Coronary Artery Bypass Graft Surgery | Johns Hopkins Medicine

Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease. Coronary artery disease (CAD) is the narrowing of the ... SkipNavigation COVID-19Updates Masksarerequiredinsideallofourcarefacilities.Wearevaccinatingalleligiblepatients.Learnmore: Vaccines,Boosters&AdditionalDoses|Testing|PatientCare|VisitorGuidelines|Coronavirus|EmailAlerts FindmoreCOVID-19testinglocationsonMaryland.gov. HealthHome Treatments,TestsandTherapies CoronaryArteryBypassGraftSurgery ShareonFacebook ShareonTwitter ShareonLinkedin ShareonPinterest ShareviaEmail PrintthisPage Cardiovascular HeartandVascular CoronaryArteryDiseaseTreatment CardiovascularSurgery Whatiscoronarybypassgraftsurgery? Coronaryarterybypassgraftsurgery(CABG)isaprocedureusedtotreatcoronaryarterydisease.Coronaryarterydisease(CAD)isthenarrowingofthecoronaryarteries–thebloodvesselsthatsupplyoxygenandnutrientstotheheartmuscle.CADiscausedbyabuild-upoffattymaterialwithinthewallsofthearteries.Thisbuild-upnarrowstheinsideofthearteries,limitingthesupplyofoxygen-richbloodtotheheartmuscle. Onewaytotreattheblockedornarrowedarteriesistobypasstheblockedportionofthecoronaryarterywithapieceofahealthybloodvesselfromelsewhereinyourbody.Bloodvessels,orgrafts,usedforthebypassproceduremaybepiecesofaveinfromyourlegoranarteryinyourchest.Anarteryfromyourwristmayalsobeused.Yourdoctorattachesoneendofthegraftabovetheblockageandtheotherendbelowtheblockage.Bloodbypassestheblockagebygoingthroughthenewgrafttoreachtheheartmuscle.Thisiscalledcoronaryarterybypasssurgery. Traditionally,tobypasstheblockedcoronaryartery,yourdoctormakesalargeincisioninthechestandtemporarilystopstheheart.Toopenthechest,yourdoctorcutsthebreastbone(sternum)inhalflengthwiseandspreadsitapart.Oncetheheartisexposed,yourdoctorinsertstubesintotheheartsothatthebloodcanbepumpedthroughthebodybyaheart-lungbypassmachine.Thebypassmachineisnecessarytopumpbloodwhiletheheartisstopped. Whilethetraditional"openheart"procedureisstillcommonlydoneandoftenpreferredinmanysituations,lessinvasivetechniqueshavebeendevelopedtobypassblockedcoronaryarteries."Off-pump"procedures,inwhichtheheartdoesnothavetobestopped,weredevelopedinthe1990's.Otherminimallyinvasiveprocedures,suchaskeyholesurgery(donethroughverysmallincisions)androboticprocedures(donewiththeaidofamovingmechanicaldevice),maybeused. WhymightIneedcoronaryarterybypasssurgery? Yourdoctorusescoronaryarterybypassgraftsurgery(CABG)totreatablockageornarrowingofoneormoreofthecoronaryarteriestorestorethebloodsupplytoyourheartmuscle. Symptomsofcoronaryarterydiseasemayinclude: Chestpain Fatigue(severetiredness) Palpitations Abnormalheartrhythms Shortnessofbreath Swellinginthehandsandfeet Indigestion Unfortunately,youmaynothaveanysymptomsinearlycoronaryarterydisease,yetthediseasewillcontinuetoprogressuntilthere’senougharteryblockagetocausesymptomsandproblems.Ifthebloodsupplytoyourheartmusclecontinuestodecreaseasaresultofincreasingblockageofacoronaryartery,youmayhaveaheartattack.Ifthebloodflowcan’tberestoredtotheparticularareaoftheheartmuscleaffected,thetissuedies. TheremaybeotherreasonsforyourdoctortorecommendCABGsurgery. Whataretherisksofcoronaryarterybypasssurgery? Possiblerisksofcoronaryarterybypassgraftsurgery(CABG)include: