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What To Expect During Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG) 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.

There are several types of CABG. They range from traditional surgery to newer, less-invasive methods.

Traditional Coronary Artery Bypass Grafting

This type of surgery usually lasts 3–6 hours, depending on the number of arteries being bypassed. Many steps take place during traditional CABG.

You'll be under general anesthesia (AN-es-THEE-ze-ah) 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. A breathing tube will be placed in your lungs through your throat. The tube will connect to a ventilator (a machine that supports breathing).

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.

A heart-lung bypass machine will keep oxygen-rich blood moving throughout your body during the surgery. For more information about this machine, including an illustration, go to the Health Topics Heart Surgery article.

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.

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.

Stitches or staples will be used to close the skin incision. The breathing tube will be removed 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. Off-pump CABG is similar to traditional CABG because the chest bone is opened to access the heart.

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.

Off-pump CABG sometimes is called beating heart bypass grafting.

Minimally Invasive Direct Coronary Artery Bypass Grafting

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 is used to bypass blood vessels at the front of the heart. Small incisions are made between your ribs on the left side of your chest, directly over the artery that needs to be bypassed.

The incisions usually are about 3 inches long. (The incision made in traditional CABG is at least 6 to 8 inches long.) The left internal mammary artery most often 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. Artery or vein grafts are used. A heart-lung bypass machine is used 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. A heart-lung bypass machine sometimes is used during this procedure.

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February 23, 2012