What is Coronary Bypass Surgery?bypass

Coronary Artery Bypass Graft Surgery (CABG) creates new pathways around narrowed or blocked coronary arteries so that more blood and oxygen flows to the heart muscle. This surgery uses segments of veins or arteries (grafts) taken from another part of the body to bypass coronary arteries on the heart that are blocked or narrowed. It diverts blood flow past the blockage allowing more blood and oxygen to flow to the heart. The goal of the procedure is to reduce the symptoms of coronary artery disease such as angina.

How do I prepare for bypass surgery?

Rest, eat well, quit smoking, and walk or do the exercise allowed by your doctor. Several routine tests are done before surgery:

Make a list of any questions you have and ask the doctor before surgery. You will receive specific instructions before surgery to completely prepare you for the procedure.

What happens during Coronary Bypass Surgery?

Graft Selection

The first step in the procedure is for the surgeon to select the bypass graph. The graph selected will depend on the location of the blockage and the condition of the patient’s coronary arteries.
The following veins and arteries are commonly used as bypass graphs:

  • Internal mammary artery (IMA)- This artery is on the inside of the chest wall and is commonly used for bypass grafting.  It has proven to have the best long term results.
  • The radial (arm) artery- is another common type of arterial graft. There are two arteries in the arm, the ulnar and radial arteries.
  • Saphenous vein -This vein on the inside of the leg running from the ankle to the groin can be used to make bypasses from the aorta to the coronary arteries. This vein is part of a deep venous system that normally does most of the work draining blood from the legs back to the heart.

Graft Harvesting

Traditionally, vein harvesting is accomplished through a lengthy surgical incision in the leg. However, a less invasive method called endoscopic vein harvesting (EVH) is becoming more common and is the preferred method of vein harvesting.  EVH requires one to three small incisions, each less than 1 inch in length. A special video camera (called an endoscope) is then used to allow the physician to clearly view the vein harvesting.

In addition to avoiding a scar, patients undergoing EVH are also less likely to experience complications and usually have shorter recovery times. Because of these advantages, more bypass procedures are being performed using endoscopic vein harvesting. Most people who require a bypass operation are candidates for EVH.   View an endoscopic vein harvesting at Genesis.

“On Pump” or “Off Pump”

Some patients are connected to a heart-lung machine (on-pump surgery) with the machine performing the functions of the patient’s heart and lungs.  The patient’s heart is stopped and the heart is not beating while the graft is sewn in place.

During the past several years, more surgeons have started performing off-pump coronary artery bypass surgery (OPCAB). In it, the heart continues beating while the bypass graft is sewn in place. In some patients, OPCAB may reduce the complications that can arise from using the heart-lung machine, such as intraoperative bleeding (the need for a blood transfusion), renal complications, postoperative neurological deficits, and lengthy hospital stays.  Also stopping the heart is too traumatic and dangerous for some patients.  At Genesis over 50% of our CABG surgeries are done off-pump leading to improved patient outcomes.

What happens to the blockage?

The blockage remains as is. The blood supply has been rerouted around it to the heart muscle.

Recovery

You will wake up in the ICU (Intensive Care Unit), and you may feel confused at first. Your family will be able to visit briefly. Be assured you are in capable, caring hands. You may be uncomfortable and unable to talk, but the nurses will help you communicate.
 
The equipment surrounding you helps you breathe, measures heart function, checks your blood pressure, heart rate, and kidney function. After all your vital signs are stable and you are doing well, you’ll be sitting up in a chair.
 
Most of the tubes and catheters will be removed within a day or two, and you’ll be moved to a regular room. You will be asked to breathe deeply and cough hard to clear any fluids from your lungs. You will feel sore, and you may experience night sweats, moodiness, or even feel down. This is all quite normal. If necessary, the surgeon will prescribe medication to keep you comfortable. If you are in pain, don’t hesitate to tell your nurse or doctor so that pain medication can be prescribed for you.
 
The nurses will have you moving and walking around right away. Within a few days you will eat a normal meal and begin to feel better each day.

Cardiac Rehabilitation

Genesis’ Cardiac Rehabilitation Program offers specialized rehabilitation programs for patients who have cardiac diseases. Cardiac rehabilitation provides patients, families, and communities with important resources in the battle against cardiovascular disease - the leading cause of death and disability in the United States. Cardiac rehabilitation programs are designed to assist patients with heart disease to recover faster, and return to full and productive lives. It is also a fitness program for people who seek personalized exercise and help in managing healthy lifestyle choices.

Lifestyle changes:
Coronary Bypass surgery does not cure coronary artery disease.  It recommended to follow your physician’s advice in making healthy lifestyle changes. 

  • Quit smoking
  • Exercise
  • Weight loss
  • Take prescribed blood pressure medications
  • Lower your cholesterol
  • Control stress
  • Share your feelings and concerns
  • Avoid angina triggers (anything that brings on your angina)
  • Communicate with your physician
  • You may want to join a support group