Bleedingduringorafterthesurgery Bloodclotsthatcancauseheartattack,stroke,orlungproblems Infectionattheincisionsite Pneumonia Breathingproblems Pancreatitis Kidneyfailure Abnormalheartrhythms Failureofthegraft Death Theremaybeotherrisksdependingonyourspecificmedicalcondition.Besuretodiscussanyconcernswithyourdoctorbeforetheprocedure. HowdoIgetreadyforcoronaryarterybypasssurgery? Yourdoctorwillexplaintheprocedureandyoucanaskquestions. Youwillbeaskedtosignaconsentformthatgivesyourpermissiontodothetest.Readtheformcarefullyandaskquestionsifanythingisunclear. Alongwithareviewofyourhealthhistory,yourdoctorwilldoacompletephysicalexamtomakesureyouareinotherwisegoodhealthbeforehavingtheprocedure.Youmayneedbloodtestsorotherdiagnostictests. Youwillbeaskedtonoteatordrinkfor8hoursbeforetheprocedure,generallyaftermidnight. Youmaybeaskedtoshowerwithasoaporspecialcleanserthenightbeforeandthemorningofsurgery. Tellyourdoctorifyouarepregnantorthinkyoucouldbe. Tellyourdoctorifyouaresensitivetoorareallergictoanymedicines,iodine,latex,tape,oranestheticmedicines(localandgeneral). Tellyourdoctoraboutallmedicines(prescriptionandover-the-counter),vitamins,herbs,andsupplementsthatyouaretaking. Tellyourdoctorifyouhaveahistoryofbleedingdisordersorifyouaretakinganyblood-thinningmedicines,aspirin,orothermedicinesthataffectbloodclotting.Youmaybetoldtostopsomeofthesemedicinesbeforetheprocedure. Yourdoctormaydobloodtestsbeforetheproceduretofindouthowlongittakesyourbloodtoclot. Tellyourdoctorifyouhaveapacemakeroranyotherimplantedcardiacdevice. Ifyousmoke,quitsmokingassoonaspossible.Thiswillimproveyourchancesforasuccessfulrecoveryfromsurgeryandbenefityouroverallhealth. Basedonyourmedicalcondition,yourdoctormayaskyoutodootherthingstogetready. Whathappensduringcoronaryarterybypass? Coronaryarterybypassgraftsurgery(CABG)requiresastayinahospital.Proceduremayvarydependingonyourconditionandyourdoctor'spractices. Generally,CABGfollowsthisprocess: Youwillbeaskedtoremoveanyjewelryorotherobjectsthatmayinterferewiththeprocedure. Youwillchangeintoahospitalgownandemptyyourbladder. Youwilllieonyourbackonanoperatingtable. Theanesthesiologistwillcontinuouslymonitoryourheartrate,bloodpressure,breathing,andbloodoxygenlevelduringthesurgery.Onceyouaresedated(putintoadeepsleep),abreathingtubewillbeputintoyourthroatandyouwillbeconnectedtoaventilator,whichwillbreatheforyouduringthesurgery. Ahealthcareprofessionalwillinsertanintravenous(IV)lineinyourarmorhand.Othercatheterswillbeputinyourneckandwristtomonitoryourheartandbloodpressure,aswellastotakebloodsamples. Acatheterwillbeputintoyourbladdertodrainurine. Theskinoverthesurgicalsitewillbecleanedwithanantisepticsolution. Onceallthetubesandmonitorsareinplace,yourdoctorwillmakeincisions(cuts)inoneorbothofyourlegsoroneofyourwriststoaccessthebloodvessel(s)tobeusedforthegrafts.Heorshewillremovethevessel(s)andclosethoseincision(s). Thedoctorwillmakeanincision(cut)belowtheAdam'sappletojustabovethenavel. Thedoctorwillcutthesternum(breastbone)inhalflengthwise.Heorshewillseparatethehalvesofthebreastboneandspreadthemaparttoexposeyourheart. Coronaryarterybypassgraftsurgery--on-pumpprocedure