Coronary Artery Bypass Surgery - Cleveland Clinic

Coronary artery bypass grafting (CABG), also known as heart bypass surgery, is a procedure to restore blood flow to areas of your heart. ThinkyoumayhaveCOVID-19? Findoutwhereyoucangettested Needavaccineorbooster? Scheduletoday ComingtoaClevelandCliniclocation? Visitationandmaskrequirements Home / HealthLibrary / Treatments&Procedures CoronaryArteryBypassSurgery Coronaryarterybypassgrafting(CABG),alsoknownasheartbypasssurgery,isaproceduretorestorebloodflowtoareasofyourheart.Arteryblockagescancutoffbloodflow,causingheartattacksorheartattack-likesymptoms.CABGrestoresbloodflowbyusingbloodvesselsfromotherpartsofyourbodytocreateadetouraroundblockages. Appointments800.659.7822 Appointments&Locations TalktoaHeartNurse ContactUs Overview ProcedureDetails Risks/Benefits RecoveryandOutlook WhentoCalltheDoctor CoronaryArteryBypassSurgery Overview ProcedureDetails Risks/Benefits RecoveryandOutlook WhentoCalltheDoctor BackToTop Overview Bypassgraftsprovidingbloodtoblockedarteries. Whatisthisprocedure? Coronaryarterybypassgraftingisasurgerythatrestoresbloodflowtoareasofyourheartthataren’tgettingenoughblood.Thissurgerycanimproveyourheartfunctionandhowyoufeel,especiallywhenyou’vejusthadaheartattackorthere’sanincreasedriskforyoutohaveoneinthenearfuture. Whyiscoronarybypasssurgerydone? Yourheartworks24/7,supplyingyourentirebodywithblood.Todoitsjob,yourheartalsoneedsbloodflow,whichitgetsthroughanetworkofsupplyarteriesthatwraparoundit.Whentissuesinyourbodyaren’tgettingenoughbloodflow,thiscausesaproblemcalledischemia(pronounced“iss-key-me-uh”). Themusclecellsinyourheartareespeciallysensitivetoischemia,andwhenit'ssevere,thoseheartmusclecellswillstarttodie.Coronaryarterybypassgrafting(abbreviatedCABGandpronounced“cabbage”)treatsischemiabyrestoringbloodflowtotheaffectedheartmuscle. Whatconditionsaretreatedbythissurgery? Theconditionthat’smostlikelytoleadtoCABGiscoronaryheartdisease,agroupofconditionsthatincludesheartattackandcoronaryarterydisease.Otherconditionsundercoronaryheartdiseaseincludeanginapectoris,whichischestpaincausedbyischemiainyourheart,andsilentmyocardialischemia,whichisheartischemiawithoutanysymptoms. Conditionsthatfallundercoronaryheartdiseaseusuallyinvolveanarrowingofthearteriesinyourheartbecauseofabuildupofafatty,wax-likeresiduecalledplaque.Asplaquebuildsupontheinsideofyourheart'sarteries,thearteriesbecomestifferandnarrower.Ifanareaofplaquebreaksopen,bloodclotscanformthereandcreateblockagesinthosearteries.Thoseblockagescauseischemiainpartsofyourheart,whichcanleadtoaheartattack. Whoneedstohavethisprocedure? TheaverageageforpeoplewhohaveCABGsurgeryisaround66yearsold.About72%ofthepeoplewhoundergoitaremen. HowcommonisCABGsurgery? CABGsurgeryisverycommon,withabout200,000suchprocedureshappeningeveryyear. ProcedureDetails Whathappensbeforethisprocedure? CABGismajorsurgery,andpeoplewhohavethisdonemustfirstundergoawiderangeoftestsandotherpreparations. Imagingandlabtests BeforeyoucanundergoCABG,youwillneedtoundergoseveralteststoseeifit'ssafeforyoutohavethissurgeryandwhetherornotyouneedthesurgeryinthefirstplace. Thepotentialtestsinclude,butaren’tlimitedto,thefollowing: Electrocardiogram(ECGorEKG). Echocardiogram. Exercisestresstest. Nuclearcardiacstresstest. Cardiaccatheterization. X-rayangiographyorcomputedtomography(CT)scanangiography. Coronarycalciumscan. Labtests,suchasacompletebloodcount,thatanalyzeyourcholesterol,bloodsugar,andotherfactors.Otherpossibletestsincludeurineteststhatanalyzehowwellyourkidneysfunction. Informationandeducation PartofpreparingforCABGinvolvesinformingandeducatingyouonwhattoexpectandwhatyouneedtodobeforeandaftersurgerytohelpyouhavethebestpossibleoutcome.Topicsthatyou'lllearnaboutinclude: