coronary artery bypass surgery is the most common heart surgery in the world. The average age for people who have CABG surgery is around 66 years old. Most of the people who undergo it are male.

How should I prepare for this procedure?

CABG is major surgery. Before heart bypass surgery, you’ll need to have several tests. These help your healthcare provider see if it’s safe for you to have this surgery and decide whether you need it.

Tests may include, but aren’t limited to, the following:

• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Exercise stress test
• Nuclear cardiac stress test
• Cardiac catheterization
• X-ray angiography or CT scan angiography
• Coronary calcium scan
• Blood and urine tests

Your healthcare provider will discuss what medications you’re taking before the surgery. They’ll also tell you which ones to keep taking and which ones you should stop. You’ll need to fast (stop eating and drinking) several hours before surgery.

What happens during CABG?

During coronary artery bypass grafting, a healthcare provider will:

1. Ensure that machines are in place to take over for your heart and lungs, and for you to receive IV fluids — sometimes, a provider performs the procedure without using the machine (off-pump approach)
2. Use medicine (anesthesia) to put you into a deep sleep
3. Make a cut in the center of your chest
4. Split your breastbone (sternum) down the middle (in select cases, a provider makes a less invasive, small incision between the ribs on your left side or also a robotic approach)
5. Spread and lift your rib cage
6. Create a bypass using a blood vessel from elsewhere in your body
7. Secure the bypass from just past the blockage to your aorta (largest artery) or use a chest artery (internal mammary artery) that’s detached from your chest but maintains its inflow from your arm vessel
8. Restart your heart (if they stopped it) and get your blood flowing again
9. Lower your rib cage back into place and wire it together so it can heal
10. Close the cut in your chest with sutures (stitches)

Forms of this surgery

Different ways to do a CABG procedure include:

• Off-pump CABG: This type doesn’t use a heart-lung bypass machine. The surgeon works while your heart is beating.
• Minimally invasive CABG: This method uses much smaller cuts. The surgeon reaches your heart through the gaps between some of your ribs.
• Robot-assisted CABG: A surgeon controls a surgical robot’s movements. Robotic surgery uses smaller cuts and doesn’t open and lift your sternum.
• Hybrid procedure: This type usually involves robot-assisted CABG on at least one artery. But a surgeon may use methods like stent placement to keep other diseased blood vessels open.

How long does this procedure take?

CABG is a complicated procedure that takes three to six hours to complete. The actual time it takes depends on the specific type of CABG surgery, how many bypasses you need and more.

What are the potential benefits and risks of this procedure?

CABG has several advantages. These include:

• A long history of use: Surgeons have been performing CABG since the 1960s. Advancements helped make bypass surgery a reliable way to restore blood flow to your heart.
• Best choice for several blockages or blockages in certain arteries: CABG is often the best choice if you have multiple blocked arteries in your heart. It’s also best for blockages in certain places.
• Lower risk of follow-up procedures: The main option instead of CABG is angioplasty. In many cases, this has a higher risk of needing a follow-up procedure than CABG surgery and generally has less durable effects.

Heart bypass surgery is a major surgery, which means it can have risks and complications. Most of these are uncommon and avoidable or treatable. But it’s important to understand them. Possible risks include:

• Irregular heart rhythms (arrhythmias)
• Bleeding
• Infections
• Confusion or delirium
• Kidney problems
• Stroke
• Heart attack

What happens after CABG?

After surgery, you’ll go to the hospital’s intensive care unit. When a provider feels you’re ready, you’ll move to a regular medical-surgical room in the hospital.

The average hospital stay for heart bypass surgery is between five and seven days. The stay is longer for people who had CABG because of a heart attack. It’s shorter for those who didn’t.

What is the recovery time?

Most people who have CABG will need six weeks to recover. During that time, it’s best to avoid anything that might put too much stress on your heart and cuts.

Your healthcare provider is the best person to tell you how long it will take to recover and what you should expect. They’ll also tell you when you can drive, go back to work or be physically active.

What are the lifestyle changes after CABG?

CABG surgery can restore blood flow. But the issues that caused you to need CABG can still happen again. It’s important to follow your healthcare provider’s guidance on improving your lifestyle. This includes what you eat and how much physical activity you get. Improving your habits can help you avoid more issues in the future.

A cardiac rehab program can make a huge difference in your overall recovery and how you feel after bypass surgery. Medical professionals who monitor cardiac rehab can help catch any potential problems or warning signs sooner rather than later.

During your recovery, be sure to take medicines as instructed and speak with a counselor if you feel anxious or depressed.

When should I call my healthcare provider?

You should see your provider for follow-up visits to check your heart function, remove stitches or staples, and make sure your wounds are healing well.

You should go to the hospital right away if you have any of the following:

• Chest pain
• Trouble breathing
• Dizziness or lightheadedness
• Fainting
• Heart palpitations
• Face drooping
• Weakness on one side of your body
• Slurred or distorted speech
• Fever or chills
• Fast heart rate or breathing

What is the success rate?

Many studies have linked CABG with improved long-term outcomes, including better survival odds. This advantage often grows when advanced bypass techniques are used, with lasting results. In clinical trials, CABG relieves angina symptoms in 8 out of 10 people.

What happens 10 years after a heart bypass?

Some people need another bypass eight to 10 years after bypass surgery because of another blockage. But you may be able to prevent this by reducing your LDL cholesterol, avoiding tobacco products and taking one aspirin a day. Also, the use of more arterial grafts instead of veins may reduce the need for future procedures.

Some people are still doing well for 20 years or more after bypass surgery. The life expectancy after bypass surgery was 18 years in one study.