Coronary artery bypass graft surgery is a type of surgery that improves blood flow to the heart.
It is performed for people with severe coronary heart disease, also called coronary artery disease.
Coronary artery disease is a condition in which a substance called plaque builds up inside the coronary arteries.
These arteries supply the heart with oxygen-rich blood.
Plaque (the invisible layer that surrounds the arteries) is made up of fats, cholesterol, calcium and other substances found in the blood.
Plaque buildup can narrow or block the coronary arteries and reduce blood flow to the heart muscle.
If the blockage is severe, angina (chest pain or discomfort), shortness of breath, and, in some cases, a heart attack can occur.
Coronary artery bypass grafting is a treatment for coronary artery disease.
During CABG, a healthy artery or vein from the body is attached to the blocked coronary artery.
The artery or vein wraps around the blocked part of the coronary artery.
This creates a new passageway, and the oxygen-rich blood is directed around the blocked artery to the heart muscle.
Coronary artery bypass grafting surgery
Up to four major blocked coronary arteries can be rerouted during a single surgery.
Summary of coronary artery bypass graft surgery
Coronary artery bypass grafting is the most common type of open-heart surgery performed by heart surgeons.
Other names for coronary artery bypass grafting:
- open heart surgery
- Coronary bypass surgery
- Coronary artery bypass surgery
- Cardiac bypass surgery
Coronary artery disease isn't always treated with CABG.
Many people with coronary heart disease can be treated with other methods, such as lifestyle changes, medications and a procedure called angioplasty.
During angioplasty, a small mesh tube called a smart tube (mesh or stent) may be placed in the artery to help keep it open.
Coronary artery bypass grafting or an angioplasty may be a good option if you have severe blockages in the large coronary arteries, especially if your heart's pumping action is already poor.
CABG may also be an option if you have blockages in your heart arteries that can't be treated with a catheter.
In this case, CABG is more effective than other types of treatment.
Objectives of coronary artery bypass graft surgery
If you are suitable for CABG surgery, the goals of the surgery include:
- Improve your quality of life and reduce angina and other symptoms of coronary heart disease.
- Allowing you to resume a more active lifestyle.
- Improving the pumping action of your heart if it has been damaged by a heart attack.
- Reducing the risk of a heart attack (in some patients, such as those with diabetes).
- Increase your chance of survival.
You may need to repeat the surgery if the grafted arteries or veins are blocked, or if new blockages develop in arteries that weren't previously blocked.
Taking medications as prescribed and making lifestyle changes as recommended by your doctor can reduce the chance of clogged arteries.
In people who are suitable for surgery, results are usually excellent.
After CABG, 85 percent of people had significantly fewer symptoms, reduced future heart attack risk, and reduced death rates dramatically within 10 years.
Types of coronary artery bypass graft surgery
First: Arterial grafting
The internal mammary artery is the most commonly used bypass graft.
The goal is to use these arteries for every patient who has had coronary bypass surgery.
The diversion produces the best long-term results.
Inside the chest there are two arteries on the left and right end of the sternum. If these arteries are used in bypass surgery, they can usually be kept intact in their origin, because they have the ability to supply the heart with a good amount of oxygen.
The other end is cut and sutured into the coronary artery below the site of the blockage.
If the artery needs to be removed completely, it is called the "free" artery.
The radial (arm) artery is another common type of arterial bypass.
The radial artery delivers blood to the arm, (due to the presence of another artery) so most people do not experience any side effects if the radial artery is used as a graft.
If your surgeon decides to use the radial artery, you'll have tests before and during surgery to make sure this is the best option for you.
If the radial artery is used as a graft, you may need to take a calcium channel blocker for several months after surgery.
This medication helps keep the artery open.
Some people who have a radial artery bypass graft experience numbness in the wrist after surgery.
But this feeling usually goes away.
This type of diversion is known to have good results, although the long-term results are not fully known.
Less common are the gastric artery, which is an artery that supplies the stomach, and the inferior artery that leads to the abdominal wall.
These arteries are difficult to use, but can be a good option if other arteries cannot be used.
Second: vein grafting
The saphenous veins are veins in your legs that can be used as bypasses.
Minimally invasive saphenous vein removal does not require a long incision.
Instead, two cuts or incisions are made in the knee and a small incision is made in the thigh.
This type of removal results in fewer cuts and faster healing than traditional surgery.
Although much has been done to improve the results of IV grafts, they still fail in the long term.
What is the best type of rerouting for me?