Medications.Yourhealthcareproviderwilldiscusswhatmedicationsyou’retakingbeforethesurgery.They’llalsotellyouwhichmedicationstokeeptakingandwhichmedicationsyoushouldstop(andwhentostopthem).Insomecases,theymayswitchyoutodifferentmedicationsorstartyouonnewones. Howtoprepareforsurgery.Yourhealthcareproviderwillprovideyouwithinformationandresourcesabouthowyoucanpreparefortheprocedure.Thisincludesknowingwhatkindofhelpyou’llneedathome,whatyoucanandcan’teataftertheprocedure,necessitiesyou’llneedtohaveathomeandmore.Italsoincludeshowtobathe(whichoftenincludesspecialsoap)andgroomyourselfbeforetheprocedure. Whattoexpectaftersurgery.Yourhealthcareproviderwillalsogiveyouinformationandresourcesthatdetailwhatyoucanexpectduringyourrecovery.Thisincludeshowlongitwilltakeyoutorecover,howyouarelikelytofeel,symptomstowatchforandmore. Whathappensduringthisprocedure? CABGisacomplicatedprocedurethattakesseveralhourstocomplete(theactualtimeneededdependsonthespecifictypeofCABGsurgery,howmanybypassesyouneed,andmore).Thefollowingstepshappenformostofthesesurgeries. Anesthesiaandlifesupport Likemostmajorsurgeries,thefirststeptothissurgeryistoputyouintoastateofdeepsleep.Thiskeepsyoufromfeelingpainduringthesurgery.Italsohelpsrelaxyouforotherstepsinthepreparation. BecauseCABGinvolvesworkonyourheart,itusuallyinvolvesmultipletypesoflifesupport.Theseinclude: Intubationandventilation.Intubationiswherehealthcareprovidersinsertatubedownyourthroatandintoyourwindpipe.Theythenattachthattubetoamachinecalledaventilator,whichdoestheworkofbreathingforyou.Yourlungsstillprocessandtransferoxygenintoandcarbondioxideoutofyourbloodstream,buttheventilatormakestheairmove. Intravenouslines.Intravenous(IV)linesaretubesthatallowproviderstodirectlyinfusemedicationsandfluidsintoyourbodythroughoneofyourveins. Urinarycatheter.Beforestartingsurgery,providerswillinsertasmalltubeintoyoururethrauntilitreachesyourbladder.Thistube,calledacatheter,allowsurinetodrainthroughthetubeandintoabag.Thisletsyouunconsciously“pee”evenwhenyou’reunderanesthesia. Heart-lungbypass.ThismachinetakesoverforyourheartandlungsbypumpingbloodoutofyourbodythroughanIVlineandintothismachine,whichalsoaddsoxygenandremovescarbondioxidetoyourblood.ThemachinethenpumpsthebloodbackintoyourbodythroughanIVline.Usingthismachineallowsproviderstotemporarilystopyourheart,makingiteasierforthemtodosomeofthesurgicalwork.Aheart-lungbypassmachineisn’talwaysnecessaryforCABG(seethesectiononvariationsofthissurgerybelow),buttheuseoftheseiscommon. Bloodvesselharvesting CABGinvolvescreatingabypassforbloodtousetoreachblockedareasofyourheart.Abypassislikeadetourforyourbloodtousetogetaroundanobstacle.Creatingthatbypassinvolvestakingabloodvesselfromsomewhereelseinyourbody,suchasyourleg,armorchest,andusingittocraftthedetouraroundtheblockage.Incaseswherethere’smorethanoneblockedartery,multiplebypassesmaybenecessary.Thesearedouble(2),triple(3)andquadruple(4)bypasses. Surgery Toreachyourhearttoperformthesurgery,acardiothoracicsurgeonwillmakeanincisioninthecenterofyourchest.They’llalsosplityourbreastbone(sternum)downthemiddle,thenspreadandliftyourribcagetomakeiteasiertoaccessyourheart. Oncetheyreachyourheart,thesurgeonwilltaketheharvestedbloodvesselandcraftthebypass.Theupperend(beginning)ofthebypassattachestoyouraorta,thelargearterythatcarriesbloodoutofyourheartandtotherestofyourbody,justafteritexitsyourheart.Thelowerend(ending)ofthebypasswillattachtotheblockedarteryjustpasttheblockage. Oncethebypassisinplace,thesurgeoncanrestartyourheart(iftheystoppedit)andgetyourbloodflowingagain.They’llthenloweryourribcagebackintoplaceandwireittogethersoitcanheal.They’llthenclosetheincisioninyourchestwithstaplesandsutures(stitches). Variationsofthissurgery WhileCABGtendstousethesametechniquesinmostpeople,thereareinstanceswheredifferenttechniquesarebetterforyourparticularneeds.Thevariationsofthissurgeryinclude: