Coronary Artery Bypass Grafting - During Surgery - During Surgery

Your surgical team will include a cardiothoracic surgeon, who will work on your heart. An anesthesiologist will give you medicine to make you sleep before the surgery, connect you to a breathing machine, and monitor your vital signs throughout the procedure. A perfusionist will manage the heart-lung pump, and nurses and other surgeons may help throughout the surgery.

Traditional CABG is the most common type of CABG surgery. This surgery takes about three to six hours, depending on how many arteries need to be bypassed. Learn more about how to prepare before surgery.

You will be given an intravenous (IV) line for fluids and medicines that will make you sleep before the surgery. You will be connected to a ventilator to support your breathing. The surgeon makes a cut down the middle of the chest, through the breastbone. The bone is split and the rib cage separated so the surgeon can reach the heart.

You will receive medicines to temporarily stop your heart from beating. This makes it easier for the surgeon to connect the healthy blood vessels, called grafts, into the coronary arteries. This requires a heart-lung bypass machine, which adds oxygen to your blood and pumps it throughout your body during surgery while your heart is not beating.

The surgeon will then take an artery or a veins from your leg, arm, stomach, or chest. The graft is connected to the blocked coronary artery. The new blood vessel bypasses the blocked portion to create a new path for blood flow to the heart muscle. The number of grafts depends on how many coronary arteries need to be bypassed.

When the grafting is finished, the surgeon will restart the heart and restore blood flow. The heart usually starts beating on its own, but sometimes mild shocks are used to start it. Surgeons will sew the breastbone back together with a wire.

Sometimes CABG can be done without stopping the heart and using a heart-lung bypass machine. This is called off-pump CABG because the heart-lung bypass machine, or pump, is not used. The heart is steadied with a mechanical device. It is more difficult for surgeons because the heart is beating, and surgeons do not have easy access to blood vessels. However, it may be safer for certain people, such as those who have a higher risk of complications from using a heart-lung bypass machine. These include older adults and people who have ventricular dysfunction, diabetes, kidney disease, and chronic lung disease. This type of surgery is also sometimes called beating-heart bypass grafting.

Sometimes, CABG surgery may not be done as open heart surgery. There are less-invasive methods, including:

• Minimally invasive direct coronary artery bypass (MIDCAB). MIDCAB is a modified version of CABG where the chest bone is not cut open. Instead, the surgeon makes a smaller cut on the left side of the chest over the artery that needs to be bypassed and enters in between the ribs. It is also usually an off-pump procedure.
• Robotic. Sometimes CABG surgery can be done using a robot to surgically place the graft. This is called robotic-assisted or robotic surgery. The surgeon controls the robot instead of doing the work by hand, and the machinery only needs small openings in the chest. A heart-lung bypass machine is sometimes used.
• Hybrid. During a hybrid bypass surgery, the robotic bypass is done for one of the main arteries, but a stent is used for other blocked arteries. The stent is a rolled-up mesh tube-like structure that goes inside the blocked artery to hold it open. This procedure is typically used only if your doctor is unable to perform the traditional bypass procedure.

• After Surgery will explain what happens in the days after surgery and the risks of the surgical procedure.
• Life After will discuss lifestyle changes, medicines, and possible long-term complications that may be part of life after surgery.