Coronary Artery Bypass Graft
Coronary artery bypass graft (CABG) is a major surgical treatment for coronary artery disease. It is usually performed when an obstruction in a coronary artery cannot be successfully treated with medication or a less invasive procedure such as angioplasty. In CABG, a section of blood vessel—usually a leg vein or an artery in the chest—is routed around the blocked portion of the coronary artery to increase blood flow to the heart muscle.
Women who need bypass surgery may benefit from minimally invasive, robot-assisted or off-pump operative techniques, which have been pioneered at Brigham and Women’s. These surgeries require smaller incisions and have a shorter recovery period than the conventional bypass operation described below. You may want to ask your surgeon if one of the newer procedures is appropriate for you.
What to Expect:
- Be sure to read your pre-op instructions and follow them carefully.
- Don’t pack for surgery as you would for a trip; the hospital will have almost everything you need.
- You’ll be comfortably asleep during surgery and won’t remember anything about it.
- Rehab programs are key to a speedy recovery. Make plans to attend one as soon as your doctor says you’re ready.
Preparing for Bypass
In most cases, surgery is scheduled several weeks in advance, so you’ll have a little time to get ready. Because it helps to go into surgery in the best condition possible, you should try to follow a healthful diet, exercise as much as you can, get adequate rest and, if you’re anxious about having a bypass, do exercises to reduce stress. If you’re a smoker, this is a good time to stop, or at least cut down. If you drink alcohol daily, you might want to cut down to avoid the effects of alcohol withdrawal after surgery. You may have the opportunity to bank your blood, should you need a transfusion during the procedure.
A few days before surgery, you will meet with an anesthesiologist or nurse anesthetist, who will determine which type of anesthesia is best for you. You’ll answer questions on your health history and have a brief physical exam that may include ECG, blood work and urinalysis. You should bag all the medications—both prescription and over-the-counter—that you take regularly and bring the bag with you to the visit. The anesthesiologist or surgeon may want you to change the dose of, or even stop taking, some medications. The anesthesiologist will explain the type of anesthesia that you will receive, including the risks and benefits associated with it. You’ll read and sign a form consenting to the anesthesia to be used.
You will be asked not to eat or drink anything the night before your bypass. You can take any drugs prescribed for surgery with a little water the morning of the procedure. You may be asked to wash your chest area with a special disinfecting soap.
You should arrive at the hospital without make-up, nail polish or jewelry, and dressed in clothing loose enough to fit over the surgical dressings you’ll be wearing when you go home. When you check in, you’ll be given an identification bracelet to wear during your stay. You’ll be given a hospital gown to wear and your clothes, handbag and other possessions will be tagged and taken to the room you will stay in after surgery.
A surgical attendant will explain what will happen during surgery, as well as the slight risks involved. You’ll sign a second consent form, giving your permission to operate. Your anesthesiologist will greet you and might give you a sedative to relax you. A nurse will install an IV catheter in your arm or hand. You may be asked to remove any dental devices that can interfere with the tube that will be installed in your trachea to help you breathe during surgery. You will be transferred to a gurney and wheeled into the surgical suite.
In the operating room, you’ll meet the surgical team, who will make you comfortable on the table. The anesthetist will place a clear mask over your nose and mouth and ask you to count backward from 10. You’re likely to be asleep before you finish counting.
Your surgeons will open your chest by cutting your breastbone (sternum) in half and spreading it apart. Once your heart is exposed, tubes are inserted into it so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine (heart-lung machine). Your heart will be stopped by an injection of a cold solution. The bypass machine is necessary to pump blood while the heart is stopped and kept still in order for the surgeon to perform the bypass operation.
The surgeon will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the coronary artery just above the blockage, and the other end over a similar opening just below the blockage. If the internal mammary artery inside your chest is being used as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage. You may have more than one bypass graft performed, depending on how many blockages you have and where they are located. After all the grafts have been completed, the physician will examine them to make sure they are working.
Once the bypass grafts have been completed, the blood circulating through the bypass machine will be allowed back into your heart and the tubes to the machine will be removed. Your heart will be restarted. Temporary wires may be fixed to your heart. They can be attached to a pacemaker if needed to stabilize your heart rhythms during the initial recovery period.
The sternum will be reattached with small wires and the skin over it will be sewn back together. Tubes will be inserted into your chest and connected to a suction device to drain blood and other fluids from around the heart. A tube will be inserted through your mouth or nose into your stomach to drain stomach fluids. Your chest will be wrapped in a sterile dressing.
After surgery, you may be taken to the recovery room or to the intensive care unit (ICU) to be closely monitored. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate and your oxygen level. You will have a tube in your throat that is connected to a ventilator until you are able to breathe on your own. As you awake from the anesthesia, the ventilator will be adjusted to allow you to take over more of the breathing. When you can breathe on your own and are able to cough, the breathing tube will be removed. The stomach tube will also be removed at this time.
Your nurse will have you cough and take deep breaths every two hours to keep mucus from collecting in your lungs and possibly causing pneumonia. Coughing will be uncomfortable because your chest will be sore, but your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
You may be on special IV drips to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these drips will be gradually decreased and turned off.
When your physician determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. As you recover, you will be encouraged to get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as you tolerate them.
The surgical incision may be tender or sore for several days after a CABG procedure, so your doctor will prescribe a pain reliever for soreness. Be sure to take only recommended medications, because aspirin and other pain medications may increase the chance of bleeding.
When your doctor decides that you can go home, you’ll be given instructions for taking care of yourself. If you don’t have anyone to help you, you may be able to arrange for a nurse to visit.
Date Last Modified: January 21, 2011
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