Coronary Artery Bypass Graft (CABG) Surgery

How can this procedure help?

Like any other muscle in your body, your heart requires blood to work. It gets the blood it needs from your coronary arteries.

A coronary artery bypass graft, or bypass surgery, is for patients who have blockages or severe narrowing in the arteries that supply the heart. A blood vessel is taken from another part of your body and is used to go around—or bypass—the blocked artery. This restores blood flow to your heart.

Coronary artery bypass graft surgery (CABG, pronounced "cabbage") is the most commonly performed type of heart surgery.

Coronary bypass surgery doesn't cure the underlying heart disease that caused blockages in the first place. This disease is referred to as atherosclerosis or coronary artery disease.

Even if you have coronary bypass surgery, lifestyle changes are still a necessary part of treatment after surgery. Medications are routine after coronary bypass surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart function as well as possible

Who should have it?

Most patients with coronary artery disease do not require surgery. Bypass surgery is usually reserved for patients with severe blockages in two or more arteries. Patients with narrowings in only one coronary artery are usually treated with balloon angioplasty or stents.

If you have other conditions, such as diabetes, bypass surgery may be the best treatment option. You may require one, two, three, or more bypass grafts depending on how many arteries are blocked.

Your doctor will recommend bypass surgery based on your symptoms and the results of diagnostic tests including cardiac catheterization.

Coronary bypass surgery is an option if:

You have severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes angioplasty and stenting will help, but for some types of blockages, coronary bypass surgery may be the best option.
You have more than one diseased coronary artery and the heart's main pump — the left ventricle — is not functioning well.
Your left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
You have an artery blockage for which angioplasty isn't appropriate, you've had a previous angioplasty or stent placement that hasn't been successful, or you've had stent placement but the artery has narrowed again (restenosis).
Coronary bypass surgery may also be performed in emergency situations, such as a heart attack, if your doctor sees that you're not responding to other treatments.

The Most Common Surgery at the Shipley Cardiothoracic Center

Coronary artery disease is the most common type of heart disease in the United States. “It’s a blockage for the arteries in the heart, which compromises blood flow to the heart. It can cause heart attacks, sudden death, arrhythmia, or heart failure.”

Lee Health Cardiothoracic Surgeon Dr. David Cervantes can treat it with a coronary artery bypass surgery. “Coronary artery bypass surgery is the most common surgery that we do here at the Shipley center. Traditionally we’ve done about 1500 cases a year.”

The procedure connects a blood vessel from another part of your body to restore blood flow to the heart. “Any blockage that’s there, we leave there and we bypass the blood flow around the blockage. So if there’s blood flow coming from the native circulation to the blockage, and then blood flow coming from the bypass graft to the blockage. If that narrowing completely closes off, there’s still blood flow to the heart,” said Dr. Cervantes.

In the past, it would require an open surgery, but now depending on the prognosis, there are more minimally invasive approaches that can utilize things like robots. “It’s a smaller incision, more aesthetically pleasing, it’s about 3 inches as opposed to opening up the whole chest,” said Dr. Cervantes. The Shipley Cardiothoracic Center is one of the few places that can do the procedure both on and off pump. You can learn more by searching for cardiology on leehealth.org.

How it's done

A coronary artery bypass graft is major surgery. It generally takes between three and six hours and requires general anesthesia. On average, surgeons repair two to four coronary arteries. The number of bypasses required depends on the location and severity of blockages in your heart.

Most coronary bypass surgeries are done through a lincision in the chest while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery).

The surgeon cuts down the center of the chest, along the breastbone. The surgeon then spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall (the internal mammary artery) or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.

Removing these healthy vessels is harmless since there are many other arteries and veins that can take over for them.

Other surgical techniques

There are other newer surgical techniques your surgeon may use if you're having coronary bypass surgery:

Off-pump or beating-heart surgery. This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize the area of the heart the surgeon is working on. This type of surgery is challenging because the heart is still moving. Because of this, it's not an option for everyone.

Minimally-invasive bypass surgery. In this procedure, a surgeon performs coronary bypass through a smaller incision in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area.Variations of minimally invasive surgery may be called port-access or keyhole surgery.

The benefits of minimally invasive surgery include a smaller incision (three to four inches instead of the six to eight-inch incision with traditional surgery) and smaller scars. Other possible benefits may include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital (three to
five days) and decreased recovery time.

Assessing risks

Because coronary bypass surgery is open-heart surgery, you may have complications during or following your procedure. The most common complications of coronary bypass surgery are:

Bleeding
Heart rhythm problems

Less common complications are:

Heart attack, if a blood clot breaks loose soon after surgery
Infection of the chest wound
Kidney failure
Memory loss or troubles with thinking clearly, which often go away within six to 12 months
Stroke
Need for repeat surgery
Your risk of developing these complications depends on your health before the surgery. Talk to your doctor to get a better idea of the likelihood of experiencing these risks.

da Vinci Artery Bypass Approach

The daVinci surgery for coronary artery disease is performed without the need for a heart-lung machine. It uses a minimally invasive approach with only small incisions between the ribs. This also avoids the need for a sternotomy.