Coronary Artery Bypass Grafting (CABG)

What is coronary artery bypass grafting (CABG)?

Coronary artery bypass grafting (CABG) is a surgical procedure to bypass (go around) blocked coronary (heart) arteries to restore normal blood flow to the heart muscle. It is commonly known as a heart bypass.

In a CABG, doctors will use healthy blood vessels from another part of your body, such as leg veins or internal mammary (breast) arteries, and sew them around the blocked artery. This creates an alternate path for oxygen-rich blood to bypass the blocked part of the coronary artery and restore normal blood flow to the heart.

Types of CABG surgery

There are 2 types of CABG procedures:

On-pump CABG

This procedure uses a heart-lung bypass machine to take over the functions of your heart and lungs. The machine allows your surgeon to operate on a still heart.

Off-pump CABG

This procedure stabilises parts of your heart instead of stopping your heart completely. Stabilising parts of your heart allows your surgeon to operate on the stabilised section while allowing the rest of the heart to beat and function normally.

Off-pump CABG can be done as a minimally invasive direct coronary artery bypass (MIDCAB) procedure, where small incisions are made to insert surgical instruments and operate using a video feed. MIDCAB is usually done when the arteries in front of the heart are blocked.

Why do you need CABG?

Your doctor may recommend coronary artery bypass grafting (CABG) if you have severe coronary artery disease (CAD). In severe CAD, plaque build-up in heart arteries can restrict blood flow to heart muscles and lead to a heart attack.

CABG creates a new pathway around these blockages to allow blood to flow normally to the heart. This reduces symptoms of coronary heart disease such as chest pain and lowers your risk of a heart attack.

What are the risks and complications of CABG?

The risk of complications from coronary artery bypass grafting generally depends on your overall health and may include:

• Stroke
• Heart attack
• Kidney problems
• Heart arrhythmias (Irregular heart rhythm)
• Memory loss or trouble thinking clearly. This often improves within 6 – 12 months.

How do you prepare for CABG?

To prepare for coronary artery bypass grafting (CABG), your doctor may recommend several tests to confirm you are in good health for the surgery. Tests may include:

• Blood tests
• Chest X-rays
• Electrocardiograms or angiograms

You may also need to stop taking certain medications such as blood thinners. If you have diabetes you may also need to adjust your medication to prevent dangerous drops in your sugar levels.

What can you expect in CABG?

CABG is performed under general anaesthesia.

Before the procedure

You will be given general anaesthesia through an intravenous drip to block the pain and keep you asleep during the procedure.

During the procedure

Your surgeon will:

• Remove the veins that will be used to bypass the blockage.
• Make a cut through the chest and chest bone to access the coronary artery.
• Connect you to a heart-lung machine (in an on-pump operation) or stabilise sections of your heart (in an off-pump operation).
• Sew one end of the bypass graft around a small opening just below the blockage in the artery, and the other end to a small opening in the aorta.
• Insert a chest tube to drain fluids and temporary pacing wires to monitor for any abnormal heart rhythm.

Care and recovery after CABG

You will remain in the intensive care unit (ICU) for 1 – 2 days of observation. Most patients can leave the hospital in a week.

As it will be several weeks before you can resume normal activity, it is best to make arrangements in advance for transport, housekeeping and meals.

It takes around 2 months to fully recover from the surgery.