your doctor has recommended an on pump coronary artery bypass graft procedure
also called cabbage before we talk about this procedure let's review some
information about your body and your medical condition the heart is in the
middle of the chest under the ribs it is protected by the sternum also called the
breastbone the heart is a muscle that pumps blood to all parts of the body
through blood vessels called arteries veins are vessels that carry blood back
to the heart the aorta is the largest artery in the body to vessels that
branch off from the aorta are the right and left coronary arteries they supply
the heart muscle with the oxygen-rich blood that is necessary to keep it
working coronary arteries can become blocked by
plaque fat and calcium deposits that build up over years the result is
coronary artery disease also called heart disease severe blockages caused
chest pain heart attacks and sometimes death during a cabbage procedure new
pathways called bypasses are put in place to carry blood past and around
blockages healthier blood vessels from other sites in the body are used to
create each bypass a section of leg vein or piece of an artery from an arm may be
removed and used to create the bypass these transplanted vessels are called
grafts the right and left internal thoracic artery ZAR also commonly used
as grafts these arteries naturally pass close to the heart when creating a
bypass with one of these vessels often only one end of the vessel is moved to
the coronary artery past the blockage
when arteries or veins are moved or removed from one body part to another
this is possible only when there will still be enough blood supplied from
other nearby vessels there are different surgical techniques for coronary artery
bypass on pump and off pump during the several hours it takes to do an on pump
cabbage surgery the heart is stopped for about 30 to 90 minutes this keeps the
heart muscle still while the surgeon says vessels into place to create the
necessary bypasses while the heart is stopped a special pump called a
heart-lung machine keeps blood oxygenated and flowing through the body
blood is carried from the body through tubing to a machine where it is mixed
with oxygen then pumped back to the body after all of the grafts have been placed
the heart is restarted and the pump is disconnected in some situations a less
invasive cabbage procedure may be offered this can include an off pump
technique where the heart is not stopped in some cases smaller incisions may be
used during these procedures converting to an on pump procedure is still
possible individual surgical treatment decisions depend on many factors
including the experience of the surgeon how many arteries are involved the
location of the blockages and their severity now let's look closer at the on
pump coronary artery bypass surgery you will be given medication to be pain-free
and asleep during this procedure the necessary grafts are created by
surgically removing sections of blood vessel from the leg and/or arm as needed
these incisions are sutured and bandaged to reach the heart the surgeon makes an
incision down the center of the chest the sternum bone is carefully cut a
retractor is then placed to hold the edges apart creating a working area the
protective sac that surrounds the heart called the pericardium is opened the
surgeon inspects the heart and identifies the vessels to be bypassed
the heart-lung machine is prepared by connecting tubing to the heart and
vessels as appropriate for each situation when the pump is primed and
the grafts are ready for placement the heart-lung machine is turned on the
heart is cooled and the aorta is able to be clamped blood flow through the heart
and motion of the heart stops the surgeon then stitches the intended
grafts into place depending on the number of blockages connections to one
or both internal thoracic artery x' may be used to complete the necessary
bypasses the clamp is removed from the aorta once the heart is beating normally
the heart-lung machine is disconnected and the tubing sites are repaired the
pericardium is positioned back over the heart flexible drains are placed and the
sternum is closed and supported with wire or small plates and screws the
remaining tissue layers are brought together the skin is closed and a
dressing is placed