What is Coronary Artery Bypass Graft (CABG) Surgery? - GO.CARE Blog
What is Coronary Artery Bypass Graft (CABG) Surgery?
Author: Hào Nghiêm
Review Date: August 5, 2018 | Last Modified: January 22, 2019
What is Coronary Artery Bypass Graft (CABG) Surgery?

Definition

1. What is Coronary Artery Bypass Graft (CABG) Surgery?

Coronary Artery Bypass Graft (CABG) Surgery is a procedure that treats coronary artery disease. Coronary artery disease (CAD) is the narrowing of the coronary arteries – the blood vessels that supply oxygen and nutrients to the heart muscle. CAD forms due to a build-up of fatty material within the walls of the arteries. As a result, this build-up narrows the inside of the arteries, limiting the supply of oxygen-rich blood to the heart muscle.

2. What is the purpose of Coronary Artery Bypass Graft (CABG) Surgery?

Generally, the purposes of the Coronary Artery Bypass Graft (CABG) Surgery are to:

  • Relieve your symptoms of coronary artery disease such as angina (chest discomfort) or shortness of breath
  • Help you return to your normal lifestyle and activities
  • Lower your risk of a future heart attack or other heart problems

Candidates

1. When is Coronary Artery Bypass Graft (CABG) Surgery needed?

Coronary Artery Bypass Graft (CABG) Surgery is necessary when treating people who have severe coronary heart disease (CHD), which could lead to a heart attack. Furthermore, surgeons also carry out CABG during or after a heart attack to treat blocked arteries.

Your doctor may recommend CABG if other treatments, such as lifestyle changes or medicines, haven’t worked. Also, he or she may recommend CABG if you have severe blockages in your large coronary (heart) arteries, especially if your heart’s pumping action has already grown weak.

Moreover, CABG also might be a treatment option if you have blockages in your coronary arteries that percutaneous coronary intervention (PCI), also known as coronary angioplasty, can’t treat.

2. Who are eligible for Coronary Artery Bypass Graft (CABG) Surgery?

In general, your doctor will decide whether you’re a candidate for CABG based on factors such as:

  • The presence and severity of CHD symptoms
  • The severity and location of blockages in your coronary arteries
  • Your response to other treatments
  • Your quality of life
  • Any other medical problems you have

Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.

Cost

Typically in the U.S., for patients not without health insurance, heart bypass surgery costs about $70,000-$200,000 or more.

In general, costs depend on the facility, but tend to be on the lower end without complications and on the higher end with complications. Patients typically require one or more sessions of physical therapy to learn how to move without harming the incision and to learn exercises to assist recovery. This typically costs $50-$350 per session.

Moreover, prescribed drugs after bypass surgery might include a blood thinning medication such as warfarin (brand name Coumadin) or Plavix to prevent blood clots, a beta-blocker to slow the heart rate, a statin to lower cholesterol and an ACE inhibitor to control blood pressure and heart failure.

For example, at Drugstore.com, Warfarin typically costs about $15-$25 per month for the generic, depending on the dose, or $50- $70 for the brand name, and Plavix costs about $200 or more per month. Beta-blockers and statins can cost $10-$200 a month, depending on the drug. And ACE inhibitors can cost $10-$100 per month.

Preparation

1. What should I do before Coronary Artery Bypass Graft (CABG) Surgery?

You may have tests to prepare you for Coronary Artery Bypass Graft (CABG) Surgery. For example, you may have blood tests, an EKG (electrocardiogram), echocardiography, a chest x ray, cardiac catheterization, and coronary angiography.

Your doctor will tell you how to prepare for CABG surgery. Moreover, he or she will advise you about what you can eat or drink, which medicines to take, and which 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. Also, you may have CABG that day or the day after.

2. What should I do after Coronary Artery Bypass Graft (CABG) Surgery?

Once you are home, it will be important to keep the surgical area clean and dry. Moreover, your doctor will give you specific bathing instructions. Also, your doctor will remove the sutures or surgical staples during a follow-up office visit, if they haven’t removed them before you leave the hospital.

