What is Coronary Artery Bypass Graft (CABG) Surgery?
Your doctor has recommended a Coronary Artery Bypass Graft procedure, also called CABG. This video will review information about the on pump CABG procedure.
During a CABG procedure, new paths called bypasses, are created to carry blood around the blockages. Healthier blood vessels from other sites in the body are used to create each bypass.
It is protected by the sternum, also called the breastbone.
The heart is a muscle that pumps blood to all parts of the body through blood vessels called arteries.
Veins are vessels that carry blood back to the heart.
The aorta is the largest artery in the body.
Two vessels that branch off from the aorta, are the right and left coronary arteries. They supply the heart muscle with the oxygen-rich blood that is necessary to keep it working.
Coronary arteries can become blocked by plaque, fat and calcium deposits that build up over years.
The result is coronary artery disease, also called heart disease.
Severe blockages cause chest pain, heart attacks, and sometimes death.
During a CABG procedure, new pathways called bypasses are put in place to carry blood past, and around blockages.
Healthier blood vessels from other sites in the body are used to create each bypass.
A section of vein from your leg, or an artery from your arm, may be removed and used to create the bypass. These transplanted vessels are called grafts.
The right and left internal thoracic arteries are also commonly used as grafts.
These arteries naturally pass close to the heart. When creating a bypass with one of these vessels often only one end of the vessel is moved to the coronary artery, past the blockage.
This concept is similar to moving a hose from watering one plant to another.
When arteries or veins are moved or removed from one body part to another, this possible only when there will still be enough blood supplied from other nearby vessels.
There are different surgical techniques for coronary artery bypass, on pump and off pump.
During the several hours, it takes to do an on-pump CABG surgery, the heart is stopped for about 30 – 90 minutes. This keeps the heart muscle still while the surgeon sews vessels into place to create the necessary bypasses.
While the heart is stopped, a special pump, called a heart-lung machine, keeps blood oxygenated and flowing through the body.
Blood is carried from the body through tubing to a machine where it is mixed with oxygen, then pumped back to the body.
After all of the grafts have been placed, the heart is restarted, and the pump is disconnected.
In some situations, a less invasive CABG procedure may be offered. This can include an off-pump technique where the heart is not stopped. In some cases, smaller incisions may be used.
During these procedures, converting to an on pump procedure is still possible.
Individual surgical treatment decisions depend on many factors, including the experience of the surgeon, how many arteries are involved, the location of the blockages, and their severity.
Now let’s look closer at the “on pump” coronary artery bypass surgery.
You will be given medication to be pain-free and asleep during this procedure.
The necessary grafts are created by surgically removing sections of blood vessel from the leg and/or arm as needed. These incisions are sutured and bandaged.
To reach the heart, the surgeon makes an incision down the center of the chest.
The sternum bone is carefully cut.
A retractor is then placed to hold the edges apart, creating a working area.
The protective sac that surrounds the heart, called the pericardium, is opened.
The surgeon inspects the heart and identifies the vessels to be bypassed.
The heart-lung machine is prepared by connecting tubing to the heart and vessels, as appropriate for each situation.
When the pump is primed and the grafts are ready for placement, the heart-lung machine is turned on.
The heart is cooled and the aorta is able to be clamped.
Blood flow through the heart and motion of the heart stops.
The surgeon then stitches the intended grafts into place.
Depending on the number of blockages, connections to one or both internal thoracic arteries may be used to complete the necessary bypasses.
The clamp is removed from the aorta.
Once the heart is beating normally, the heart-lung machine is disconnected, and the tubing sites are repaired.
The pericardium is positioned back over the heart,
flexible drains are placed, and the sternum is closed and supported with wire, or small plates and screws.
The remaining tissue layers are brought together.
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