Coronary Artery Bypass Grafting
Treating Cardiovascular Diseases in Wisconsin and Northern Illinois
Coronary artery bypass grafting, often referred to as CABG (pronounced “cabbage”), is one of the most common types of open-heart surgery. During a cornonary bypass surgery procedure, a surgeon creates a new pathway around a blocked coronary artery. Your coronary arteriessupply blood and oxygen to your heart.
A heart attack occurs when a blockage in your coronary arteries prevents or severely restricts oxygen-rich blood from reaching part of heart. Unless blood flow is quickly restored, the part of the heart deprived of blood and oxygen can quickly die or suffer permanent damage.
Today, many blockages are treated with a coronary angioplasty procedure and stenting. An angioplasty is non-surgical procedure performed with a catheter (a long, thin tube) that’s threaded into your coronary arteries to push open the blockage. A stent is a small mesh tube that’s inserted into the artery to help it stay open.
When blockages in the coronary arteries are too large or difficult to open with angioplasty, a cardiac bypass surgery procedure remains a valuable option.
Managing your heart disease risks is an important part of recovering from a coronary bypass surgery. To learn more, read about cardiovascular disease prevention.
Performing a Coronary Artery Bypass Surgery
Surgeons gain access to your heart by making an incision down the middle of your breastbone. To create the bypass, they first take a portion of the large artery from behind the breastbone and/or part of your leg vein. When obtaining a portion of leg vein, surgeons use minimally invasive tools, which are inserted through a tiny incision at the knee to minimize pain and scarring.
This new piece of blood vessel is then grafted (attached) to the coronary artery above and below the blockage. This creates a new pathway and restores normal blood flow to the heart. Surgeons can bypass multiple coronary arteries during one surgery.
Preparing for a Coronary Artery Bypass Surgery
In the days or weeks before your bypass surgery, your doctor is likely to request the following pre-operative tests:
- Cardiac catheterization to check for blockages in the blood vessels of the heart
- Carotid ultrasound to check the arteries in your neckfor blockages, which could potentially interfere with blood flow to the brain and increase your stroke risk
- Chest X-rays to help identify lung/heart abnormalities before your surgery
- Dental examination if you haven’t had a recent exam
- Echocardiogram (cardiac ultrasound testing) to check your heart muscle strength and the function of your heart valves
- Electrocardiograph testing (EKG) to check your heart rate and rhythm
- Lab testing to check your kidney function, liver function, blood count, urine, thyroid function and blood type (in case a transfusion is needed during your surgery)
On the day before your bypass surgery, you will be asked to:
- Refrain from taking certain medications on the day of surgery (Check with your doctor for special instructions regarding medications for diabetes, medications that make your urinate more frequently, blood pressure medications and blood thinners)
- Wash your chest and legs using a special soap that helps kill bacteria to prevent infection. You may also be instructed to clip your chest and/or leg hair
On the morning of your bypass surgery, you will be asked to:
- Arrive at the hospital about 2 hours before your scheduled surgery
- Bring all your medications with you to ensure that your home medication list is correct
- Have your blood pressure and vital signs checked when you are admitted
- Refrain from eating or drinking after midnight
- Take only those medications your doctor has allowed with only a sip of water
Immediately before your bypass surgery:
When you are ready for surgery, you will be taken to the pre-op holding area where you will meet the anesthesiologist. As you wait, a nurse will be available to answer any questions.
Before going to the surgical holding area, you will have an IV placed in your arm that will deliver antibiotics. The anesthesiologist will give you medicine to help your relax and make you sleepy.
You may feel cold when you are moved to the operating room and will receive extra blankets to keep warm. You will be transferred to a hard table and, once in position, will receive anesthesia and be prepared for surgery.
During Your Coronary Artery Bypass Surgery
Once anesthesia is given, you will be completely asleep. Your anesthesiologist will put in a central line, which is a large IV for delivering medications. Another line will be used to monitor your heart function.
To help with breathing during the surgery, you will have a breathing tube that is connected to a ventilator (breathing machine). You will also have a bladder catheter.
In addition to your anesthesiologist and surgeon, you will have surgical assistants, nurses and a physician assistant helping with your procedure. Depending on the number of bypasses performed, your surgery is likely to take about 3 – 5 hours.
During your procedure, your surgeon will make an incision down the middle of your breastbone, approximately 7 – 8 inches long. You will be connected to a heart-lung bypass machine, which allows the surgeon to stop your heart from beating and moves the blood away from your heart.
After surgery is complete, your breastbone will be put back together with metal wires. Your skin will be closed with sutures and, in some cases, staples. Drainage tubes will be put in your chest cavity to drain blood and fluid. Also, temporary pacemaker wires will be placed in case your heart rate becomes too slow or requires assistance with rhythm.
Coronary Bypass Surgery Risks
All surgeries have potential risks, and some risks are higher in older adults and people with other health concerns. Your doctor will explain your risks in greater detail. Potential heart bypass surgery complications include:
- Breathing/kidney problems
- Heart arrhythmias (irregular heartbeat)
- Infection (including of surgical wounds, pneumonia, urinary infection from bladder catheter)
- Stroke (with possible short- or long-term effects, depending on its severity)
Coronary Bypass Surgery Recovery
After your procedure, you will be taken from the operating room to the intensive care unit (ICU). You will have a breathing tube in place until you wake up from general anesthesia. Your blood pressure, oxygen levels, temperature and heart rhythm will be monitored. Medication adjustments will be made as necessary.
You will be able to move out of the ICU once your breathing tube is removed, your heart rhythm and blood pressure stablize, and special intravenous medications are no longer needed. A few days after surgery, when you are deemed stable, your chest drainage tubes and temporary pacing wires can be removed.
You can expect to remain in the hospital 4 – 6 days following surgery. You are likely to begin an exercise program the day after surgery. Prescriptions, including pain medication, will be given at discharge.
Nationally Recognized for Cardiac Artery Bypass Grafting
Aurora Health Care has extensive experience performing all types of open-heart surgeries. Our teams include a surgeon, anesthesiologist, operating room nurses, surgical techs, physician assistants, nurse practitioners and nurses, who are specially trained and experienced in open-heart surgery.
You will see members of your team at your doctor’s visit before surgery, during your surgery and hospital stay, and afterward at follow-up visits. Our teams help make sure you get the care you need before, during and after your surgery.
Many Aurora surgeons are involved in research and clinical trials to stay on the cutting edge of surgical technology and techniques. To take care of your other medical needs, they work closely with other specialists, including cardiologists and doctors who specialize in diabetes, lung conditions and other disorders.
Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.