Coronary artery bypass grafting is a surgery that restores blood flow to areas of your heart that aren’t getting enough blood while you are having an heart attack or coronary heart disease with and without symptoms.This surgery can improve your heart function and how you feel, especially when you’ve just had a heart attack or there’s an increased risk for you to have one in the near future.
The condition that’s most likely to lead to CABG is coronary heart disease, a group of conditions that includes heart attack and coronary artery disease. Other conditions under coronary heart disease include angina pectoris, which is chest pain caused by ischemia in your heart, and silent myocardial ischemia, which is heart ischemia without any symptoms.
Conditions that fall under coronary heart disease usually involve a narrowing of the arteries in your heart because of a buildup of a fatty, wax-like residue called plaque. As plaque builds up on the inside of your heart's arteries, the arteries become stiffer and narrower. If an area of plaque breaks open, blood clots can form there and create blockages in those arteries. Those blockages cause ischemia in parts of your heart, which can lead to a heart attack.
The average age for people who have CABG surgery is around 64 years old, and most of the people (70%) who undergo it are men.
CABG involves creating a bypass for blood to use to reach blocked areas of your heart. A bypass is like a detour for your blood to use to get around an obstacle. Creating that bypass involves taking a blood vessel from somewhere else in your body, such as your leg, arm or chest, and using it to craft the detour around the blockage. In cases where there’s more than one blocked artery, multiple bypasses may be necessary.
To reach your heart to perform the surgery, a cardiothoracic surgeon will make an incision in the center of your chest. They’ll also split your breastbone (sternum) down the middle, then spread and lift your rib cage to make it easier to access your heart.
Once they reach your heart, the surgeon will take the harvested blood vessel and craft the bypass. The upper end (beginning) of the bypass attaches to your aorta, the large artery that carries blood out of your heart and to the rest of your body, just after it exits your heart. The lower end (ending) of the bypass will attach to the blocked artery just past the blockage.
Once the bypass is in place, the surgeon can restart your heart (if they stopped it) and get your blood flowing again. They’ll then lower your rib cage back into place and wire it together so it can heal. They’ll then close the incision in your chest with staples and sutures (stitches).
While CABG tends to use the same techniques in most people, there are instances where different techniques are better for your particular needs. The variations of this surgery include:
Off-pump CABG doesn’t use a heart-lung bypass machine. That means the surgeon doesn’t stop your heart during this procedure and does all the work while your heart is still beating. This type of surgery is not for every patient, and it is more challenging for the surgeon. However, some surgeons have special training and experience in performing CABG surgery this way.
Minimally invasive CABG doesn’t use a large incision and splitting/lifting of your sternum and rib cage. Instead, the surgeon uses much smaller incisions and accesses your heart through the gaps between some of your ribs. This version of the procedure may also use the off-pump technique.
Hybrid procedure mixes CABG with other techniques or approaches. This usually involves robot-assisted CABG on at least one artery, but non-CABG techniques like stenting for the remaining diseased blood vessels. Stenting is the placement of a stent, a device with a frame-like structure, into an artery. Inserting a stent helps hold the artery open because the stent acts as a skeleton inside the artery.
After surgery, people who undergo CABG go to the hospital’s intensive care unit Staying in the intensive care unit (ICU) is necessary because ICU staff have specialized training and experience that is better suited for people with specialized needs like those who’ve just undergone CABG.
Once a person is stable and a doctor feels they’re ready, they can transfer to a regular medical-surgical room in the hospital for the remainder of their stay. The average hospital stay for CABG is between 5 and 7 days.
CABG has several advantages that make it a useful and common part of treating heart problems.
It is a safe procedure because it has a long history of use. Surgeons performed the first CABG procedures in the early 1960s. In the decades that followed, additional studies and advancements helped make this procedure a key and reliable technique for treating ischemia of the heart.
CABG is better for multiple blockages or blockages in certain arteries. It’s also a superior procedure for blockages in certain places. Many studies have linked CABG with improved long-term outcomes, including better survival odds. This advantage often grows when used alongside advanced bypass techniques with durable results.
CABG is a durable and needs less follow-up procedures, when compared to the main alternative to CABG is percutaneous coronary intervention (PCI), often known as coronary angioplasty.