Your surgeon will determine which type of bypass is right for you. Choice depends on many factors, including the location and size of the blockage, the size of your coronary arteries, the availability of arteries and veins, your age and other medical conditions you have.
Who are the people who need coronary artery bypass grafting?
Coronary artery bypass grafting is used to treat people with severe coronary heart disease that can lead to a heart attack.
CABG may also be used to treat people who have blocked arteries after a heart attack.
Your doctor may recommend CABG if other treatments, such as lifestyle changes or medications, haven't worked.
He may also recommend CABG surgery if you have severe blockages in the large coronary arteries that supply blood to a large part of your heart muscle — especially if your heart's pumping action is already impaired.
CABG may also be a treatment option if you have a heart block that can't be treated with a catheter.
Your doctor will decide if you are a candidate for CABG surgery based on a number of factors, including:
- Severity of coronary artery disease symptoms.
- The severity and location of the blockage in the coronary arteries.
- Your response to other treatments.
- how your life.
- Any other medical problems you have.
A CABG can be done on an emergency basis, such as during a heart attack.
Physical examination and diagnostic tests
To determine if you're a good fit for CABG, your doctor will perform a physical exam.
He'll check your cardiovascular system, focusing on your heart, lungs, and pulse.
Your doctor will also ask you about any symptoms you have, such as chest pain or shortness of breath.
He or she will ask how often, how long, and how severe your symptoms are.
Tests will be done to find out which arteries are blocked, how clogged they are, and whether there is any damage to the heart.
An electrocardiogram is a simple test that detects and records the electrical activity of your heart.
This test is used to help discover and determine the source of heart problems.
An electrocardiogram shows how fast and how fast your heart is beating (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of your heart.
Some heart problems are easier to diagnose when your heart is working hard and beating fast.
During a stress test, you exercise (or are given medication if you're unable to exercise) to make your heart work harder and beat fast while the heart tests are done.
These tests may include a nuclear cardiac scan, echocardiogram, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan of the heart.
Echocardiography (otherwise known as echocardiography)
An echocardiogram, or echo, uses sound waves to create a moving image of your heart. The test provides information about the size and shape of your heart and how well your heart's chambers and valves are working.
The test can also identify areas of poor blood flow to the heart, areas of the heart muscle that aren't contracting normally, and previous injury to the heart muscle due to poor blood flow.
There are several types of ultrasonography, including stress echo.
This test is done before and after the stress test.
A stress echo is usually done to see if you have reduced blood flow to your heart, which is a sign of coronary artery disease.
Coronary angiography uses a special dye and X-ray to show the anatomy of the coronary arteries (the heart).
During the test, a long, thin, flexible tube called a is placed catheter In a blood vessel in your arm, thigh (upper thigh), or neck.
The tube is then inserted into the coronary arteries, and a dye is injected into the bloodstream. A special X-ray is taken as the dye flows through the coronary arteries.
The dye allows your doctor to study the flow of blood through your heart and blood vessels.
This helps your doctor find obstructions that could cause a heart attack.
Other considerations for coronary artery bypass graft surgery
When deciding if you're a good fit for a CABG, your doctor will also consider:
- History and previous treatment of heart disease, including surgeries, procedures and medications.
- History of diseases and other conditions.
- Age and general health.
- Family history of coronary heart disease, heart attack, or other heart disease.
Medications and other medical procedures may be tried before CABG.
Drugs that lower cholesterol levels and blood pressure and improve blood flow through the coronary arteries are often tried.
Catheters may also be tried.
During this procedure, a thin tube with a balloon or other device at the end is passed through a blood vessel into a narrowed or blocked coronary artery.
Once in place, the balloon is inflated to push the plaque aside against the artery wall.
This widens the artery and restores blood flow.
Often, a small mesh tube called a stent is placed in the artery to keep it open after the procedure.
What to expect before a coronary artery bypass graft
Tests may be done to prepare you for CABG.
For example, you may have blood tests, electrocardiograms, echocardiograms, chest x-rays, cardiac catheterization, and coronary angiography.
Your doctor will give you specific instructions on how to prepare for surgery.
Then he or she will tell you about what to eat or drink, what medications to take, and what activities to stop (such as smoking).
You will likely be admitted to the hospital the same day as your surgery.
If tests for coronary artery disease show that you have severe blockages in your coronary arteries (the heart), your doctor may admit you to the hospital immediately.
You may have to have a CABG on the same day or the next day.