Off-pumpCABG.ThistypeofCABGdoesn’tuseaheart-lungbypassmachine.Thatmeansthesurgeondoesn’tstopyourheartduringthisprocedureanddoesalltheworkwhileyourheartisstillbeating.Thistypeofsurgeryisnotforeverypatient,anditismorechallengingforthesurgeon.However,somesurgeonshavespecialtrainingandexperienceinperformingCABGsurgerythisway. MinimallyinvasiveCABG.ThisvariationofCABGdoesn’tusealargeincisionandsplitting/liftingofyoursternumandribcage.Instead,thesurgeonusesmuchsmallerincisionsandaccessesyourheartthroughthegapsbetweensomeofyourribs.Thisversionoftheproceduremayalsousetheoff-pumptechnique. Robot-assistedCABG.SurgicalrobotsarehighlyadvancedmachinesthatasurgeoncanusetoperformCABGsurgery.Todothis,asurgeon"drives"therobot,meaningtheycontroltherobot'smovements.Roboticsurgeryusessmallerincisionsanddoesn'tinvolveopeningandliftingyoursternum.Roboticsurgerymayinvolveheart-lungbypass,oritmayusetheoff-pumptechnique. Hybridprocedure.ThisversionoftheproceduremixesCABGwithothertechniquesorapproaches.Thisusuallyinvolvesrobot-assistedCABGonatleastoneartery,butnon-CABGtechniqueslikestentingfortheremainingdiseasedbloodvessels.Stentingistheplacementofastent,adevicewithaframe-likestructure,intoanartery.Insertingastenthelpsholdthearteryopenbecausethestentactsasaskeletoninsidetheartery. Whathappensafterthisprocedure? Aftersurgery,peoplewhoundergoCABGgotothehospital’sintensivecareunit(somehospitalsusedifferenttermslikecriticalcareunit).Stayingintheintensivecareunit(ICU)isnecessarybecauseICUstaffhavespecializedtrainingandexperiencethatisbettersuitedforpeoplewithspecializedneedslikethosewho’vejustundergoneCABG. Onceapersonisstableandadoctorfeelsthey’reready,theycantransfertoaregularmedical-surgicalroominthehospitalfortheremainderoftheirstay.TheaveragehospitalstayforCABGisbetween8and12days(longerforpeoplewhohadCABGbecauseofaheartattack,shorterforpeoplewhohadstableischemicheartdiseaseorsimilarproblems). Afterleavingthehospital,mostpeoplewhohaveCABGwillalsocompleteacardiacrehabilitationprogram.Oftencalledcardiacrehab,theseprogramshelpyourecoverandrebuildyourstrengthafterintensivecardiacproceduresoreventslikeheartattacks.Cardiacrehabprogramsincludespeciallytrainedandhighlyqualifiedstaff.Theyusuallyincludenurses,exercisephysiologists,nutritionistsanddietitians,counselorsandbehavioralhealthspecialistsanddoctors. Risks/Benefits Whataretheadvantagesofthisprocedure? CABGhasseveraladvantagesthatmakeitausefulandcommonpartoftreatingheartproblems. Alonghistoryofuse.SurgeonsperformedthefirstCABGproceduresintheearly1960s.Inthedecadesthatfollowed,additionalstudiesandadvancementshelpedmakethisprocedureakeyandreliabletechniquefortreatingischemiaoftheheart. Betterformultipleblockagesorblockagesincertainarteries.CABGisoftenthebestchoicewhenapersonhasmultipleblockedarteriesintheirheart.It’salsoasuperiorprocedureforblockagesincertainplaces.ManystudieshavelinkedCABGwithimprovedlong-termoutcomes,includingbettersurvivalodds.Thisadvantageoftengrowswhenusedalongsideadvancedbypasstechniqueswithdurableresults. Lowerriskforfollow-upprocedures.ThemainalternativetoCABGispercutaneouscoronaryintervention(PCI),oftenknownasangioplasty.Inmanycases,PCIhasahigherriskofneedingafollow-upprocedure. Whataretherisksorcomplicationsofthisprocedure? CABGisamajorsurgery,whichmeanstherearesomepotentialrisksandcomplications.Whilemostoftheserisksandcomplicationsareavoidableortreatable,it’sstillimportanttounderstandthem.Possiblerisksinclude: Irregularheartrhythms(arrhythmias).ThemostcommonarrhythmiaafterCABGisatrialfibrillation,whichcausesanincreasedriskofstroke.Fortunately,it’susuallyonlyatemporaryconcern. Bleeding.Thisisariskwithanymajorsurgery.Toavoidthis,peoplewhotakebloodthinnerswillneedtostoptakingthem(withguidanceandmonitoringfromtheirhealthcareprovider)beforethesurgery. Infections.Anotherpossiblecomplicationofsurgeryisinfection.Wheninfectionsspreadthroughoutyourbody,theycancausesepsis,alife-threateningoverreactionofyourimmunesystem.Sepsisisamedicalemergency,andhavingtwoormoreofitssymptoms(fastheartrate,fever,chills,confusion,rapidbreathingorconfusion)shouldbeconsideredasdangerousasaheartattackorstroke.Fortunately,majorinfectionsafterCABGarerarethankstoimprovedsurgicalcareandtechniques. Confusionordelirium.Thesecausesymptomslikeagitation,troublethinkingclearly,memoryproblemsorsomeonebehavingunusually(wheretheyseemlikeadifferentperson). Kidneyproblems. Stroke. Heartattack. RecoveryandOutlook