Coronary Artery Bypass Surgery

Coronary artery bypass surgery is a procedure that establishes a new pathway for blood to circulate around a blocked or partially blocked artery in the heart. During the surgery, a healthy blood vessel is typically harvested from the chest or leg area and connected below the obstructed heart artery. This newly created route enhances blood flow to the heart muscle. Common alternative names for this surgery include Coronary artery bypass grafting, CABG (pronounced "cabbage"), Coronary artery bypass graft, or heart bypass surgery.

It is crucial to understand that coronary artery bypass surgery does not treat the root cause of the blockage, such as atherosclerosis or coronary artery disease. Nevertheless, the surgery can relieve symptoms such as chest pain and shortness of breath and also lower the risk of death from heart disease.

What is Coronary Artery Bypass Surgery?

Coronary bypass surgery is a procedure performed to restore blood flow around a blocked heart artery, and it can also be necessary as an emergency treatment for a heart attack when immediate interventions prove ineffective.

Your healthcare provider may recommend coronary artery bypass surgery based on specific conditions you exhibit, such as blockage in the left main heart artery, severe narrowing of the main heart artery, severe chest pain from multiple heart artery narrowing, multiple diseased heart arteries affecting the lower left heart chamber's function, a blocked heart artery not suitable for coronary angioplasty, or unsuccessful angioplasty with or without a stent, like artery re-narrowing post-stenting.

Risks

Coronary artery bypass surgery, categorized as open-heart surgery, involves inherent risks like any surgical procedure. Potential complications may include bleeding, heart attack from a post-surgery blood clot, infection at the chest wound site, prolonged reliance on a breathing machine, irregular heartbeats, kidney disease, temporary memory loss or cognitive impairment, and stroke. The likelihood of complications is higher in emergency surgeries. Individual risk factors such as pre-existing health conditions like blocked leg arteries, chronic obstructive pulmonary disease (COPD), diabetes, or kidney disease can further elevate the risk of post-operative issues. Precautionary measures like medications to manage bleeding, blood pressure, and infection are typically integrated into the surgical plan to minimize risks.

Before the Procedure

If coronary artery bypass surgery is a scheduled procedure, you are usually admitted to the hospital the morning of the surgery. You have many heart tests and blood tests the days and hours before surgery.

During the Procedure

Coronary artery bypass surgery is a significant procedure carried out in a hospital setting by cardiovascular surgeons specialized in heart surgery, with support from a specialized team of cardiac-trained healthcare professionals.

Prior to entering the operating room, an IV is inserted into your forearm or hand by a healthcare provider who administers a sedative through it to help you relax. Once in the operating room, you can expect to receive a combination of medicines through the IV and a face mask to induce general anesthesia, placing you in a pain-free, sleep-like state. A breathing tube is inserted into your mouth, connecting you to a ventilator that assists with breathing during and immediately after the surgery. A heart-lung machine, known as on-pump coronary bypass, is utilized during the procedure to maintain blood and oxygen circulation throughout your body.

The duration of coronary artery bypass surgery typically ranges from 3 to 6 hours, depending on the extent of the artery blockages. The surgical process involves making a long incision down the center of the chest along the breastbone, spreading open the rib cage to access the heart. The heart is temporarily halted with medication, and the heart-lung machine is activated to support circulation. The surgeon removes a section of healthy blood vessel, often from inside the chest wall or from the lower leg. This piece of healthy tissue is called a graft. The surgeon attaches the ends of the graft below the blocked heart artery. This creates a new path for blood to flow around a blockage. More than one graft may be used.

There are different approaches to coronary artery bypass surgery, including:

Off-pump or beating-heart surgery: In this method, the surgery is performed on the beating heart without using a heart-lung machine. Special equipment stabilizes the specific area of the heart that requires attention, although this technique can be complex due to the heart's continual movement.

Minimally invasive surgery: This approach involves the heart surgeon operating through small incisions in the chest, sometimes called port-access or keyhole surgery. Once the surgery is completed, the healthcare team restores your heartbeat in the operating room and discontinues the heart-lung machine. The surgeon utilizes wire to close the chest bone, which remains in your body as the bone mends.

After the Procedure

After coronary artery bypass surgery, your healthcare team checks on you and makes sure you are as comfortable as possible. You may feel sore and confused when you wake up. You can usually expect the following:

• Breathing tube. The breathing tube stays in your throat until you wake up and can breathe on your own.
• Hospital stay. Expect to spend 1 to 2 days in a hospital intensive care unit. How long you stay in the hospital depends on how you recover and if you have complications. Some people who have coronary artery bypass surgery go home within a week.
• Heart rhythm and breathing checks. Your healthcare team watches you closely after surgery to check for complications and to take your temperature. Machines record your breathing and heart rhythm.
• Medicines. You get medicines to reduce pain and prevent complications such as blood clots. If you don't already take a daily aspirin, your healthcare professional may recommend you do so. You may need to take the aspirin every day for life. There are specific medical recommendations about who benefits from aspirin therapy. Talk with your healthcare professional about aspirin use.
• Cardiac rehabilitation. Often called cardiac rehab, this supervised program of education, counseling, and exercise helps improve heart health after heart surgery. You'll be encouraged to start moving and walking while in the hospital. When you go home, you continue cardiac rehab at a medical center near you until you can safely follow a home program. After surgery, when you're at home, you need to watch for symptoms of complications. Call your healthcare team if you have:
  • Fever.
  • Rapid heart rate.
  • Pain around your chest wound that is new or gets worse.
  • A change in skin color around your chest wound.
  • Bleeding or other discharge from your chest wound.

It usually takes about 6 to 12 weeks to get better after coronary artery bypass surgery. With your healthcare team's OK, you can usually drive, return to work or the gym, and have sex after 4 to 6 weeks. But everyone recovers differently. Ask your healthcare professional for guidance.

Results

Following recovery from coronary artery bypass surgery, many individuals experience improved well-being, with some remaining symptom-free for extended periods. However, there is a possibility of future clogging in the graft or other arteries, which may necessitate additional surgery or treatment.

Your long-term prognosis is influenced by effectively managing blood pressure, cholesterol levels, and conditions like diabetes, alongside adhering to prescribed medications. Adopting healthy lifestyle practices can help maintain and enhance heart health. Consider the following recommendations:

Quit smoking: Smoking is a significant risk factor for heart disease, particularly atherosclerosis. Ceasing tobacco use is the most effective way to reduce heart disease risk. Seek assistance from your healthcare team if needed.

Embrace a nutritious diet: Prioritize fruits, vegetables, and whole grains while limiting sugar, salt, and saturated fats.

Maintain a healthy weight: Consult your healthcare professional to determine an appropriate weight for you, as excess weight can heighten heart disease risk.

Stay physically active: Regular exercise aids in managing diabetes, high cholesterol, and high blood pressure, all of which are heart disease risk factors. Aim for 30 to 60 minutes of physical activity most days, following approval from your healthcare team post-surgery.

Manage stress: Implement strategies to reduce emotional stress, such as mindfulness practices and engagement with support groups. Consult your healthcare team if you are experiencing anxiety or depression for guidance on coping strategies.

Prioritize sleep: Adequate sleep is crucial for heart health and overall well-being. Aim for 7 to 9 hours of sleep at night to lower the risk of heart disease and other chronic conditions.