Tosewthegraftsontotheverysmallcoronaryarteries,yourdoctorwillneedtostopyourhearttemporarily.Tubeswillbeputintotheheartsothatyourbloodcanbepumpedthroughyourbodybyaheart-lungbypassmachine. Oncethebloodhasbeendivertedintothebypassmachineforpumping,yourdoctorwillstoptheheartbyinjectingitwithacoldsolution. Whenthehearthasbeenstopped,thedoctorwilldothebypassgraftprocedurebysewingoneendofasectionofveinoveratinyopeningmadeintheaorta,andtheotherendoveratinyopeningmadeinthecoronaryarteryjustbelowtheblockage.Ifyourdoctorusestheinternalmammaryarteryinsideyourchestasabypassgraft,thelowerendofthearterywillbecutfrominsidethechestandsewnoveranopeningmadeinthecoronaryarterybelowtheblockage. Youmayneedmorethanonebypassgraftdone,dependingonhowmanyblockagesyouhaveandwheretheyarelocated.Afterallthegraftshavebeencompleted,thedoctorwillcloselycheckthemasbloodrunsthroughthemtomakesuretheyareworking. Oncethebypassgraftshavebeenchecked,thedoctorwillletthebloodcirculatingthroughthebypassmachinebackintoyourheartandheorshewillremovethetubestothemachine.Yourheartmayrestartonitsown,oramildelectricshockmaybeusedtorestartit. Yourdoctormayputtemporarywiresforpacingintoyourheart.Thesewirescanbeattachedtoapacemakerandyourheartcanbepaced,ifneeded,duringtheinitialrecoveryperiod. Coronaryarterybypasssurgery--off-pumpprocedure Onceyourdoctorhasopenedthechest,heorshewillstabilizetheareaaroundthearterytobebypassedwithaspecialinstrument. Therestoftheheartwillcontinuetofunctionandpumpbloodthroughthebody. Theheart-lungbypassmachineandthepersonwhorunsitmaybekeptonstand-byjustincasetheprocedureneedtobecompletedonbypass. Thedoctorwilldothebypassgraftprocedurebysewingoneendofasectionofveinoveratinyopeningmadeintheaorta,andtheotherendoveratinyopeningmadeinthecoronaryarteryjustbelowtheblockage. Youmayhavemorethanonebypassgraftdone,dependingonhowmanyblockagesyouhaveandwheretheyarelocated. Beforethechestisclosed,thedoctorwillcloselyexaminethegraftstomakesuretheyareworking. Procedurecompletion,bothmethods Yourdoctorwillsewthesternumtogetherwithsmallwires(likethosesometimesusedtorepairabrokenbone). Heorshewillinserttubesintoyourchesttodrainbloodandotherfluidsfromaroundtheheart. Yourdoctorwillsewtheskinoverthesternumbacktogether. Yourdoctorwillputatubethroughyourmouthornoseintoyourstomachtodrainstomachfluids. Heorshewillthenapplyasterilebandageordressing. Whathappensaftercoronaryarterybypasssurgery? Inthehospital