Whatistherecoverytime? MostpeoplewhohaveCABGwillneedseveralweekstofullyrecoverfromthisprocedure.Duringthattime,yourproviderwilllikelyhaveyouavoidinganystrenuousactivitiesorsituationsthatmightputtoomuchstressonyourheartandincisions. Yourhealthcareprovideristhebestpersontotellyouhowlongitwillprobablytakeyoutorecoverandwhatyoushouldexpect.They’llalsotellyouwhenyoucanstartresumingyourregularactivitieslikework,exercising,driving,etc. WhentoCalltheDoctor WhenshouldIseemyhealthcareprovider? Youshouldseeyourhealthcareproviderasrecommendedafteryourprocedure.They'llschedulefollow-upvisitswheretheycancheckyourheartfunction,removeanyremainingstitchesorstaples,andmakesureyourwoundsarehealingwell. Duringyourrecovery,youshouldalsofollowyourprovider’sguidanceregardingthefollowing: Takeyourmedication.Thisisanessentialpartofyourrecovery,andit'sveryimportantthatyoutakemedicationsexactlyasyourproviderprescribesthem.Ifyouhaveanyquestionsabouthowtotakeyourmedicationsorstorethem,youshouldaskyourproviderthesequestionsassoonaspossible. Gotocardiacrehab.Theseprogramscanmakeahugedifferenceinyouroverallrecoveryandhowyoufeelafteryourprocedure.Becausethey’remedicallymonitoredandstaffedbytrainedmedicalprofessionals,theycanalsohelpcatchanypotentialproblemsorwarningsignssoonerratherthanlater. Takecareofyourmentalhealth.PeoplewhoundergoCABGcouldexperiencementalhealthissueslikeanxietyordepression.Thesearenormalandarenothingtofeelshameover.Talkingtomentalhealthcareprofessionalsabouttheseissuesisjustasimportantasseeingaprovideraboutyourheartproblems. Makelifestylechanges.ThoughCABGcanrestorebloodflow,theissuesthatcausedyoutoneedCABGcanstillhappenagain.It’simportanttofollowyourhealthcareprovider’sguidanceonimprovingyourlifestyle,includingdietandhowmuchyouexercise.Improvingyourlifestylecanhelpyouavoidfurthercomplicationsinthefuture. WhenshouldIgototheemergencyroom? Youshouldgotothehospitalrightawayifyouhaveanyofthefollowing: Chestpain. Troublebreathing. Feelingdizzyorlightheaded. Passingoutorfainting. Heartpalpitations(theunpleasantfeelingofyourheartbeatingwithoutfeelingforyourpulse). Droopingofyourfaceorweaknessononesideofyourbody. Slurredordistortedspeech. Havingafeverorchills. Fastheartrateorbreathing. AnotefromClevelandClinic Coronaryarterybypassgraftingisasurgerythatcanmakeabigdifferenceinhowyoufeelandyouroveralllengthandqualityoflife.It'salsoamajorprocedure,andit’snormaltoworryorfeelanxiousabouthavingthissurgery.Talkingtoyourhealthcareproviderisimportantbecausetheycanprovideyouwithinformationandresourcesthatcanhelpyoubetterunderstandwhat’shappening.Theycanalsoguideyouonwhatyoucandotohelpyourselfavoidcomplicationsandhavethebestpossibleoutcome. Share Facebook Twitter LinkedIn Email Print Getuseful,helpfulandrelevanthealth+wellnessinformation enews ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. Policy RelatedInstitutes&Services Heart,Vascular&ThoracicInstitute(MillerFamily) Thelatestinformationaboutheart&vasculardisorders,treatments,testsandpreventionfromtheNo.1-rankedheartprogramintheUnitedStates. RelatedHealthInformation BifurcationBlockage CardiacCatheterization&CoronaryInterventionalProcedures(AngioplastyandStent) CoronaryArteryBypassSurgery CoronaryArteryDiseaseTreatments EnhancedExternalCounterpulsation(EECP) In-StentRestenosis:DoctorsWhoTreat TotalCoronaryOcclusions ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. Policy Morehealthnews+info ShowMore Appointments800.659.7822 Appointments&Locations TalktoaHeartNurse ContactUs Facebook Twitter YouTube Instagram LinkedIn Pinterest Snapchat