Coronary Artery Bypass Graft (CABG)
MEDICAL ANIMATION TRANSCRIPT: If you or someone you know has recently had a coronary artery bypass graft, or CABG, this video will help you understand the steps of the procedure and how it restores blood flow to your heart. A coronary artery bypass graft, or CABG, is performed to improve circulation to the heart muscle. 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 may be connected to a cardiopulmonary bypass pump, or heart-lung machine. This machine may temporarily perform the functions of your heart and lungs during the surgery, allowing your heart to be stopped if desired while the surgeon sews the grafts into place. Different blood vessels may typically be used for the grafts: the internal thoracic arteries in the chest, also known as internal mammary arteries, or the saphenous veins in the legs. 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 sew 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 grafts securely in place, your surgeon may use electrical signals to restore the heartbeat and attach a temporary pacemaker to the heart. Once your heart is again beating normally, if the surgeon used the heart-lung machine, it would 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. When the surgeon chooses to do the surgery without using the heart-lung machine, the heart continues to beat. This may be referred to as off-pump bypass surgery or minimally invasive surgery. 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. After surgery you will be taken to the intensive care unit. The activity of your heart will be carefully monitored. If necessary, 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 from surgery over the next three to four days, all of these devices will be gradually removed. Upon discharge from your procedure, be sure to contact your doctor if you have any questions or experience any side effects from the medications you are taking.