Afterthesurgery,youwillbetakentotheintensivecareunit(ICU)tobecloselymonitored.Machineswillconstantlydisplayyourelectrocardiogram(ECG)tracing,bloodpressure,otherpressurereadings,breathingrate,andyouroxygenlevel.Coronaryarterybypasssurgery(CABG)requiresanin-hospitalstayofatleastseveraldays. Youwillmostlikelyhaveatubeinyourthroattohelpwithbreathingthroughaventilator(breathingmachine)untilyouarestableenoughtobreatheonyourown.Asyoucontinuetowakeupfromtheanesthesiaandstarttobreatheonyourown,yourdoctorcanadjustthebreathingmachinetoallowyoutotakeovermoreofthebreathing.Whenyouareawakeenoughtobreathecompletelyonyourownandyouareabletocough,yourdoctorwillremovethebreathingtube. Afterthebreathingtubeisout,anursewillhelpyoucoughandtakedeepbreathseverycoupleofhours.Thiswillbeuncomfortableduetosoreness,butitisveryimportantthatyoudothistokeepmucusfromcollectinginyourlungsandpossiblycausingpneumonia.Yournursewillshowyouhowtohugapillowtightlyagainstyourchestwhilecoughingtohelpeasethediscomfort. ThesurgicalincisionmaybetenderorsoreforseveraldaysafteraCABGprocedure.Takeapainrelieverforsorenessasrecommendedbyyourdoctor.Aspirinorcertainotherpainmedicinesmayincreasethechanceofbleeding.Besuretotakeonlyrecommendedmedicines. YourdoctormaydeliverymedicinesthroughtheIVtohelpyourbloodpressureandyourheart,andtocontrolanyproblemswithbleeding.Asyourconditionstabilizes,heorshewillgraduallydecreaseandthenstopthesemedicines. Onceyourdoctorremovesthebreathingandstomachtubesandyouarestable,youmaystarttodrinkliquids.Youcangraduallyincludemoresolidfoodsasyoucanhandlethem. Whenyourdoctordeterminesthatyouareready,youwillbemovedfromtheICUtoapost-surgicalnursingunit.Yourrecoverywillcontinuethere.Youcangraduallyincreaseyouractivityasyougetoutofbedandwalkaroundforlongerperiods.Youcaneatsolidfoodsassoonasyoucantoleratethem. Amemberofyourcareteamwillarrangeforyoutogohomeandscheduleafollow-upvisitwithyourdoctor. Athome Onceyouarehome,itwillbeimportanttokeepthesurgicalareacleananddry.Yourdoctorwillgiveyouspecificbathinginstructions.Yourdoctorwillremovethesuturesorsurgicalstaplesduringafollow-upofficevisit,iftheywerenotremovedbeforeleavingthehospital. Donotdriveuntilyourdoctortellsyouit'sOK.Youmayhaveotheractivityrestrictions. Tellyourdoctorifyouhaveanyofthefollowing: Feverof100.4°F(38°C)orhigher,orchills Redness,swelling,orbleedingorotherdrainagefromanyoftheincisionsites Increaseinpainaroundanyoftheincisionsites Troublebreathing Rapidorirregularpulse Swellinginthelegs Numbnessinthearmsandlegs Persistentnauseaorvomiting Yourdoctormaygiveyouotherinstructionsaftertheprocedure,dependingonyoursituation. Nextsteps Beforeyouagreetothetestortheproceduremakesureyouknow: Thenameofthetestorprocedure Thereasonyouarehavingthetestorprocedure Whatresultstoexpectandwhattheymean Therisksandbenefitsofthetestorprocedure Whatthepossiblesideeffectsorcomplicationsare Whenandwhereyouaretohavethetestorprocedure Whowilldothetestorprocedureandwhatthatperson’squalificationsare Whatwouldhappenifyoudidnothavethetestorprocedure Anyalternativetestsorprocedurestothinkabout Whenandhowwillyougettheresults Whotocallafterthetestorprocedureifyouhavequestionsorproblems Howmuchwillyouhavetopayforthetestorprocedure Yourthoughtsmattertous.Joinourcommunitytoday. JohnsHopkinsMedicineVirtualAdvisors(VirtualAdvisors)isagroupofindividualswhosharetheirinsightsabouttheJohnsHopkinscareexperience.Onetotwotimespermonth,VirtualAdvisorsreceivealinktoshort,interactivesurveys.Allresponsesareconfidential. 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