During the surgery, the chest bone is opened to access the heart. Medicines are given to stop the heart, and a heart-lung bypass machine is used to keep blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart. After surgery, blood flow to the heart is restored.
Usually, the heart starts beating again on its own. In some cases, mild electric shocks are used to restart the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump CABG is sometimes called beating heart bypass grafting. This surgery is similar to off-pump CABG. However, instead of a large incision cut to open the chest bone, several small incisions are made on the left side of the chest between the ribs.
This type of surgery mainly is used for bypassing the blood vessels in front of the heart. It's a fairly new procedure that's done less often than the other types of CABG. This type of CABG isn't for everybody, especially if more than one or two coronary arteries need to be bypassed. Coronary artery bypass grafting CABG is used to treat people who have severe coronary heart disease CHD that could lead to a heart attack. CABG also may be used to treat people who have heart damage following a heart attack but still have blocked arteries.
Your doctor may recommend CABG if other treatments, such as lifestyle changes or medicines, haven't worked. He or she also may recommend CABG if you have severe blockages in the large coronary heart arteries that supply a major part of the heart muscle with blood-especially if your heart's pumping action has already been weakened.
CABG also may be a treatment option if you have blockages in the heart that can't be treated with angioplasty. Your doctor will decide whether you're a candidate for CABG based on a number of factors, including:. To decide whether you're a candidate for CABG, your doctor will do a physical exam. He or she will check your cardiovascular system, focusing on your heart, lungs, and pulse. Your doctor also will ask you about any symptoms you have, such as chest pain or shortness of breath.
He or she will want to know how often and for how long your symptoms occur and how severe they are. Tests will be done to find out which arteries are clogged, how much they're clogged, and whether there's any heart damage.
An EKG is a simple test that detects and records your heart's electrical activity. This test is used to help detect and locate the source of heart problems. An EKG shows how fast your heart is beating and its rhythm steady or irregular.
It also records the strength and timing of electrical signals as they pass through each part of your heart. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing , you exercise or are given medicine if you're unable to exercise to make your heart work hard and beat fast while heart tests are done. These tests may include nuclear heart scanning , echocardiography, and magnetic resonance imaging MRI and positron emission tomography PET scanning of the heart.
Echocardiography EK-o-kar-de-OG-ra-fee , or echo, uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart's chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including stress echo. This test is done both before and after a stress test. A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of CHD. Coronary angiography uses dye and special x rays to show the insides of your coronary heart arteries. During the test, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin upper thigh , or neck.
The tube is then threaded into your coronary arteries, and the dye is injected into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack. Medicines and other medical procedures may be tried before CABG.
Medicines that lower cholesterol levels and blood pressure and improve blood flow through the coronary arteries often are tried. Angioplasty also may be tried. During this procedure, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery.
Once in place, the balloon is inflated to push the plaque against the wall of the artery. This widens the artery and restores the flow of blood. Often, a small mesh tube called a stent is placed in the artery to keep it open after the procedure. Tests may be done to prepare you for coronary artery bypass grafting CABG.
For example, you may have blood tests , an EKG electrocardiogram , echocardiography , a chest x ray , cardiac catheterization , and coronary angiography. Your doctor will give you specific instructions about how to prepare for surgery. He or she will advise you about what to eat or drink, what medicines to take, and what activities to stop such as smoking. You'll likely be admitted to the hospital on the same day as the surgery.
If tests for coronary heart disease show that you have severe blockages in your coronary heart arteries, your doctor may admit you to the hospital right away. You may have CABG that day or the day after. Coronary artery bypass grafting CABG requires a team of experts. A cardiothoracic surgeon does the surgery with support from an anesthesiologist, perfusionist heart-lung bypass machine specialist , other surgeons, and nurses.
There are several types of CABG. They range from traditional surgery in which the chest is opened to reach the heart, to nontraditional surgery in which small incisions cuts are made to bypass the blocked or narrowed artery. This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed.
Numerous steps take place during traditional CABG. The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep. During the surgery, the anesthesiologist checks your heartbeat, blood pressure, oxygen levels, and breathing. A breathing tube is placed in your lungs through your throat. The tube is connected to a ventilator a machine that helps you breathe.
Related Issues. Heart bypass surgery - slideshow Medical Encyclopedia Also in Spanish. Videos and Tutorials. Heart bypass surgery Medical Encyclopedia Also in Spanish.
Clinical Trials. Article: Preoperative Short Physical Performance Battery as a predictor of prolonged hospitalization Article: Improving the prediction of long-term readmission and mortality using a novel Article: Challenges experienced by post coronary artery bypass grafting patients: A qualitative Coronary Artery Bypass Surgery -- see more articles. Reference Desk. Medications are prescribed routinely after coronary bypass surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart work as well as possible.
Because coronary bypass surgery is an open-heart surgery, you might have complications during or after your procedure. Possible complications include:. Your risk of developing complications is generally low, but it depends on your health before surgery. Your risk of complications is higher if the surgery is done as an emergency procedure or if you have other medical conditions, such as emphysema, kidney disease, diabetes or blocked arteries in your legs.
Your doctor will give you specific instructions about activity restrictions and changes in your diet or medications that you should make before surgery. Make arrangements for assistance after your surgery. It will take about four to six weeks for you to recover to the point where you can resume driving, return to work and perform daily chores. If your coronary bypass surgery isn't performed as emergency surgery, you'll likely be admitted to the hospital the morning of the surgery.
Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. The number of bypasses you need depends on where in your heart and how severe your blockages are. For general anesthesia, a breathing tube is inserted through your mouth. This tube attaches to a ventilator, which breathes for you during and immediately after the surgery. Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung machine keeps blood and oxygen flowing through your body.
This is called on-pump coronary bypass surgery. The surgeon cuts down the center of the chest along the breastbone and spreads open the rib cage to expose the heart.
After the chest is opened, the heart is temporarily stopped with medication and a heart-lung machine takes over to circulate blood to the body. The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.
After completing the graft, the surgeon will restore your heartbeat, disconnect you from the heart-lung machine and use wire to close your chest bone. The wire will remain in your body after the bone heals.
Expect to spend a day or two in the intensive care unit. The breathing tube will remain in your throat until you are awake and able to breathe on your own. Cardiac rehabilitation often begins while you're still in the hospital. You'll be given an exercise and education program designed to help you recover. You'll continue with monitored programs in an outpatient setting until you can safely follow a home-based maintenance program.
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