Do not drive until your doctor tells you it’s OK. Also, you may have other activity restrictions.

Moreover, tell your doctor if you have any of the following:

  • Fever of 38°C or higher, or chills
  • Redness, swelling, or bleeding or other drainage from any of the incision sites
  • Increase in pain around any of the incision sites
  • Trouble breathing
  • Rapid or irregular pulse
  • Swelling in the legs
  • Numbness in the arms and legs
  • Persistent nausea or vomiting

Furthemore, your doctor may give you other instructions after the procedure, depending on your situation.

Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.

Procedure

1. How long does Coronary Artery Bypass Graft (CABG) Surgery last?

Usually, traditional Coronary Artery Bypass Grafting lasts 3–6 hours, depending on the number of arteries being bypassed.

2. How is the procedure of Coronary Artery Bypass Graft (CABG) Surgery?

Coronary Artery Bypass Graft (CABG) Surgery requires a team of experts. A cardiothoracic surgeon will do the surgery with support from an anesthesiologist, perfusionist (heart-lung bypass machine specialist), other surgeons, and nurses.

More specifically, there are several types of CABG, ranging from traditional surgery to newer, less-invasive methods.

Traditional Coronary Artery Bypass Grafting

You’ll be under general anesthesia for the surgery. The term “anesthesia” refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.

During the surgery, the anesthesiologist will check your heartbeat, blood pressure, oxygen levels, and breathing. They will place a breathing tube in your lungs through your throat. The tube will connect to a ventilator (a machine that supports breathing).

Firstly, the surgeon will make an incision (cut) down the center of your chest. He or she will cut your chest bone and open your rib cage to reach your heart.

You’ll receive medicines to stop your heart. This allows the surgeon to operate on your heart while it’s not beating. You’ll also receive medicines to protect your heart function during the time that it’s not beating.

Next, heart-lung bypass machine will keep oxygen-rich blood moving throughout your body during the surgery.

The surgeon will take an artery or vein from your body—for example, from your chest or leg—to use as the bypass graft. For surgeries with several bypasses, both artery and vein grafts are commonly used.

  • Artery grafts.

These grafts are much less likely than vein grafts to become blocked over time. The left internal mammary artery most often is used for an artery graft. This artery is located inside the chest, close to the heart. Arteries from the arm or other places in the body also are used.

  • Vein grafts.

Although veins are commonly used as grafts, they’re more likely than artery grafts to become blocked over time. The saphenous vein—a long vein running along the inner side of the leg—typically is used.

When the surgeon finishes the grafting, he or she will restore blood flow to your heart. Usually, the heart starts beating again on its own. Sometimes, mild electric shocks are used to restart the heart.

You’ll be disconnected from the heart-lung bypass machine. Then, tubes will be inserted into your chest to drain fluid.

Next, the surgeon will use wire to close your chest bone (much like how a broken bone is repaired). The wire will stay in your body permanently. After your chest bone heals, it will be as strong as it was before the surgery.

The surgeon will use stitches or staples to close the skin incision. Finally, the medical team will remove the breathing tube when you’re able to breathe without it.

Nontraditional Coronary Artery Bypass Grafting

Nontraditional CABG includes off-pump CABG and minimally invasive CABG.

  • Off-Pump Coronary Artery Bypass Grafting

Surgeons can use off-pump CABG to bypass any of the coronary (heart) arteries.  As the chest bone is opened to access the heart, Off-pump CABG is similar to traditional CABG.

However, the heart isn’t stopped and a heart-lung-bypass machine isn’t used. Instead, the surgeon steadies the heart with a mechanical device.

In addition, off-pump CABG sometimes is called beating heart bypass grafting.

