- [Narrator] A coronary artery bypass graft, or CABG,
is performed to improve circulation to the heart muscle
in people with severe coronary artery disease.
In this procedure, 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 the blocked portion
of the coronary artery,
carrying oxygen-rich blood to the heart muscle.
One or more coronary arteries may be bypassed
during a single operation.
Before the surgery, an intravenous line will be started,
and you may be given a medication to help you relax.
CABG procedures are done under general anesthesia,
which will put you to sleep
for the duration of the operation.
A breathing tube will be inserted through your mouth
and into your throat to help you breathe.
A catheter will be placed
in your bladder to drain your urine.
Coronary artery bypass surgery
generally takes three to six hours.
During a conventional bypass surgery,
your surgeon begins by making an incision
in the skin over your breastbone or sternum.
He or she will then cut the sternum and move your ribcage
in order to get to your heart.
Throughout the procedure,
your circulatory system will be connected
to a cardiopulmonary bypass pump or heart-lung machine.
This machine temporarily performs the functions
of your heart and lungs during the surgery,
allowing your heart to be stopped
while the surgeon sews the grafts into place.
One of two blood vessels is typically used for the grafts:
the internal thoracic artery in the chest
or the saphenous vein in the leg.
For the internal thoracic artery graft,
your surgeon will leave the upper end attached
to the subclavian artery and divert the lower end
from your chest wall to your coronary artery
just beyond the blockage.
Your surgeon will then sow the graft into place.
For the saphenous vein graft,
your surgeon will suture one end to the aorta
and the other end to the narrowed artery
just beyond the blockage.
With the graft securely in place,
your surgeon will use use electrical signals
to restore the heartbeat
and attach a temporary pacemaker to the heart.
Once your heart is again beating normally,
the heart-lung machine will be disconnected.
Your surgeon will wire the breastbone back together
and suture the skin incision closed.
A temporary drainage tube will be placed
through the skin beneath the incision.
Two other types of CABG procedures
have recently been developed:
off-pump and minimally invasive bypass surgery.
Off-pump CABG is also called beating heart bypass grafting
because the heart isn't stopped
and a heart-lung machine isn't used.
Instead, a mechanical device is used to steady the part
of the heart where grafting is being done.
Surgeons perform minimally invasive bypass procedures
using specially designed instruments
inserted through small incisions or ports in the chest.
These procedures sometimes require a heart-lung machine.
After surgery, you will be taken to the intensive care unit.
The activity of your heart will be carefully monitored.
If necessary, the pacing wires will be used
to temporarily control your heart rate.
The chest tube will remain in place
to drain excess blood and air from the chest cavity.
Once you can breathe on your own,
your breathing tube will be removed
and replaced with an oxygen mask.
The bladder catheter will remain in place.
As you recover over the next three to four days,
all of these devices will be gradually removed.