Heart Bypass Surgery (CABG)

Summary

A Coronary Artery Bypass Graft (CABG) is a surgical procedure to enhance heart circulation in patients with severe coronary artery disease. It involves grafting a healthy artery or vein from another body part to bypass the blocked coronary artery, ensuring oxygen-rich blood reaches the heart muscle. The surgery, performed under general anesthesia, may use the internal thoracic artery or saphenous vein for grafting and can be conducted on-pump or off-pump. Post-surgery, patients are closely monitored in ICU, with temporary devices in place for recovery.

Takeaways

• 🩺 A coronary artery bypass graft (CABG) is a surgical procedure to improve blood circulation to the heart muscle in patients with severe coronary artery disease.
• 🔁 The procedure involves grafting a healthy blood vessel from another part of the body to bypass the blocked coronary artery.
• 💉 Before surgery, patients receive an intravenous line, relaxation medication, and are placed under general anesthesia.
• 🌐 The surgery may involve bypassing one or more coronary arteries in a single operation.
• ⏱ CABG surgery typically takes three to six hours to complete.
• 🔪 The surgeon makes an incision in the chest and uses a heart-lung machine to temporarily take over the functions of the heart and lungs.
• 🩸 Two types of blood vessels are commonly used for grafts: the internal thoracic artery or the saphenous vein.
• 🛠️ Off-pump and minimally invasive CABG procedures have been developed as alternatives to conventional bypass surgery.
• 🛑 In off-pump CABG, the heart is not stopped, and a heart-lung machine is not used; instead, a mechanical device stabilizes the heart.
• 🏥 After surgery, patients are closely monitored in the ICU, with devices in place to support heart function and drain excess fluids.

Q & A

What is a coronary artery bypass graft (CABG)?

A coronary artery bypass graft (CABG) is a surgical procedure performed to improve circulation to the heart muscle in people with severe coronary artery disease by using a healthy artery or vein from another part of the body to bypass the blocked coronary artery.

Why is CABG performed?

CABG is performed to improve blood flow and oxygen supply to the heart muscle in patients with severe coronary artery disease, where the coronary arteries are blocked or narrowed.

What happens during a CABG procedure?

During a CABG, a healthy blood vessel from another part of the body is grafted to the blocked coronary artery, bypassing the blockage and allowing oxygen-rich blood to reach the heart muscle.

What types of vessels are typically used for grafts in a CABG?

Typically, the internal thoracic artery in the chest or the saphenous vein in the leg are used for grafts in a CABG.

How does the heart-lung machine function during a CABG?

The heart-lung machine temporarily takes over the functions of the heart and lungs during the surgery, allowing the heart to be stopped while the surgeon sews the grafts into place.

What is off-pump CABG, and how does it differ from conventional CABG?

Off-pump CABG, also known as beating heart bypass grafting, is a procedure where the heart is not stopped and a heart-lung machine is not used. Instead, a mechanical device is used to steady the part of the heart where grafting is being done.

What is minimally invasive bypass surgery, and how does it compare to traditional CABG?

Minimally invasive bypass surgery is a type of CABG performed through small incisions or ports in the chest using specially designed instruments, which can sometimes require a heart-lung machine and is less invasive than traditional open-chest CABG.

What preparations are made before a CABG surgery?

Before CABG surgery, an intravenous line is started, patients may be given medication to help them relax, and general anesthesia is administered to put the patient to sleep for the duration of the operation.

What is the typical duration of a CABG surgery?

Coronary artery bypass surgery generally takes three to six hours to complete.

What happens after a CABG surgery?

After surgery, patients are taken to the intensive care unit where their heart activity is monitored. Devices such as a temporary pacemaker, chest tube, and bladder catheter are used during the initial recovery period.

How long does it typically take for a patient to recover after a CABG?

Patients typically spend three to four days recovering in the hospital, during which time various devices are gradually removed as the patient's condition improves.

Outlines

00:00

🩺 Coronary Artery Bypass Graft (CABG) Surgery Overview

The paragraph introduces Coronary Artery Bypass Graft (CABG) surgery, a procedure performed to enhance blood circulation to the heart muscle in individuals with severe coronary artery disease. It explains that a healthy blood vessel from another part of the body is used to bypass the blocked coronary artery, allowing oxygen-rich blood to reach the heart muscle. The paragraph also outlines the pre-surgery preparations, including the establishment of an intravenous line and the administration of medication to help the patient relax. It details the surgery process under general anesthesia, the use of a breathing tube, and a catheter for urine drainage. The surgery duration is noted to be three to six hours, with a description of the incision and the use of a cardiopulmonary bypass pump or heart-lung machine to temporarily take over the functions of the heart and lungs. The types of blood vessels typically used for grafts are identified as the internal thoracic artery or the saphenous vein. The paragraph concludes with a description of the post-surgery steps, including the use of electrical signals to restore the heartbeat, the placement of a temporary pacemaker, and the eventual disconnection of the heart-lung machine. It also mentions the closure of the incision and the placement of a temporary drainage tube. Additionally, it introduces two newer types of CABG procedures: off-pump and minimally invasive bypass surgery, with brief descriptions of their differences from conventional surgery.

Keywords

💡Coronary Artery Bypass Graft (CABG)

CABG is a surgical procedure performed to improve blood flow to the heart muscle in individuals suffering from severe coronary artery disease. It involves using a healthy blood vessel from another part of the body to bypass the blocked coronary artery. In the context of the video, CABG is the central theme as it describes the procedure in detail, including the preparation, execution, and recovery phases.

