How is CABG done?

Coronary artery bypass graft is known as CABG for short. It is major open-heart surgery. You have it done while in a hospital and under general anesthesia. That means you will not be awake for the surgery.

Before you go into the operating room, a healthcare professional will give you medicine to help you relax. You will probably take this by mouth. You will also take anticoagulant medicine. This prevents your blood from clotting more than it should during the bypass. Then in the operating room, you'll receive anesthesia to put you to sleep. The entire operation takes from 3 to 6 hours, depending on the number of arteries affected and possible complications.


How Your Surgeon Performs Coronary Artery Bypass Surgery

Your surgeon will make an incision through the middle of your chest and through your breastbone. Your heart will then be exposed from beneath the breastbone. A heart and lung machine called an artificial bypass pump will take over your breathing and blood circulation. Then the surgical team will lower the temperature of your heart until it stops beating. This makes it much easier for your surgeon to do the delicate sewing that's part of the procedure.

Next, your surgeon will take one or more blood vessels from another part of your body to use for the graft. The vessels used may be a leg vein, called the saphenous vein. Or at times, your surgeon may use an artery from behind your breastbone, called the mammary artery. Neither of these blood vessels is critical to the blood flow in the area where they are found.

To use a leg vein, the surgeon will make an incision in your leg and remove a small piece of your vein. Then the surgeon will sew one end of that vein onto the large artery of your heart called the aorta. The aorta supplies all of the blood flowing from your heart to the rest of your body. Next the surgeon will connect the other end to the coronary artery below the blockage. This will bypass the clogged area and allow the blood to flow through the vein and around the blockage - just like a side road in a detour. If you have more than one blockage, you need more than one bypass graft. In that case, the surgeon will use another piece of the leg vein.

To use a mammary artery, the surgeon will detach one end of the artery from the chest wall. The surgeon will then attach the open end of the artery to the coronary artery below the blocked area. The blood continues to flow through this artery, bypassing the blockage. In this way, it supplies the heart with much-needed oxygen.

Once the graft or grafts are in place, the surgeon will restart your heart by warming it or by applying an electric current. Then the surgeon will close all the incisions. This includes the one in your chest, as well as the ones used to obtain all the necessary veins for the grafts.

After the Surgery

After the surgery, you will go to the recovery room or to the intensive care unit, called the ICU. There, you'll have lung and chest tubes to drain fluids and to make it easier for you to breathe. The breathing tube is called an endotracheal tube. A healthcare provider will remove it when you are awake and can breathe on your own. This usually takes up to 24 hours.

Within 24 hours after CABG, you should be eating and walking around. Most people can leave the hospital after 4 to 7 days. Full recovery generally takes several weeks. Your doctor may want you to attend a cardiac rehabilitation program. You can usually find these programs at your local hospital. Most of them are covered by insurance. A rehab program can help you recover more quickly from surgery and manage your CHD.


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