How it's performed - - - Coronary artery bypass graft - NHS

A coronary artery bypass graft is often described as on-pump surgery because it involves using a heart-lung bypass machine to pump blood and oxygen around your ... Skiptomaincontent Home HealthAtoZ Coronaryarterybypassgraft Backto Coronaryarterybypassgraft Howit'sperformed - Coronaryarterybypassgraft Contents Overview Gettingready Howit'sperformed Recovery Risks Livingwith Alternatives Beforeyourcoronaryarterybypassgraft(CABG),yoursurgeonwilldiscusseveryaspectoftheprocedurewithyou.Thiswillgiveyoutheopportunitytoaskanyquestionstomakesureyouunderstandtheprocedurefully.Astheprocedureiscarriedoutusingageneralanaesthetic(whereyou'reasleepduringtheoperation),youmustn'teatordrinkforatleast6hoursbeforetheoperation.Youmaybeabletodrinkclearfluidslikewater,squash,blackteaorblackcoffeeuntilabout2hoursbeforetheoperation.Yourcareteamwillbeabletoadviseyoufurtheraboutthis. Duringtheoperation Coronaryarterybypassgraftsurgeryusuallylasts3to6hours.Butitmaytakelongerdependingonhowmanybloodvesselsarebeingattached.Bloodvesselscanbetakenfromyourleg(saphenousvein),insideyourchest(internalmammaryartery),oryourarm(radialartery).Otherbloodvesselsintheseareasareabletocompensateforthelossofthesebloodvesselsaftertheoperation. Coronaryarterybypassgraftsites Credit: Thenumberofbloodvesselsusedwilldependonhowsevereyourcoronaryheartdiseaseisandhowmanyofthecoronarybloodvesselshavebecomenarrowed.Ifyouneed2,3or4grafts,youmayhearyouroperationreferredtoasadouble,tripleorquadruplebypass.Oneofthegraftvesselsisusuallytakenfromyourchest(internalmammaryartery).Surgeonsprefertousethisvesselbecauseitdoesn'tnarrowovertime,unlikethebloodvesselstakenfromyourlegorarm.Onceallthegraftvesselshavebeenremoved,yoursurgeonwillmakeacutdownthemiddleofyourchestsotheycandivideyourbreastbone(sternum)andaccessyourheart.Duringtheprocedure,yourbloodmaybereroutedtoaheart-lungbypassmachine.Thistakesoverfromyourheartandlungs,pumpingbloodandoxygenthroughyourbody.Yourheartwillbetemporarilystoppedusingmedicinewhileyoursurgeonattachesthenewgraftstodivertthebloodsupplyaroundtheblockedartery.Afterthegraftshavebeenattached,yourheartwillbestartedagainusingcontrolledelectricalshocks.Yourbreastbonewillthenbefixedtogetherusingpermanentmetalwiresandtheskinonyourchestsewnupusingdissolvablestitches. Newersurgicaltechniques Off-pumpcoronaryarterybypasssurgery(OPCAB)Moresurgeonsarenowperformingoff-pumpcoronaryarterybypasssurgery(OPCAB),whichisavariationoftheconventionalprocedure.A coronaryarterybypassgraftisoftendescribedason-pumpsurgerybecauseitinvolvesusingaheart-lungbypassmachinetopumpbloodandoxygenaroundyourbodyduringtheprocedure,whiletheheartistemporarilystopped.DuringOPCAB,yourheartisstillbeatingwhilethenewbloodvesselgraftsareattachedanda heart-lungbypassmachineisn'tused.AccordingtotheNationalInstituteforHealthandCareExcellence(NICE),theprocedureworksaswellasacoronaryarterybypassusingapump.ThebenefitsofOPCABare:itoftentakeslesstimetoperformthantheconventionalprocedureitcanreduceyourchanceofbleedingduringthesurgeryyoumaybelesslikelytodevelopcertainseriouscomplicationsaftersurgery,suchasastrokeyourstayinhospitalwillusuallybeshorterThemaindisadvantageisthatOPCABismoretechnicallydemandingbecause thegraftedvesselshavetobedelicatelyconnectedwhiletheheartisbeating.Thismeanstheproceduremaybetoodifficulttoperformifalargenumberofbloodvesselsneedtobegrafted.Forthesamereason,ifemergencysurgeryisrequired,theremaynotbeaccesstoasurgeonwiththetrainingrequiredtoperformanOPCAB.ReadtheNICEguidelinesabout off-pumpcoronaryarterybypassgraftingEndoscopicsaphenousveinharvesting(ESVH)Endoscopicsaphenousveinharvesting(ESVH)isalessinvasivemethodofremovingtheveinsfromyourlegs.Ratherthanmakingalargecutinyourleg,thesurgeonmakesanumberofsmallonesnearyourknee.Thisisknownaskeyholesurgery.Aspecialdevicecalledanendoscopewillbeinsertedintothecut.Anendoscopeisathin,longflexibletubewithalightsourceandvideocameraatoneend,sothatimagesoftheinsideofyourbodycanberelayedtoanexternaltelevisionmonitor.Theendoscopeallowsthesurgeontolocateyoursaphenousvein.Surgicalinstrumentscanalsobepassedalongtheendoscopetoremoveasectionofthevein.Nearbytissueisthensterilisedwithantibioticfluidandthecutishealed.Themainadvantagesofthistechniquearethatthere'slikelytobea:shorterhospitalstaylowerriskoflegwoundinfectionsquickerrecoveryfromCABGReadtheNICEguidelinesaboutendoscopicsaphenousveinharvestforcoronaryarterybypassgraftingTotallyendoscopicroboticallyassistedcoronaryarterybypass(TECAB)graftingTotallyendoscopicroboticallyassistedcoronaryarterybypass(TECAB)graftingisanewertechniqueinheartsurgery.It'saminimallyinvasive(keyhole)methodofperformingaheartbypass.DuringaTECABgraftingprocedure,thesurgeondeflatesyourlungsandmakesanumberofsmallcutsbetweenyourribs.Roboticarms,controlledbythesurgeon,areusedtocarryoutthesurgery.Anendoscopeisattachedtotheroboticarmssothesurgeoncanseeinsideyourbodyandviewtheresultsofthesurgeryonascreen.TECABgraftingcanbecarriedoutusingaheart-lungbypassmachine,oritcanbedoneoff-pump.Therearelowerratesofwoundinfectionwiththistypeofsurgery,plus minimalscarringandafasterrecoverytime.Butasthisisanewertechniquethat'sonlybeencarriedoutonasmallnumberofpeople,it'sdifficulttoassesshoweffectiveandsafeitisintheshortandlongterm,andhowtheoutcomescomparewithothertypesofsurgery.Ifyou'reconsideringhavingTECAB,it'simportantyouunderstandtherearestilluncertaintiesabouthowsafetheprocedureisandhowwellitworks.ReadtheNICEguidelinesabouttotallyendoscopicroboticallyassistedcoronaryarterybypassgrafting Video:yourguidetocoronarybypasssurgery Watchthisvideotofindoutwhattoexpectfrombypasssurgery. Medialastreviewed:1April2021 Mediareviewdue:1April2024 Pagelastreviewed:23November2021 Nextreviewdue:23November2024 Previous : Gettingready Next : Recovery