  • Minimally Invasive Direct Coronary Artery Bypass Grafting

Generally, there are several types of minimally invasive direct coronary artery bypass (MIDCAB) grafting. These types of surgery differ from traditional bypass surgery because the chest bone isn’t opened to reach the heart. Also, a heart-lung bypass machine isn’t always used for these procedures.

  • MIDCAB procedure

This type of surgery mainly helps bypass blood vessels at the front of the heart. Here, the surgeon will make small incisions between your ribs on the left side of your chest, directly over the artery that needs to be bypassed.

Usually, the incisions are about 3 inches long. (The incision made in traditional CABG is at least 6 to 8 inches long.) Most oftenly, the left internal mammary artery is used for the graft in this procedure. A heart-lung bypass machine isn’t used during MIDCAB grafting.

Port-access coronary artery bypass procedure

The surgeon does this procedure through small incisions (ports) made in your chest, using artery or vein grafts. Also, the medical team will use a heart-lung bypass machine during this procedure.

Robot-assisted technique

This type of procedure allows for even smaller, keyhole-sized incisions. A small video camera is inserted in one incision to show the heart, while the surgeon uses remote-controlled surgical instruments to do the surgery. Moreover, a heart-lung bypass machine sometimes is used during this procedure.

3. What happens after the procedure?

After surgery, you’ll typically spend 1 or 2 days in an intensive care unit (ICU). The medical team will check your heart rate, blood pressure, and oxygen levels regularly during this time.

The surgeon will likely insert an intravenous line (IV) into a vein in your arm. Through the IV line, you may get medicines to control blood circulation and blood pressure. You also will likely have a tube in your bladder to drain urine and a tube to drain fluid from your chest.

Also, you may receive oxygen therapy (oxygen given through nasal prongs or a mask) and a temporary pacemaker while in the ICU. A pacemaker is a small device that the surgeon places in the chest or abdomen to help control abnormal heart rhythms.

In addition, your doctor may recommend that you wear compression stockings on your legs as well. These stockings stay tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

While in the ICU, you’ll also have bandages on your chest incision (cut) and on the areas of a removed for grafting artery or vein.

After you leave the ICU, the medical team will move you to a less intensive care area of the hospital for 3 to 5 days before going home.

Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.

Complications & Side Effects

1. What complications could arise from Coronary Artery Bypass Graft (CABG) Surgery?

Possible complications of Coronary Artery Bypass Graft (CABG) Surgery include:

  • Bleeding during or after the surgery
  • Blood clots that can cause heart attack, stroke, or lung problems
  • Infection at the incision site
  • Pneumonia
  • Breathing problems
  • Pancreatitis
  • Kidney failure
  • Abnormal heart rhythms
  • Failure of the graft
  • Death

2. What are the possible side effects of Coronary Artery Bypass Graft (CABG) Surgery?

Oftentimes, side effects go away within 4 to 6 weeks after surgery, but may include:

  • Discomfort or itching from healing incisions
  • Swelling of the area of a removed for grafting artery or vein
  • Muscle pain or tightness in the shoulders and upper back
  • Fatigue (tiredness), mood swings, or depression
  • Problems sleeping or loss of appetite
  • Constipation
  • Chest pain around the site of the chest bone incision (more frequent with traditional CABG)

Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.

Please choose the best hospitals and clinics that provide coronary artery bypass graft surgery (CABG)  in Asia to get the most suitable healthcare for your condition.

GO.CARE  does not provide medical advice, diagnosis or treatment.

 

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2. Coronary Artery Bypass Grafting. https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting. Accessed June 12, 2018.

3. Coronary Artery Bypass Graft Surgeryhttps://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/coronary_artery_bypass_graft_surgery_92,P07967. Accessed June 12, 2018.

4. Coronary Artery Bypass Grafting (CABG).https://adultct.surgery.ucsf.edu/conditions–procedures/coronary-artery-bypass-grafting-(cabg).aspx. Accessed June 12, 2018.

5. Heart Bypass Surgery Costhttp://health.costhelper.com/bypass.html. Accessed June 12, 2018.