💡General Anesthesia

General anesthesia is a type of anesthesia that induces a state of unconsciousness, preventing the patient from feeling pain during surgery. In the video script, it is mentioned that CABG procedures are done under general anesthesia, which puts the patient to sleep for the duration of the operation, ensuring they do not experience any discomfort.

💡Cardiopulmonary Bypass Pump

A cardiopulmonary bypass pump, also known as a heart-lung machine, is a device that temporarily takes over the function of the heart and lungs during surgery. The script explains that during conventional CABG, the patient's circulatory system is connected to this machine, allowing the heart to be stopped while the surgeon sews the grafts into place.

💡Internal Thoracic Artery

The internal thoracic artery is a blood vessel located in the chest, which can be used as a graft in CABG surgery. The script describes how the surgeon leaves the upper end attached to the subclavian artery and diverts the lower end to the coronary artery beyond the blockage, showcasing its use in the procedure.

💡Saphenous Vein

The saphenous vein is a vein in the leg that is commonly used as a graft in CABG surgery. The video script explains that for a saphenous vein graft, one end is sutured to the aorta and the other end to the narrowed artery, just beyond the blockage, illustrating its role in the surgical process.

💡Off-Pump CABG

Off-pump CABG, also referred to as beating heart bypass grafting, is a variation of the traditional CABG procedure where the heart is not stopped, and a heart-lung machine is not used. Instead, a mechanical device is used to steady the part of the heart where grafting is being done. This is mentioned in the script as an alternative to conventional CABG.

💡Minimally Invasive Bypass Surgery

Minimally invasive bypass surgery is a type of CABG procedure that involves smaller incisions or ports in the chest, allowing for less invasive surgery. The script mentions that specially designed instruments are used for this type of surgery, which may sometimes require a heart-lung machine.

💡Intensive Care Unit (ICU)

The intensive care unit is a specialized hospital unit that provides close monitoring and treatment for patients with severe or life-threatening conditions. After CABG surgery, the script notes that patients are taken to the ICU where their heart activity is carefully monitored, highlighting the critical nature of post-operative care.

💡Pacing Wires

Pacing wires are temporary wires that can be attached to the heart to control the heart rate if necessary. The script mentions that if needed, pacing wires will be used to temporarily control the patient's heart rate during the recovery period after CABG surgery.

💡Breathing Tube

A breathing tube, also known as an endotracheal tube, is inserted through the mouth and into the throat to assist with breathing during surgery. The video script describes how a breathing tube is used during CABG surgery to ensure the patient can breathe while under general anesthesia.

💡Bladder Catheter

A bladder catheter is a tube that is placed in the bladder to drain urine during surgery. The script explains that a catheter will be placed in the patient's bladder to drain urine, which is a common practice to ensure comfort and hygiene during the procedure.

Highlights

CABG is performed to improve circulation to the heart muscle in severe coronary artery disease.

A healthy artery or vein from another part of the body is grafted to the blocked coronary artery.

The grafted vessel bypasses the blockage, carrying oxygen-rich blood to the heart muscle.

One or more coronary arteries may be bypassed in a single operation.

Surgery is performed under general anesthesia, and a breathing tube is inserted to assist breathing.

A catheter is placed in the bladder to drain urine during the procedure.

Conventional bypass surgery involves an incision in the skin over the sternum and cutting the sternum to access the heart.

A cardiopulmonary bypass pump or heart-lung machine is used to temporarily perform heart and lung functions.

The internal thoracic artery or saphenous vein is typically used for the grafts.

For the internal thoracic artery graft, the upper end is attached to the subclavian artery and the lower end is diverted to the coronary artery.

For the saphenous vein graft, one end is sutured to the aorta and the other to the narrowed artery beyond the blockage.

A temporary pacemaker may be attached to the heart to restore the heartbeat.

The heart-lung machine is disconnected once the heart is beating normally.

The breastbone is wired back together, and the skin incision is closed after the graft is in place.

A temporary drainage tube is placed to drain excess blood and air from the chest cavity.

Off-pump CABG, also known as beating heart bypass grafting, does not use a heart-lung machine and steadies the heart with a mechanical device.

Minimally invasive bypass procedures use specially designed instruments through small incisions or ports in the chest.

After surgery, the heart's activity is monitored in the intensive care unit.

Pacing wires may be used to temporarily control the heart rate if necessary.

The chest tube remains in place to drain excess blood and air from the chest cavity post-surgery.

The breathing tube is removed once the patient can breathe independently, and an oxygen mask is used.

The bladder catheter remains in place during the initial recovery period.

Devices are gradually removed as the patient recovers over the next three to four days.

Transcripts

- [Narrator] A coronary artery bypass graft, or CABG,

is performed to improve circulation to the heart muscle

in people with severe coronary artery disease.

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 will be connected

to a cardiopulmonary bypass pump or heart-lung machine.

This machine temporarily performs the functions

of your heart and lungs during the surgery,

allowing your heart to be stopped

while the surgeon sews the grafts into place.

One of two blood vessels is typically used for the grafts:

the internal thoracic artery in the chest

or the saphenous vein in the leg.

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 sow 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 graft securely in place,

your surgeon will use use electrical signals

to restore the heartbeat

and attach a temporary pacemaker to the heart.

Once your heart is again beating normally,

the heart-lung machine will 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.

Two other types of CABG procedures

have recently been developed:

off-pump and minimally invasive bypass surgery.

Off-pump CABG is also called beating heart bypass grafting

because the heart isn't stopped

and a heart-lung machine isn't used.

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.

These procedures sometimes require a heart-lung machine.

After surgery, you will be taken to the intensive care unit.

The activity of your heart will be carefully monitored.

If necessary, the 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 over the next three to four days,

all of these devices will be gradually removed.