How Is Coronary Artery Bypass Graft Performed?

Coronary artery bypass grafting (CABG) is a surgery that helps create adequate blood flow to the heart by using healthy blood vessels harvested from some other sites (e.g., leg, arm, or chest) to bypass the flow of blood from the site of the blockage.

Coronary artery bypass grafting (CABG) is a surgery performed in patients with coronary artery disease (CAD). 

Your heart is fed oxygen and nutrients through blood vessels called coronary arteries. If the coronary arteries get clogged by fat or other causes, the blood supply to the heart muscles may be compromised. 

Coronary artery bypass grafting (CABG) is a surgery that helps create adequate blood flow to the heart by using healthy blood vessels harvested from some other sites (e.g., leg, arm, or chest) to bypass the flow of blood from the site of the blockage. The harvested blood vessels that are used to redirect blood to the heart are called grafts. 

The procedure prevents heart damage caused by a reduced blood supply and eases the related symptoms like chest pain and breathlessness.

A coronary artery bypass graft (CABG) surgery is performed by a cardiothoracic and vascular surgeon (CTVS). The surgery is done under deep general anesthesia with a breathing tube placed in the windpipe (endotracheal tube).

Before the surgery

Your doctor may:

• Order some blood tests and other tests such as electrocardiography, angiography, echocardiography, and computerized tomography scan
• Ask you about any chronic health conditions like diabetes and kidney diseases
• Ask you about any medications you are on
• Ask about any allergies you may have
• Explain the surgical procedure in detail, including possible complications and address your doubts and concerns related to the surgery
• Obtain your written consent
• Ask you to not eat anything for at least eight hours before the surgery

During the surgery

• You will be asked to wear a hospital gown.
• The anesthesiologist will attach an intravenous line and administer anesthesia.
• A breathing tube (endotracheal tube) will be put into your throat and you will be connected to a ventilator. 
• A catheter will be placed into your bladder to drain urine.
• The anesthesiologist will monitor your vitals (heart rate, blood pressure, breathing, and blood oxygen level) during the surgery. 
• The skin over the surgical site will be cleaned with an antiseptic solution.
• The surgeon will clean the skin over the surgical site with an antiseptic and make cuts (incisions) on one or both of your legs or one of your wrists to access the blood vessel(s) to be used for the grafts. 
• The surgeon will remove the vessel(s) and close those incision(s) with stitches.
• Thereafter, the surgeon will make an incision (cut) down the center of your chest from just below the Adam’s apple to just above the navel.
• The surgeon will cut the breastbone (sternum) in two parts along the length. 
• The halves of the breastbone are separated and spread apart to expose the heart.
• The surgeon follows a series of steps to place the graft(s) for ensuring adequate blood supply to the heart.
• After ensuring that the grafts are functioning properly, the surgeon will sew the sternum together with small wires.
• They will insert tubes into your chest to drain blood and other fluids from around the heart.
• The skin over the sternum is stitched and dressing is done.
• A tube is inserted through your mouth or nose into your stomach to drain stomach fluids.

After the surgery

• Your vital signs will be monitored in the recovery room. 
• You will be weaned off the anesthesia and shifted to the intensive care unit for intensive monitoring.

The number of arteries bypassed during the CABG surgery depends on the number of blockages your heart may have. Generally, up to four arteries can be bypassed during single heart surgery.

Coronary artery bypass grafting is necessary whenever the blood supply to the heart is compromised due to the narrowing of the coronary arteries. It may provide significant relief from the symptoms and protect the heart from further damage. Coronary artery bypass grafting may have the following complications:

• Bleeding
• Irregular heartbeat
• Heart attack
• Stroke
• Kidney failure
• Cardiac tamponade (compression of the heart by the fluid collected around it)
• Infections
• Injury to blood vessels