Coronary Artery Bypass Graft Surgery
Coronary artery bypass graft surgery, or CABG (pronounced “cabbage”), is an open-heart surgery used to treat one or more critical blockages in the heart arteries that supply the heart muscle with oxygen-rich blood. When a heart artery is blocked, it can cause chest pain or discomfort and other unpleasant symptoms such as shortness of breath, fatigue, nausea, or dizziness. A blocked artery can also cause a heart attack.
The name of the surgery accurately describes exactly what it accomplishes: grafting (or sewing) a new blood vessel to a heart artery to reroute blood flow around a blockage. During CABG, a heart surgeon makes an incision in the chest, opens the sternum (or breastbone), and makes an incision in a membrane around the heart to expose the heart for the procedure.
You likely have a family member, friend, or coworker who’s had bypass surgery. With approximately 200,000 bypass surgeries performed yearly in the U.S., CABG remains the most common cardiac surgery performed worldwide.1 This surgery has been performed for over 50 years and is a well-proven treatment for serious heart disease.
CABG is a major surgery and will require some preparation on your part to be sure you have completed all necessary tests before the operation, have any personal items you need while in the hospital, and can focus only on your recovery in the weeks after you leave the hospital. Knowing what you can expect in advance can help relieve anxiety and help you make necessary preparations.
During the procedure, your surgeon will take a section of a healthy artery or vein from one of several sites in the body, usually from the chest, arm, or leg. The most successful bypasses use the internal mammary artery, which runs just inside the edge of each side of the breastbone. Your doctor will then attach (or graft) the artery or vein so that blood flows through this “new” vessel beyond the blockage in the diseased portion of the heart artery. This creates a “bypass” through which blood may flow around the blockage to the heart muscle. When referring to CABG, double or triple bypass—or even quadruple or quintuple bypass—may be used. These terms refer to the number of heart arteries that needed to be bypassed with grafts.
Types of CABG
Today, most coronary bypass surgeries are of the “traditional” type, involving the use of a heart-lung machine to take over the function of those organs during the procedure and to allow for surgery on a still heart. However, “off-pump” surgeries—performed on a beating heart without using a heart-lung machine—are becoming more common. Some minimally invasive surgeries are now performed through smaller incisions between the ribs without needing open-chest surgery.
- “Traditional” CABG – This term refers to surgeries performed through a 6- to 8-inch incision through the sternum (breast bone) of the chest and with a heart-lung machine to take over the heart and lungs during the surgery. The surgeon makes the incision in the chest, cuts the sternum (chest bone), and opens the rib cage to access the heart. The patient is given medications to stop the heart from beating, and the heart-lung machine circulates blood throughout the body. After the surgeon has sewn blood vessels to detour blood around a blockage in the heart arteries, the patient’s heart will take over again as the heart-lung machine is discontinued. The surgeon will then rewire the sternum closed and close up the incision in the chest. This traditional form of CABG is well-proven and widely practiced.
- Off-pump CABG – Some CABG surgeries are now performed without a heart-lung machine. The patient is given medications for these surgeries to slow the heart, but it remains to beat. The surgeon attaches devices to stabilize the section of the heart that will be worked on during the procedure. This procedure was developed to minimize some complications and side effects of traditional CABG, such as temporary cognitive problems (memory loss, difficulty in thinking clearly) and bleeding. Off-pump surgery reduces recovery time and has been shown to reduce the need for blood transfusions. However, patients might have a slightly higher risk of needing a repeat procedure to reopen blocked blood vessels. Some research has suggested that high-risk patients may be better candidates for off-pump procedures. Still, more research will be needed to determine if one procedure has clear benefits over the other for certain types of patients.
- Minimally invasive CABG – Minimally invasive describes a range of newer coronary bypass surgery techniques, including those that do not use a heart-lung machine and surgeries with smaller incisions.
- CABG with smaller incisions – Off-pump techniques have made CABG surgeries with smaller incisions possible. The surgeon accesses the heart muscle through a 3-inch incision between the ribs for minimally invasive CABG. Robotically assisted CABG allows surgery via several tiny incisions of 2 inches or less. The surgical instruments and a tiny camera are placed through the incisions.
Not all patients are good candidates for minimally invasive CABG with smaller incisions, but it dramatically reduces recovery time when possible. Most of the long recovery time from traditional CABG is due to the need for the sternum (chest bone) to heal.