Coronary artery bypass grafting (CABG) requires a team of experts. A cardiothoracic surgeon does the surgery with support from an anesthesiologist, perfusionist (heart-lung bypass machine specialist), other surgeons, and nurses.
There are several types of CABG. They range from traditional surgery in which the chest is opened to reach the heart, to nontraditional surgery in which small incisions (cuts) are made to bypass the blocked or narrowed artery.
Traditional Coronary Artery Bypass Grafting
This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed. Numerous steps take place during traditional CABG.
You'll be under general anesthesia (AN-es-THE-ze-a) for the surgery. The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.
During the surgery, the anesthesiologist checks your heartbeat, blood pressure, oxygen levels, and breathing. A breathing tube is placed in your lungs through your throat. The tube is connected to a ventilator (a machine that helps you breathe).
An incision is made down the center of your chest. The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart.
Medicines are used to stop your heart, which allows the surgeon to operate on it while it's not beating. You're also given medicines to protect your heart function during the time that it's not beating.
A heart-lung bypass machine keeps oxygen-rich blood moving throughout your body during the surgery.
An artery or vein is taken from your body—for example, from your chest or leg—and prepared to be used as a graft for the bypass. In surgery with several bypasses, both artery and vein grafts are commonly used.
After the grafting is done, blood flow to your heart is restored. Usually, the heart starts beating again on its own. In some cases, mild electric shocks are used to restart the heart. You're then disconnected from the heart-lung bypass machine. Tubes are inserted into your chest to drain fluid.
The surgeon uses wires to close your chest bone (much like how a broken bone is repaired). The wires stay in your body permanently. After your chest bone heals, it will be as strong as it was before the surgery.
Stitches or staples are used to close the skin incision. The breathing tube is removed when you're able to breathe without it.
Nontraditional Coronary Artery Bypass Grafting
Nontraditional CABG includes off-pump CABG and minimally invasive CABG.
Off-Pump Coronary Artery Bypass Grafting
This type of surgery can be used to bypass any of the coronary (heart) arteries. Off-pump CABG also is called beating heart bypass grafting because the heart isn't stopped and a heart-lung bypass machine isn't used. Instead, the part of the heart where grafting is being done is steadied with a mechanical device.
Minimally Invasive Direct Coronary Artery Bypass Grafting
There are several types of minimally invasive direct coronary artery bypass (MIDCAB) grafting. These types of surgery differ from traditional bypass surgery. They only require small incisions rather than opening the chest bone to get to the heart. These procedures sometimes use a heart-lung bypass machine.
MIDCAB procedure - This procedure is used when only one or two coronary arteries need to be bypassed. A series of small incisions is made between your ribs on the left side of your chest, directly over the artery to be bypassed.
The incisions usually are about 3 inches long. (The incision made in traditional CABG is at least 6 to 8 inches long.) The left internal mammary artery most often is used for the graft. A heart-lung bypass machine isn't used during this procedure.
Port-access coronary artery bypass procedure - This procedure is done through small incisions (ports) made in your chest. Artery or vein grafts are used. A heart-lung bypass machine is used during this procedure.
Robot-assisted technique - This type of procedure allows for even smaller, keyhole-sized incisions. A small video camera is inserted in one incision to show the heart, while the surgeon uses remote-controlled surgical instruments to do the surgery. A heart-lung bypass machine is sometimes used during this procedure.
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