Coronary Artery Bypass Graft (CABG) Surgery
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple coronary arteries during one surgery.
Types of Coronary Artery Bypass Grafting (CABG)
There are several types of coronary artery bypass grafting (CABG). Your doctor will recommend the best option for you based on your needs.
Traditional Coronary Artery Bypass Grafting
Traditional CABG is used when at least one major artery needs to be bypassed. During the surgery, the chest bone is opened to access the heart.
Medicines are given to stop the heart; a heart-lung bypass machine keeps blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart.
After surgery, blood flow to the heart is restored. Usually, the heart starts beating again on its own. Sometimes mild electric shocks are used to restart the heart.
Off-Pump Coronary Artery Bypass Grafting
This type of CABG is similar to traditional CABG because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump CABG sometimes is called beating heart bypass grafting.
Minimally Invasive Direct Coronary Artery Bypass Grafting
This type of surgery differs from traditional CABG because the chest bone isn't opened to reach the heart. Instead, several small cuts are made on the left side of the chest between the ribs. This type of surgery mainly is used to bypass blood vessels at the front of the heart.
Minimally invasive bypass grafting is a fairly new procedure. It isn't right for everyone, especially if more than one or two coronary arteries need to be bypassed.
As with any type of surgery, coronary artery bypass grafting (CABG) has risks. The risks of CABG include:
- Wound infection and bleeding
- Reactions to anesthesia
- Stroke, heart attack, or even death
Some patients have a fever associated with chest pain, irritability, and decreased appetite. This is due to inflammation involving the lung and heart sac.
This complication sometimes occurs after surgeries that involve cutting through the pericardium (the outer covering of the heart). The problem usually is mild, but some patients may develop fluid buildup around the heart that requires treatment.
Memory loss and other issues, such as problems concentrating or thinking clearly, might occur in some people.
These problems are more likely to affect older patients and women. These issues often improve within 6–12 months of surgery.
In general, the risk of complications is higher if CABG is done in an emergency situation (for example, during a heart attack). The risk also is higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral arterial disease (P.A.D.).