Coronary Artery Bypass Grafting (CABG)

The left and right coronary arteries provide the heart with constant blood supply to function correctly. Over time, these arteries can become narrowed, blocked or hardened by atherosclerosis—a condition that occurs when plaque builds up in the arteries. Plaque is made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood). Blood flow to the heart can become blocked when plaque breaks open, forming a blood clot. People with atherosclerosis may develop coronary artery disease, which can lead to chest pain called angina or trigger a heart attack.

Although angina can be treated with medicine, severe angina may require coronary artery bypass graft surgery to help improve blood flow to the heart. This procedure is also recommended to reduce the risk of having a heart attack in people with coronary artery disease.

What Is Coronary Artery Bypass Grafting?

Coronary artery bypass graft surgery, or CABG surgery, is a medical procedure that involves using healthy blood vessels from another part of the body, usually from the arm or chest or veins from the legs and connecting them to blood vessels above and below a blocked artery. This new blood vessel is called a graft. CABG surgery creates a new pathway for oxygen-rich blood to flow around or bypass the narrowed or blocked coronary arteries.

As with all types of surgery, coronary artery bypass graft surgery carries the risk of possible complications. These complications, such as an irregular heartbeat or a wound infection, are usually relatively minor and treatable. During recovery from CABG surgery, doctors may recommend medications and heart-healthy lifestyle changes to reduce further symptoms, treat the disease and help prevent complications like blood clots, stroke or heart attack. They may also discuss steps to avoid or lower the risk of future blockages or other health issues.

Is CABG Open Heart Surgery?

Coronary artery bypass grafting can be performed in three ways—traditional CABG surgery, off-pump CABG surgery and minimally invasive CABG surgery. In traditional CABG surgery, surgeons make an incision in the chest, and a machine is used to perform the functions of the heart and lungs. As with off-pump CABG surgery, the chest is also opened, but a machine for pumping blood is not used. In minimally invasive CABG surgery, surgeons make small incisions in the chest, and a machine is not used to perform the procedure.

How Is a Coronary Artery Bypass Graft Performed?

The most common coronary artery bypass grafting technique is the traditional “open heart” CABG surgery. In this method, the patient will be asleep and connected to a ventilator to support breathing during the procedure. Then, an incision is made down the middle of the chest, through the breastbone. The bone is divided and held open during surgery so the surgeon can access the heart. The patient will be given medicines to temporarily stop the heart from beating and help surgeons connect the healthy blood vessels, called grafts, into the blocked coronary arteries. A heart-lung bypass machine takes over the job of the heart and lungs by adding oxygen to the patient’s blood through the machine’s tubes and pumping it throughout the body while the heart is not beating.

During coronary artery bypass surgery, grafts create new paths for blood flow to the heart muscle. The number of grafts depends on how many blocked coronary arteries need bypassing. After grafting, the surgeon restarts the heart, which may begin beating independently. Controlled electrical shocks may be used if necessary. The surgeon will then sew the breastbone back together with a wire.

The number of blood vessels used depends on the severity of the coronary heart disease. If the patient requires two, three or four grafts, the procedure may be called a double, triple or quadruple bypass.

How Long Does Coronary Artery Bypass Surgery Take?

Traditional coronary artery bypass graft surgery usually takes three to six hours. However, the procedure may take longer depending on the number of arteries that need to be bypassed.

How Long Can You Wait To Have Bypass Surgery?

The waiting time for a coronary artery bypass graft surgery can vary by location. Ideally, treatment should occur within three months of the decision to operate. Your cardiovascular surgeon can provide information about waiting lists in your area or at your chosen hospital.

Takeaways

Most patients experience significant improvement, including reduced breathlessness and chest pain, as well as lowered heart attack risk after undergoing coronary artery bypass surgery. However, CABG surgery is not a cure for coronary heart disease. Without lifestyle changes like maintaining a healthy diet and regular exercise, the grafted arteries can eventually become hardened and narrowed. In some cases, a repeat CABG surgery or a procedure like coronary angioplasty with a stent may be necessary.

Find a Cardiovascular and Thoracic Surgeon in San Antonio

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The journey to good heart health is better taken together. Please call 210-798-4311, and we’ll connect you to one of our providers or find a cardiovascular and thoracic surgeon near your location.

If you or someone has signs of heart attack, stroke or cardiac arrest, please call 911 or go to the nearest emergency room. Please don’t delay care.