How Coronary artery bypass surgery works

Summary

Coronary artery bypass graft (CABG) is a surgical procedure for severe coronary artery disease, where a healthy blood vessel graft is used to bypass blocked arteries, improving heart muscle circulation. The surgery involves general anesthesia, a cardiopulmonary bypass pump, and may use the internal thoracic artery or saphenous vein for grafts. Recent advancements include off-pump and minimally invasive techniques. Post-surgery, patients are closely monitored in the ICU, with temporary devices in place for recovery.

Takeaways

• 💡 Coronary artery bypass graft (CABG) surgery is performed to improve blood circulation to the heart muscle in patients with severe coronary artery disease.
• 🔍 During CABG, a healthy artery or vein from another part of the body is grafted to the blocked coronary artery to bypass the blockage and supply oxygen-rich blood to the heart muscle.
• 💊 Prior to surgery, an intravenous line is started and patients may receive medication to help them relax.
• 😴 CABG procedures are conducted under general anesthesia, which puts the patient to sleep during the operation.
• 🌬️ A breathing tube is inserted through the mouth to assist with breathing, and a catheter is placed in the bladder to drain urine.
• ⏱ The surgery typically takes between three to six hours to complete.
• 🔪 In conventional bypass surgery, an incision is made over the breastbone, and the sternum is cut to access the heart.
• 🔄 A cardiopulmonary bypass pump, or heart-lung machine, is used to temporarily perform the functions of the heart and lungs, allowing the heart to be stopped for graft placement.
• 🔍 Two common blood vessels are used for grafts: the internal thoracic artery in the chest or the saphenous vein in the leg.
• 📌 For grafts, the surgeon sews one end to the aorta or subclavian artery and the other end to the narrowed artery beyond the blockage.
• 💓 Once the grafts are in place, the surgeon uses electrical signals to restore the heartbeat and may attach a temporary pacemaker.
• 🛌 Post-surgery, patients are taken to the intensive care unit where their heart activity is monitored, and devices like chest tubes and breathing tubes are gradually removed as they recover.

Q & A

What is a coronary artery bypass graft (CABG) surgery?

CABG surgery is a procedure performed to improve blood circulation to the heart muscle in individuals with severe coronary artery disease. It involves grafting a healthy artery or vein from another part of the body to bypass the blocked coronary artery, thus restoring the flow of oxygen-rich blood to the heart muscle.

How many coronary arteries can be bypassed in a single CABG operation?

During a single CABG operation, one or more coronary arteries may be bypassed, depending on the extent of the blockages and the patient's condition.

What preparations are made before CABG surgery?

Before the surgery, an intravenous line is started, and the patient may be given medication to help them relax. The procedure is performed under general anesthesia, which puts the patient to sleep for the duration of the operation.

What is the role of the cardiopulmonary bypass pump during CABG surgery?

The cardiopulmonary bypass pump, also known as 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 are the two types of blood vessels typically used for grafts in CABG surgery?

The two types of blood vessels typically used for grafts in CABG surgery are the internal thoracic artery in the chest and the saphenous vein in the leg.

How is the internal thoracic artery graft connected during CABG surgery?

For the internal thoracic artery graft, the surgeon leaves the upper end attached to the subclavian artery and diverts the lower end from the chest wall to the coronary artery just beyond the blockage, then sews the graft into place.

What is the process for attaching a saphenous vein graft during CABG surgery?

For the saphenous vein graft, the surgeon sutures one end to the aorta and the other end to the narrowed artery just beyond the blockage.

What is the purpose of the temporary pacemaker attached to the heart after the grafts are in place?

The temporary pacemaker is attached to the heart to help restore the heartbeat and ensure the heart is beating normally after the grafts have been secured.

What are the two alternative types of CABG procedures that have been developed?

The two alternative types of CABG procedures are off-pump CABG, also known as beating heart bypass grafting, and minimally invasive bypass surgery, which uses specially designed instruments inserted through small incisions or ports in the chest.

What happens after the CABG surgery is completed?

After the surgery, the patient is taken to the intensive care unit where their heart activity is monitored. Devices such as a chest tube for draining excess blood and air, a breathing tube, and a bladder catheter are used during the recovery period, and are gradually removed over the next few days.

How long does a conventional CABG surgery typically take?

A conventional CABG surgery generally takes between three to six hours.