There may be other reasons for your physician to recommend coronary artery bypass surgery. At Home. Previous Section Next Section. Clinical Trials. MyHealth Login. Financial Assistance. Medical Records.
Contact Us. Video Visits. Get a Second Opinion. Healthcare Professionals. Referring Physicians. Allied Healthcare. The term "anesthesia" refers to a loss of feeling and awareness.
General anesthesia temporarily puts you to sleep. During the surgery, the anesthesiologist checks your heartbeat, blood pressure, oxygen levels, and breathing. A breathing tube is placed in your lungs through your throat. The tube is connected to a ventilator a machine that helps you breathe.
An incision is made down the center of your chest. The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart. Medicines are used to stop your heart, which allows the surgeon to operate on it while it's not beating. You're also given medicines to protect your heart function during the time that it's not beating.
A heart-lung bypass machine keeps oxygen-rich blood moving throughout your body during the surgery. For more information about heart-lung bypass machines, including an illustration, go to "What To Expect During Heart Surgery.
An artery or vein is taken from your body-for example, from your chest or leg-and prepared to be used as a graft for the bypass. In surgery with several bypasses, both artery and vein grafts are commonly used. After the grafting is done, blood flow to your heart is restored. You're then disconnected from the heart-lung bypass machine. Tubes are inserted into your chest to drain fluid. The surgeon uses wires to close your chest bone much like how a broken bone is repaired. The wires stay in your body permanently.
After your chest bone heals, it will be as strong as it was before the surgery. Stitches or staples are used to close the skin incision. The breathing tube is removed when you're able to breathe without it. This type of surgery can be used to bypass any of the coronary heart arteries. Off-pump CABG also is called beating heart bypass grafting because the heart isn't stopped and a heart-lung bypass machine isn't used.
Instead, the part of the heart where grafting is being done is steadied with a mechanical device. These types of surgery differ from traditional bypass surgery. They only require small incisions rather than opening the chest bone to get to the heart. These procedures sometimes use a heart-lung bypass machine. This procedure is used when only one or two coronary arteries need to be bypassed. A series of small incisions is made between your ribs on the left side of your chest, directly over the artery to be bypassed.
The incisions usually are about 3 inches long. The incision made in traditional CABG is at least 6 to 8 inches long. The left internal mammary artery most often is used for the graft. A heart-lung bypass machine isn't used during this procedure. Port-access coronary artery bypass procedure. This procedure is done through small incisions ports made in your chest. Artery or vein grafts are used. A heart-lung bypass machine is used during this procedure.
Robot-assisted technique. This type of procedure allows for even smaller, keyhole-sized incisions. A small video camera is inserted in one incision to show the heart, while the surgeon uses remote-controlled surgical instruments to do the surgery. A heart-lung bypass machine is sometimes used during this procedure. After surgery, you'll typically spend 1 or 2 days in an intensive care unit ICU.
Your heart rate, blood pressure, and oxygen levels will be checked regularly during this time. An intravenous line IV will likely be inserted into a vein in your arm. Through the IV line, you may get medicines to control blood circulation and blood pressure. You also will likely have a tube in your bladder to drain urine and a tube to drain fluid from your chest. You may receive oxygen therapy oxygen given through nasal prongs or a mask and a temporary pacemaker while in the ICU.
A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. Your doctor may recommend that you wear compression stockings on your legs as well. These stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg.
The pressure keeps blood from pooling and clotting. While in the ICU, you'll also have bandages on your chest incision cut and on the areas where an artery or vein was removed for grafting.
After you leave the ICU, you'll be moved to a less intensive care area of the hospital for 3 to 5 days before going home. You also may get instructions on how to deal with common side effects from surgery.
Side effects often go away within 4 to 6 weeks after surgery, but may include:. Full recovery from traditional CABG may take 6 to 12 weeks or more. Less recovery time is needed for nontraditional CABG. Your doctor will tell you when you can start physical activity again. It varies from person to person, but there are some typical timeframes.
Most people can resume sexual activity within about 4 weeks and driving after 3 to 8 weeks. Returning to work after 6 weeks is common unless your job involves specific and demanding physical activity. Some people may need to find less physically demanding types of work or work a reduced schedule at first.
Care after surgery may include periodic checkups with doctors. During these visits, tests may be done to see how your heart is working. You and your doctor may develop a treatment plan that includes lifestyle changes to help you stay healthy and reduce the chance of CHD getting worse. Lifestyle changes may include making changes to your diet, quitting smoking, doing physical activity regularly, and lowering and managing stress. Your doctor also may refer you to cardiac rehabilitation rehab.
CABG is a treatment but not a cure for ischemic heart disease. It is important to work with your doctor after CABG to help you stay healthy. This may include taking medicines prescribed by your doctor, making healthy lifestyle changes, getting regular medical checkups, and participating in cardiac rehabilitation.
Your doctor will likely discuss medicines with you shortly after your surgery. Some of them are important to start right away. You may need to take them for up to one year or even continuously throughout your life.
These medicines may include:. After surgery and after recovery, your doctor will want to schedule checkups to look for common complications of CABG or further problems from ischemic heart disease. Even if you do not experience any signs or symptoms, you may need testing about five years after CABG surgery, or sooner if you have new symptoms or have other risk factors.
You may take a stress test with an electrocardiogram or echocardiogram, or other heart and lung imaging. If you have symptoms such as chest pain, especially before or during the stress test, your doctor will likely recommend coronary angiography to check on the graft and other arteries. Your doctor will discuss heart-healthy lifestyle habits and changes that are important to maintaining your health and controlling risk factors, such as hypertension and diabetes.
