Your doctor has recommended a coronary artery bypass graft procedure, also called CABG .
This video will review information about the off pump CABG procedure.
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.
Two 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 cause chest pain, heart attacks, and sometimes death.
During a CABG 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 a piece of 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 arteries are 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.
Arteries or veins are moved or removed from one body part to another, only when there
will still be enough blood supplied from other nearby vessels.
There are two methods, for doing coronary artery bypass graft surgery, called on pump
and off pump.
To help understand the off pump method, let’s discuss what it means to be on pump.
During the several hours it takes to do an on pump CABG surgery, the heart is stopped
for about 30 - 90 minutes.
This keeps the heart muscle still while the surgeon sews 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.
During an off pump procedure, the heart is not stopped, instead,
special tools steady areas of the heart while the surgeon stitches grafts into place.
The pads and arms of the tools brace the moving heart muscle to hold small sections still.
A heart-lung machine is kept on standby during off pump surgery.
The pump can be necessary to help manage some situations during surgery.
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.
------------------------------------------------------------------ Procedure
Now let’s look closer at the “off 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 intended grafts are stitched into place as needed, to complete the necessary bypasses.
Blood flow through the grafts is checked.
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.