Coronary Artery Bypass Graft Surgery (CABG)

Coronary artery bypass grafting (CABG) is a type of surgery called revascularization, used to improve blood flow to the heart in people with severe coronary artery disease (CAD). CABG is one treatment for CAD. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (goes around) the blocked portion of the coronary artery. This new passage routes oxygen-rich blood around the blockage to the heart muscle. As many as four major blocked coronary arteries can be bypassed during one surgery.

• Coronary artery bypass grafting (CABG) is a type of surgery used to improve blood flow to the heart in people with severe coronary artery disease (CAD).
• During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to a blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked portion of the coronary artery. This improves the flow of blood and oxygen to your heart muscle.
• CABG is one type of treatment for CAD. Not everyone with CAD needs CABG. In people who are candidates for the surgery, the results are usually excellent, with 85 percent of people having significantly reduced symptoms, less risk for future heart attacks, and a decreased chance of dying within 10 years following the surgery.
• Your doctor will determine if you're a candidate for CABG based on a number of factors, including the presence and severity of CAD. Often nonsurgical treatments, such as medicines and angioplasty, will be tried first.
• Although the surgery is usually done on an elective (scheduled) basis, it may need to be performed in an emergency, such as pending or during a heart attack.
• Although complications are rare, risks of CABG include infection at the incision site, bleeding, reactions to the anesthesia, fever and pain, stroke, heart attack, or even death.
• Recovery may take 6 to 12 weeks or more. Most people can get back to their normal activities about 6 weeks after the surgery.
• Care after surgery may include follow-up visits with doctors, lifestyle changes to prevent further progression of CAD, and taking medicines as prescribed.

Types of Coronary Artery Bypass Grafting:

Traditional Coronary Artery Bypass Grafting
This is the most common type of coronary artery bypass grafting (CABG). It's 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, and a heart-lung machine is used to keep blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart. After surgery, the heart is restarted using mild electric shocks.

Off-Pump Coronary Artery Bypass Grafting
This type of CABG is similar to traditional CABG in that the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung machine isn't used. Off-pump CABG is sometimes called beating heart bypass grafting. This type of surgery may reduce complications that can occur when a heart-lung machine is used, and it may speed up recovery time after surgery.
Minimally Invasive Direct Coronary Artery Bypass Grafting
This surgery is similar to off-pump, but instead of a large incision to open the chest bone, several small incisions are made on the left side of the chest between the ribs. This type of surgery is used mainly for bypassing the vessels in front of the heart. It's a fairly new procedure, which is performed less often than the other types. This type of surgery is not for everybody, especially if more than one or two coronary arteries need to be bypassed.

Written by Dr. Mark Steiner, Cardiologist in Orlando