Coronary Artery Bypass Grafting (CABG)

Physical examChest x-rayElectrocardiogram (ECG, EKG) a test that records the heart's activity by measuring electrical currents through the heart muscle Coronary angiogram a test to determine the extent and location of blockages in blood vessels in the heart In the days leading up to your surgery: Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor.The night before, eat a light meal and do not eat or drink anything after midnight.Arrange for a ride to and from the hospital.Arrange for help at home after returning from the hospital. During ProcedureAnesthesiaIV fluidsOxygenCatheter placed in your bladder to drain urineA heart-lung machine to maintain blood circulation and cool the blood and body temperature AnesthesiaGeneral Description of the ProcedureThe surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine pulls blood from the heart, adds oxygen to it, and pumps it back into the bloodstream while the surgeon is working on the heart and/or lungs.To harvest a blood vessel to graft into the heart, the surgeon may detach an artery from the chest wall, or make one or several incisions in the leg and remove a section of vein from the leg. Sometimes two surgeons work together, one on the chest and one on the leg to remove a vessel for grafting. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions. When the grafts are in place, the blood (and thus the body temperature) is rewarmed to normal temperature, and therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.

Certain medical centers are using a less invasive approach to coronary artery bypass grafting, called minimally invasive coronary artery surgery. The purpose of this surgery is the same, to bypass the clogged arteries, but the technique and indications are different. Patients who have only one or two clogged arteries may be candidates for this approach.In this technique, a small incision is made in the chest, over the site of the clogged artery. The surgeon usually uses an artery from inside the chest wall to bypass the obstruction. The key difference in this technique is that the surgeon operates while the heart is beating, thus avoiding the use of the heart-lung machine. This type of surgery is promising, but the benefits and risks of the traditional procedure versus this new technique need to be weighed for each individual. Talk to your doctor about what is best for you. After Procedure You'll have close attention and monitoring in the intensive care unit. You'll be hooked up to various tubes and monitors, including: Heart monitorPacing wires to help control heart rateTubes connected to a machine that helps drain excess blood and air from the woundBreathing tube until you can breathe independently; then an oxygen maskBladder catheter How Long Will It Take?4-5 hours

Will It Hurt?Anesthesia prevents pain during surgery. You may experience pain during recovery, but will be given medications to relieve the discomfort. Possible ComplicationsInfectionPneumoniaPhlebitis (blood clots in a vein), which can lead to heart attack or strokeHigh or low blood pressure Excessive bleeding Neurological deficits, stupor, coma , or decreased intellectual function StrokeKidney dysfunctionIrregular heart rateDepressionDeath Average Hospital Stay5-7 days Postoperative Care Take medications as directed by your doctor. These may include: Blood pressure medicationDigitalisto help your heart pump more stronglyAnti-arrhythmicsto keep your heart's rhythms regularBlood thinnersto prevent blood clots from formingTo reduce the risk of fluid buildup in your lungs, breathe deeply and cough 10-20 times every hour.If a leg vein was removed, elevate your legs above your heart while sitting and do not cross legs.The day after surgery, try to walk with help.Dressings will be removed in a day or two; pacing wires and chest tubes will be removed after a few days.Internal stitches will dissolve; staples will be taken out 5-7 days after surgery.Small paper strips on incisions will peel off and can be removed one week after discharge.Once home, only take medications approved by your doctor, check your temperature twice daily, and weigh yourself every morning.Follow activity and cardiac rehabilitation program as recommended by your doctor to speed recovery and improve cardiovascular health. OutcomeBypass surgery restores blood flow through the heart, but does not cure heart disease; the grafted blood vessels can also become clogged. Therefore, you will be encouraged to make lifestyle changes to improve your cardiovascular health. These include exercising regularly, not smoking, and eating a heart healthy dietone that is low in saturated fat, simple sugars, and salt, and high in fiber, fruits, and vegetables. Ask your doctor for a referral to a registered dietitian if you need help changing your dietary habits. Most patients can return to office-type work in 4-6 weeks.

According to a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using balloon angioplasty or coronary stenting . * Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge at the incision sitesCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency, frequency of urination, or persistent bleeding in the urineGaining more than four pounds within one or two daysPain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain RESOURCES: American Heart Associationhttp://www.americanheart.org National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov CANADIAN RESOURCES: Health Canadahttp://www.hc-sc.gc.ca/index_e.html Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/Page.asp?PageID=24 References: American Heart Association website. Available at: http://www.americanheart.org . National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov .

Updated Outcome section on 11/7/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print] Last reviewed November 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.