What to expect during CABG surgery
Coronary artery bypass grafting requires a team of experts. The heart surgeon performs the surgery with the support of an anesthesiologist, cardiologist, other surgeons, and nurses.
There are several types of coronary artery bypass grafting. They range from traditional surgery in which the chest is opened to access the heart, to unconventional surgery in which small incisions (cuts) are made to bypass a blocked or narrowed artery.
Types of coronary artery bypass graft surgery
- Conventional coronary artery bypass surgery.
- Unconventional coronary artery bypass surgery.
Unconventional CABG surgery includes:
- Coronary artery bypass grafting outside the pump.
- Coronary artery bypass grafting The minimally invasive surgery.
- Coronary artery bypass grafting minimally invasive
- Minimally invasive direct coronary bypass surgery.
- Coronary artery bypass grafting.
- Assistive robotics technology.
Conventional coronary artery bypass grafting surgery
This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed.
Several steps are performed during a conventional CABG.
You will be under general anesthesia for surgery.
The term "anesthesia" refers to the loss of sensation and consciousness.
General anesthesia temporarily puts you to sleep.
During surgery, the anesthesiologist checks your heart rate, blood pressure, oxygen levels and breathing.
A breathing tube is placed into your lungs through your throat.
The tube is connected to a ventilator (a machine that helps you breathe).
An incision is made down the middle of your chest.
The breastbone is then cut and the rib cage opened so the surgeon can access your heart.
Medications are used to stop your heart, allowing the surgeon to operate on it while it's not beating.
You are also given medications to protect the function of your heart during the time when it is not beating.
You can contact us to learn more about the process Open heart without stopping the heart.
It has also become possible in Turkey to perform an arterial bypass without the need for a large incision and an opening for the ribs, but rather through a small incision about 3 cm (called minimally invasive).
The cardiopulmonary bypass machine keeps oxygen-rich blood moving throughout the body during surgery.
An artery or vein is taken from your body - for example, from your chest or leg - and prepared for use as graft.
In multipath surgery, both artery and vein grafts are commonly used.
These grafts are less likely to clog up over time compared to vein grafts.
The left internal thoracic artery is often used in artery grafting.
Sometimes arteries in the arm or arteries from other parts of the body are used as well.
Although veins are commonly used as grafts, they are more susceptible to plaque formation and blockage over time than arterial grafts.
Usually the saphenous vein is used - a long vein that runs along the inner side of the leg.
After the graft is done, blood flow to your heart is restored.
Usually, the heart begins to beat again on its own.
In some cases, mild electrical shocks are used to restart the heart.
Then you are disconnected from the heart-lung bypass machine.
Tubes are also inserted into your chest to drain fluid.
The surgeon uses wires to close your breastbone (much like how a broken bone is repaired). The wires stay in your body permanently.
After your breast bones have healed, they will be as strong as they were before the surgery.
Sutures or staples are used to close the skin incision.
The breathing tube is removed when you are able to breathe without it.
Unconventional coronary artery bypass graft surgery
Unconventional CABG surgery includes off-pump CABG and minimally invasive CABG.
off-pump coronary artery bypass grafting
This type of surgery may be used to bypass any of the coronary (heart) arteries.
Coronary artery bypass grafting off the pump Also beating heart bypass because the heart does not stop beating and the heart-lung bypass machine is not used.
Instead, the part of the heart where the graft is to be made is attached to a mechanical device.
Minimally invasive direct coronary artery bypass graft
There are several types of Minimally invasive direct coronary artery bypass graft. which only require small incisions rather than opening the breastbone to access the heart.
These procedures sometimes use a cardiopulmonary bypass machine.
Minimally invasive coronary artery bypass graft surgery
This procedure is used when only one or two coronary arteries need to be bypassed.
A series of small incisions are made between your ribs on the left side of your chest, just above the artery to be bypassed.
The incisions are usually about 3 inches long. (The incision made in a conventional CABG is at least 6 to 8 inches long.)
The left internal thoracic artery is often used for grafting.
A cardiopulmonary bypass machine is not used during this procedure.
Coronary artery bypass graft surgery
This procedure is done through small incisions (ports) in your chest.
An artery or vein graft is used.
A cardiopulmonary bypass device is used during this procedure.
assistive robotics technology
This type of procedure allows for incisions smaller than the size of a keyhole.
A small video camera is inserted into one incision to show the heart, while the surgeon uses remote-controlled surgical tools to perform the surgery.
