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Coronary Artery Bypass Grafting

(CABG)

by Editorial Staff and Contributors

Home | Health Information Center | Procedure & Surgery Fact Sheets | Article

Definition

Reasons for Procedure

Possible Complications

What to Expect

Call Your Doctor

En Español

Click here to view an animated version of this procedure.

Definition

A coronary artery bypass graft (CABG) is an open-heart surgery. A part of a blood vessel from another part of the body is attached to a blocked artery of the heart. The attached blood vessel improves blood flow to an area of the heart.

Coronary Artery Bypass Surgery

Reasons for Procedure

CABG can improve blood flow in arteries of the heart. Problems with blood flow are most often caused by atherosclerosis. This is a build up of fatty substance on the wall of the blood vessel. It builds overtime and decreases the amount of blood that can flow through to the heart muscle. Slowed blood flow can cause chest pain called angina, damage to heart, or a heart attack.

CABG may be done if there are severe blockages in arteries of the heart. It may be done as part of a treatment plan if other treatment has not worked. CABG may also be done as part of emergency care during or after a heart attack.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will talk about possible problems, like:

Post-surgical infection
Blood clots
High blood pressure or low blood pressure
Bleeding
Stroke
Damage to other organs such as the kidneys
Irregular heart rate
Death

Some factors that may increase the risk of complications include:

Lung disease, especially chronic obstructive pulmonary disease (COPD) or emphysema
Prior heart attack or bypass surgery
Advanced age
Severe condition (the need to have emergency surgery)
Obesity
Diabetes
Smoking
High blood pressure
Thyroid disease
Depression

What to Expect

Prior to Procedure

Earlier tests will be reviewed. They help guide treatment.

The care team will ask about regular medicine. Some medicine may need to be stopped for one week before surgery, unless it is an emergency. Before surgery:

Do not eat or drink anything after midnight.
Arrange for a ride to and from the hospital.
Arrange for help at home after the procedure.

Anesthesia

General anesthesia will be given. You will be asleep and pain will be blocked.

Description of Procedure

There are 3 different types of CABG:

Traditional—A cut will be made through the skin on the chest. The breastbone will be split with a tool to open the chest. Medicines will be given to stop the heart so the work can be done. A heart-lung machine will act as the heart and lungs during the surgery.
Off-pump—A cut will be made through the skin on the chest. The breastbone will be split with a tool to open the chest. The heart will be beating during surgery. The heart-lung machine is not used.
Minimally invasive—Smaller cuts are made around the chest. It can lead to a faster recovery but it is not suited for everyone. It is often limited to people with only 1 or 2 clogged arteries. It is a less common option.

A piece of blood vessel will be taken from the chest wall or the leg. One end of the new vessel will be attached just above the blockage in the heart. The other end will be attached just below the blockage. In traditional CABG, the heart will then be allowed to restart. Electrical shocks may be needed to make sure the heart is beating as it should. The heart-lung machine will be disconnected.

Temporary tubes may be placed in the chest. It will help to drain any fluid from the chest. The breastbone will be wired together if needed. The chest will be closed with stitches or staples.

Immediately After Procedure

Recovery will take place in the intensive care unit. The heart and lungs will be closely monitored. Medicine for pain will be given through an IV. Oxygen may also be given. Pacing wires may also be attached. They can help to correct abnormal rhythms from the heart.

How Long Will It Take?

4 to 5 hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. There will be pain for a few weeks if the chest was open. Medicine and support tips will help manage pain during recovery.

Average Hospital Stay

5 to 7 days

Post-procedure Care

At the Hospital

Dressings will be removed in 1 to 2 days. Pacing wires and chest tubes will be removed after a few days. Movement and other steps will be encouraged to help prevent complications. Step may include:

At Home

It will be several weeks before you can return to all normal activity. A cardiac rehabilitation program may help to make changes to further improve heart health.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. Call your doctor for:

Pain that you cannot control with the medication you were given
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
Persistent nausea or vomiting
Cough, shortness of breath, or chest pain
Pain, burning, urgency, frequency of urination, or persistent blood in the urine
Gaining more than 4 pounds within 1-2 days
Pain or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/

References:

Coronary artery bypass graft (CABG) surgery. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Accessed April 13, 2021.

Diodato M, Chedrawy EG. Coronary artery bypass graft surgery: the past, present, and future of myocardial revascularisation. Surg Res Pract. 2014;2014:726158.

Explore coronary artery bypass grafting. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cabg. Accessed April 13, 2021.

Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Dec 6;124(23):e652

Last reviewed November 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 12/20/2020

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