These include:. Your doctor may refer you to cardiac rehabilitation to improve your heart health after a heart-related procedure or heart condition. Cardiac rehabilitation helps you maintain or adopt heart-healthy lifestyle practices to lower your risk for cardiovascular diseases. This program includes exercise training, education on heart-healthy living, and counseling to reduce stress and help you return to an active life.
These rehabilitation programs are supervised by doctors and are usually offered in hospitals or community facilities. Your doctor will likely ask if you have had any changes in your mood or other aspects of your well-being. It is important to be treated for depression to increase your chance of full recovery.
If you have symptoms of depression, your doctor may refer you to a mental health specialist. Treatment may include counseling and medicine. Complications can occur quickly or years after CABG.
One possible complication is that the graft will become blocked with plaque and limit or stop blood flow to the heart. If your graft stops working, this may cause a heart attack or other problem with your heart, and you may need additional surgery or PCI.
If you think that you are or someone else is having the following symptoms, call right away. Every minute matters. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders including coronary artery bypass grafting CABG procedures.
Learn about current and future NHLBI efforts to improve health through research and scientific discovery. Learn about the following ways the NHLBI continues to translate current research into improved health for people who need coronary artery bypass grafting.
In support of our mission , we are committed to advancing research on coronary artery bypass grafting, in part through the following ways. We lead or sponsor many studies on coronary artery bypass surgery and heart disease treatments. See if you or someone you know is eligible to participate in our clinical trials. Learn more about participating in a clinical trial. View all trials from ClinicalTrials. After reading our Coronary Artery Bypass Grafting Health Topic, you may be interested in additional information found in the following resources.
Coronary Artery Bypass Grafting. Also known as Heart Bypass Surgery. Coronary artery bypass grafting CABG is a procedure to improve poor blood flow to the heart. It may be needed when the arteries supplying blood to heart tissue, called coronary arteries, are narrowed or blocked.
This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, a type of ischemic heart disease. CABG may also be used in an emergency, such as a severe heart attack. CABG uses blood vessels from another part of the body and connects them to blood vessels above and below the narrowed artery, bypassing the narrowed or blocked coronary arteries.
One or more blood vessels may be used, depending on the severity and number of blockages. The blood vessels are usually arteries from the arm or chest, or veins from the legs. Risks and possible complications may occur with this procedure.
After CABG, your doctor may recommend medicines and heart-healthy lifestyle changes to further reduce your symptoms, treat your disease, and help prevent complications such as blood clots. Explore this Health Topic to learn more about CABG, our role in research and clinical trials to improve health, and where to find more information.
Image of coronary artery disease before and after heart bypass surgery. The image on the left shows the heart before CABG. The gray region shows decreased blood flow due to coronary artery disease. The image on the right shows two grafts after a CABG procedure. One graft, shown in blue, is a vein that was taken from the leg, and the other, shown in red, is an artery that came from the chest.
For each graft, one side connects to a coronary artery and the other side connects to a large artery that supplies blood to parts of the heart. These grafts bypass the blocked arteries and restore blood flow to the heart. When is CABG recommended? Diagnostic tests and procedures. An EKG can show signs of heart damage. Stress tests to measure how well your heart works during physical stress.
The stress may be physical exercise, such as walking on a treadmill, or it may be a medicine given to have the same effect. Echocardiogram to assess heart function. This includes whether the valves or pumping is abnormal. Coronary angiography to see how blood flows through your arteries.
It is performed along with cardiac catheterization. The angiogram shows how severe the disease is, which arteries are affected, and the location of the affected arteries. CT angiography to take pictures of your blood vessels. This is an alternative to cardiac catheterization that uses an injection of dye in the arm along with computed tomography CT imaging.
Because it does not involve threading a catheter into the heart as cardiac catheterization does, CT angiography may be safer for some patients. Coronary calcium scan to get images of the calcium in the walls of your coronary arteries, which is linked to coronary artery disease. This test uses CT imaging. Preparing for surgery. If your surgery is scheduled, talk to your doctor about what to expect and how to prepare, such as: Which medicines you should stop taking and when to stop.
Ask about all the medicines you take, even if they are not prescription, as well as supplements. Which medicines you should begin taking and when to start them. How to bathe before surgery. You may be told to use a special soap to wash your body. When to stop eating and drinking before surgery.
When to arrive at the hospital and where to go. What to expect after surgery and during the recovery period. Look for. After Surgery will explain what happens in the days after surgery and the risks of the surgical procedure. Surgical team. Traditional CABG surgery.
How a heart-lung bypass machine works during surgery. The heart-lung bypass machine adds oxygen and pumps blood throughout the body while the heart is stopped during surgery. The blood supply is connected to the machine through tubes. First, blood that needs oxygen leaves the heart and goes into the machine, bypassing the lungs. Oxygen is added to the blood in the machine. Then the machine pumps the oxygen-rich blood to the rest of the body. Off-pump CABG. Minimally invasive CABG.
Instead, the surgeon makes a smaller cut on the left side of the chest over the artery that needs to be bypassed and enters in between the ribs. It is also usually an off-pump procedure. Sometimes CABG surgery can be done using a robot to surgically place the graft. This is called robotic-assisted or robotic surgery. The surgeon controls the robot instead of doing the work by hand, and the machinery only needs small openings in the chest.
A heart-lung bypass machine is sometimes used. During a hybrid bypass surgery, the robotic bypass is done for one of the main arteries, but a stent is used for other blocked arteries.
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