A heart-lung bypass machine is sometimes used during this procedure.
What to expect after coronary artery bypass graft
Healing in the hospital
After surgery, you'll usually spend a day or two in the intensive care unit (ICU).
Your heart rate, blood pressure, and oxygen levels will be checked regularly during this time.
An intravenous (IV) line may be inserted into a vein in your arm.
Through an intravenous line, you can receive medications to control your circulation and blood pressure.
You'll also likely have a tube in your bladder to drain urine and a tube to drain fluid from your chest.
You may receive oxygen therapy (oxygen given through the nose or through a mask) and a temporary pacemaker while in the intensive care unit.
A pacemaker is a small device placed in the chest or abdomen to help control an abnormal heartbeat.
Your doctor may recommend that you wear compression stockings on your legs as well.
These socks are narrow at the ankle and become looser as they go up the leg.
This creates gentle pressure on the leg.
The pressure prevents blood from pooling and clotting.
While you're in the ICU, you'll also have dressings on the chest incision and on areas where an artery or vein was removed bypass.
After leaving the ICU, you will be moved to the ward for 3 to 5 days before going home.
Healing at home
Your doctor will give you specific instructions for recovery at home, especially regarding:
- How to care for your wound.
- How to recognize signs of infection or other complications.
- When to call the doctor immediately.
- When should follow-up appointments be made?
You may also get instructions on how to deal with common side effects from the surgery. Side effects often go away within 4 to 6 weeks after surgery, but may include:
- Discomfort or itching from the incisions that have healed.
- Swelling in the area where an artery or vein was removed to divert.
- Muscle aches or tightness in the shoulders and upper back.
- Tiredness, mood swings, or depression.
- Sleep problems or loss of appetite.
- Chest pain around the site of the breastbone incision (more common with conventional CABG).
Full recovery from a traditional CABG may take 6 to 12 weeks or longer.
Less recovery time is needed for Unconventional coronary artery bypass grafting.
Your doctor will tell you when you can start physical activity again.
It varies from person to person, but there are some typical time periods.
Most people can resume sexual activity within about 4 weeks and drive after 3 to 8 weeks.
Returning to work after 6 weeks is common unless your job includes specific physical activity.
Some people may need to find less physically demanding types of work or work with a reduced schedule initially.
Postoperative care may include regular check-ups with doctors.
During these visits, tests may be done to see how your heart is working. Tests may include an electrocardiogram (EKG), stress test, echocardiogram and computed tomography (CT) of the heart.
CABG is not a cure for coronary heart disease (CHD).
You and your doctor may develop a treatment plan that includes lifestyle changes to help you stay healthy and reduce the chance of developing CHD.
Lifestyle changes may include making changes to your diet, quitting smoking, getting regular physical activity, and reducing and managing stress.
Your doctor may also refer you to cardiac rehabilitation.
Cardiac rehabilitation is a medically supervised program that helps improve the health and well-being of people with heart problems.
Rehabilitation programs include exercise training, education about heart-healthy living, and counseling to reduce stress and help you return to an active life.
Physicians oversee these programs, which may be offered in hospitals and other community facilities.
Talk to your doctor about whether cardiac rehabilitation might benefit you.
Taking medications as prescribed is also an important part of postoperative care.
Your doctor may prescribe medications to control pain during your recovery.
Lower cholesterol and blood pressure, reduce the risk of forming blood clots, manage diabetes or treat depression.
What are the risks of coronary artery bypass grafting?
Although complications from CABG are uncommon, risks include:
- Wound infection and bleeding.
- Effects of anesthesia on the body.
- the pain.
- Stroke, heart attack, or even death.
Some patients develop fever with chest pain, irritability, and decreased appetite.
This is due to inflammation of the lung and heart.
This complication sometimes appears one to six weeks after surgeries that involve cutting the pericardium (the outer covering of the heart).
This reaction is usually mild. However, some patients may develop fluid buildup around the heart that requires treatment.
Memory loss and other changes, such as problems concentrating or thinking clearly, may occur in some people.
These changes are more likely to occur in older adults, those with high blood pressure or lung disease, or those who drink large amounts of alcohol.
These side effects often improve several months after surgery.
Using a cardiopulmonary bypass device increases the risk of blood clots forming in your blood vessels.
Clots can travel to the brain or other parts of the body and block blood flow, which can cause a stroke or other problems.
Recent technological improvements in cardiopulmonary bypass devices are helping to reduce the risk of blood clots.
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