Coronary Artery Bypass Grafting
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A coronary artery bypass graft (CABG) is an open-heart surgery. A part of a blood vessel from another part of the body is attached to a blocked artery of the heart. The attached blood vessel improves blood flow to an area of the heart.
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Reasons for Procedure
CABG can improve blood flow in arteries of the heart. Problems with blood flow are most often caused by atherosclerosis. This is a build up of fatty substance on the wall of the blood vessel. It builds overtime and decreases the amount of blood that can flow through to the heart muscle. Slowed blood flow can cause chest pain called angina, damage to heart, or a heart attack.
CABG may be done if there are severe blockages in arteries of the heart. It may be done as part of a treatment plan if other treatment has not worked. CABG may also be done as part of emergency care during or after a heart attack.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will talk about possible problems, like:
- Post-surgical infection
- Blood clots
- High blood pressure or low blood pressure
- Damage to other organs such as the kidneys
- Irregular heart rate
Some factors that may increase the risk of complications include:
What to Expect
Prior to Procedure
Earlier tests will be reviewed. They help guide treatment.
The care team will ask about regular medicine. Some medicine may need to be stopped for one week before surgery, unless it is an emergency. Before surgery:
- Do not eat or drink anything after midnight.
- Arrange for a ride to and from the hospital.
- Arrange for help at home after the procedure.
General anesthesia will be given. You will be asleep and pain will be blocked.
Description of Procedure
There are 3 different types of CABG:
- Traditional—A cut will be made through the skin on the chest. The breastbone will be split with a tool to open the chest. Medicines will be given to stop the heart so the work can be done. A heart-lung machine will act as the heart and lungs during the surgery.
- Off-pump—A cut will be made through the skin on the chest. The breastbone will be split with a tool to open the chest. The heart will be beating during surgery. The heart-lung machine is not used.
- Minimally invasive—Smaller cuts are made around the chest. It can lead to a faster recovery but it is not suited for everyone. It is often limited to people with only 1 or 2 clogged arteries. It is a less common option.
A piece of blood vessel will be taken from the chest wall or the leg. One end of the new vessel will be attached just above the blockage in the heart. The other end will be attached just below the blockage. In traditional CABG, the heart will then be allowed to restart. Electrical shocks may be needed to make sure the heart is beating as it should. The heart-lung machine will be disconnected.
Temporary tubes may be placed in the chest. It will help to drain any fluid from the chest. The breastbone will be wired together if needed. The chest will be closed with stitches or staples.
Immediately After Procedure
Recovery will take place in the intensive care unit. The heart and lungs will be closely monitored. Medicine for pain will be given through an IV. Oxygen may also be given. Pacing wires may also be attached. They can help to correct abnormal rhythms from the heart.
How Long Will It Take?
4 to 5 hours
How Much Will It Hurt?
Anesthesia prevents pain during surgery. There will be pain for a few weeks if the chest was open. Medicine and support tips will help manage pain during recovery.
Average Hospital Stay
5 to 7 days
At the Hospital
Dressings will be removed in 1 to 2 days. Pacing wires and chest tubes will be removed after a few days. Movement and other steps will be encouraged to help prevent complications. Step may include:
It will be several weeks before you can return to all normal activity. A cardiac rehabilitation program may help to make changes to further improve heart health.
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. Call your doctor for:
- Pain that you cannot control with the medication you were given
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
- Persistent nausea or vomiting
- Cough, shortness of breath, or chest pain
- Pain, burning, urgency, frequency of urination, or persistent blood in the urine
- Gaining more than 4 pounds within 1-2 days
- Pain or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
If you think you have an emergency, call for emergency medical services right away.
American Heart Association
National Heart, Lung, and Blood Institute
Heart and Stroke Foundation of Canada
Coronary artery bypass graft (CABG) surgery. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T113960/Coronary-artery-bypass-graft-CABG-surgery. Accessed April 13, 2021.
Diodato M, Chedrawy EG. Coronary artery bypass graft surgery: the past, present, and future of myocardial revascularisation. Surg Res Pract. 2014;2014:726158.
Explore coronary artery bypass grafting. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cabg. Accessed April 13, 2021.
Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Dec 6;124(23):e652
Last reviewed November 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 12/20/2020