Patient education: Coronary artery bypass graft surgery (The Basics)

What is coronary artery bypass graft surgery? — This is a type of surgery that is used to treat coronary heart disease. It is also known as "bypass surgery." Doctors also call this surgery "CABG" (pronounced "cabbage").

In people who have coronary heart disease, the arteries that supply blood to the heart get clogged with fatty deposits (figure 1). This can block the flow of blood to parts of the heart muscle.

During bypass surgery, a surgeon uses healthy pieces of blood vessels from other parts of the body (called "grafts") to re-route blood. They do this by attaching a graft to the aorta, which is the largest blood vessel in the body, and then to a place below a blockage. This creates a way around the blockage. Sometimes, the surgeon redirects an artery that is supposed to supply the chest muscle and attaches it to the heart. These types of grafts allow blood to get past blockages and to the heart muscle that was not getting enough blood (figure 2).

In many cases, a doctor can first try something called "stent placement" to treat coronary heart disease. This involves putting a thin plastic tube into the blocked artery, and using a tiny balloon to open the blockage. Then, the doctor leaves a tiny mesh tube called a "stent" inside the artery to hold it open. Bypass surgery is usually recommended for people with coronary heart disease who cannot have a stent.

How do I prepare for bypass surgery? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart.

●Blood tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during bypass surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Bypass surgery is done with general anesthesia. This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The surgeon will make a cut, or "incision," in the skin over your breastbone. Then, they will split the breastbone to get to your heart.

●The surgeon will cut out the piece or pieces of blood vessels that will be used as grafts. This could mean that the surgeon will need to make cuts in your arm, leg, belly, or within the chest itself.

●When the surgeon is ready to attach the grafts, they will need to stop your heart for a short time. While your heart is stopped, a machine called a "heart-lung machine" will take over the work of your heart. The machine will keep blood flowing throughout your body. After the surgeon sews on the grafts, they can restart your heart and take you off of the heart-lung machine.

●The surgeon will put the breastbone and skin back together. They will cover your incisions with clean bandages.

●The procedure usually takes 3 to 6 hours.

With 1 type of bypass surgery, called "minimally invasive bypass surgery" or "off-pump surgery," your surgery might be different from that described above. These approaches use a smaller chest incision and are done with the heart still beating. But they are not appropriate for all bypass situations and are not necessarily "better" than traditional surgery.

What happens after bypass surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You will spend 1 to 2 days in an intensive care unit ("ICU"). While in the ICU, you will be connected to machines that will monitor your heart, blood pressure, body temperature, and breathing. As you get stronger, you will need fewer and fewer of these machines. You might also have a number of tubes to help you breathe, urinate, and do other normal body functions. These will gradually be removed as you improve. When you are ready to leave the ICU, you will go to a regular hospital room for another couple of days.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

●The wound from the surgery will be sore for 2 to 3 days, but you will get pain medicines to help with this. You will also have some tubes draining fluid from your chest.

●During the few days after surgery, it is normal to have a poor appetite, be constipated, and have trouble sleeping. Give yourself time to get back to normal.

●If you had a graft taken from your leg, you might notice some swelling in that leg after surgery. Elevating the leg and wearing special socks called "compression stockings" can help to reduce swelling.

What are the risks of bypass surgery? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Major bleeding

●Heart attack

●Heart failure, which is when the heart cannot pump enough blood

●A heartbeat that is too fast or too slow

●Stroke

●Confusion and trouble thinking clearly

●Lung problems

●Wound infection (either in the chest or the body part where the grafts were taken)

●Kidney failure

●Depression

●Death

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

After bypass surgery, your doctor will make a treatment plan with you. The goals of this plan are to treat your coronary heart disease and help you feel better. This will include medicines and lifestyle changes and, possibly, other treatments.

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