Bypass surgery can improve the health of your heart
Coronary artery bypass grafting (CABG), also called heart bypass surgery, is the most common type of cardiovascular surgery. Used to treat coronary artery disease, the surgery involves using a healthy artery or vein to bypass a blocked artery and restore blood flow to the heart muscle.
Traditional CABG is an open-heart surgery in which your surgeon makes a 6-8-inch incision on the front of your chest. However, newer variations of the procedure use smaller incisions, potentially leading to faster recovery and less post-surgical pain.
Treating coronary artery disease with CABG
Coronary artery disease develops when plaque collects in your coronary arteries, blocking oxygen-rich blood from reaching your heart. Treating coronary artery disease helps prevent other conditions, such as heart failure, heart attacks and arrhythmia (irregular heartbeats).
Your cardiac surgeon may recommend CABG if you have:
- Advanced heart failure due to coronary artery disease
- Coronary artery disease with chest pain that has not responded well to other treatments.
- Had a heart attack that cannot be treated with percutaneous coronary intervention
- More than one blocked artery
Options for CABG surgery
During CABG surgery, your surgeon connects, or grafts, a healthy artery or vein from your body to a blocked coronary artery, allowing blood to bypass the blocked area of the artery and flow to the heart muscle.
You may hear CABG surgery referred to by a number:
- Double bypass surgery redirects blood around two blocked arteries.
- Triple bypass surgery redirects blood around three blocked arteries.
- Quadruple bypass surgery redirects blood around four blocked arteries.
In traditional CABG, your surgeon splits your breastbone to access your heart. You receive medications to stop your heart and lungs and are connected to a heart-lung bypass machine, which performs the job of your heart and lungs as your surgeon operates. At the end of the surgery, your heart is restarted, and you are separated from the machine.
Depending on the extent of your coronary artery disease, existing health conditions and other factors, you may be eligible for an alternative to open-heart surgery that doesn’t require your breastbone to be cut.
These CABG variations can be performed alone, or your heart surgeon may determine that you would benefit from combining one of the following procedures with stenting (when a small mesh coil is placed in your artery to help it stay open) in what’s referred to as a hybrid surgery.
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Off-pump coronary artery bypass (OPCAB)
Off-pump coronary artery bypass (OPCAB)
This technique doesn’t require the heart to be stopped and avoids the heart-lung bypass machine. Your heart continues to beat during surgery, but your surgeon immobilizes a small portion of the heart muscle near the blocked artery during the procedure.
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Minimally invasive direct coronary artery bypass (MIDCAB)
Minimally invasive direct coronary artery bypass (MIDCAB)
This CABG procedure is often used to repair one of the arteries on the left side of the heart or in combination with other procedures to treat multiple blocked arteries. Your surgeon makes a small incision under the left side of your chest, takes a nearby healthy artery and attaches it to your blocked artery, while your heart continues beating.
In certain circumstances, surgeons perform robotic-assisted MIDCAB, in which small, delicate tools allow them to access the artery with less impact on surrounding bones and tissues.
Off-pump coronary artery bypass (OPCAB)
This technique doesn’t require the heart to be stopped and avoids the heart-lung bypass machine. Your heart continues to beat during surgery, but your surgeon immobilizes a small portion of the heart muscle near the blocked artery during the procedure.
Minimally invasive direct coronary artery bypass (MIDCAB)
This CABG procedure is often used to repair one of the arteries on the left side of the heart or in combination with other procedures to treat multiple blocked arteries. Your surgeon makes a small incision under the left side of your chest, takes a nearby healthy artery and attaches it to your blocked artery, while your heart continues beating.
In certain circumstances, surgeons perform robotic-assisted MIDCAB, in which small, delicate tools allow them to access the artery with less impact on surrounding bones and tissues.
Benefits of CABG surgery
All forms of CABG improve blood flow to your heart. This means that your heart disease symptoms improve and the risk of complications from other conditions decreases.
If you are a candidate for minimally invasive types of CABG, there are many benefits compared with open-heart surgery. These include:
- Faster recovery and return to normal activities
- Less risk of infection
- Reduced pain and scarring
- A shorter hospital stay
What to expect from a CABG procedure
You can schedule CABG in advance, but some people have emergency CABG to treat a heart attack.
If your surgery is planned, your doctor will tell you how to prepare. You may need to:
- Attend appointments for blood and imaging tests in the weeks of your surgery.
- Adjust which medicines or supplements you take, particularly if you have diabetes or another chronic condition.
- Stop eating and drinking a few hours before surgery.
Confirm with your care team when you should arrive to complete the paperwork and any presurgical tests. You’ll also want to have someone available to drive you to and from surgery.
Traditional open-heart CABG can take anywhere from three to six hours, depending on how many arteries will be bypassed. Minimally invasive surgery options may not take as much time.
Your surgery team will work with you and your family to ensure you have the information you need to feel confident in your decision to have CAGB. During your procedure, they’ll keep your family updated on how you’re doing.
Recovering from CABG
After CABG, you will stay in the hospital and may spend the first evening in the intensive care unit (ICU). Your care team might:
- Connect you to an electrocardiograph machine to monitor your heart rate.
- Give you medicine to control your pain and heart rhythm and prevent blood clots.
- Provide oxygen therapy
- Implant a temporary pacemaker
Once you are home, it will take six to 12 weeks to completely recover, depending on the type of surgery you had. Be sure to follow your doctor’s instructions on how to take care of yourself after surgery.
Your recovery plan will include cardiac rehabilitation. Cardiac rehab connects you with a team of professionals who will teach you diet, exercise and stress management strategies to strengthen your heart after surgery and help you protect it for the long term.