Coronary Artery Bypass Grafting


Dr. Mansfield
Coronary artery bypass grafting, or CABG, is a type of surgery. Arteries or veins from other areas in the body are used to bypass, or go around, the narrowed coronary artery. Dr. Patel, can you tell us more?

Dr. Patel
Sure, Dr. Mansfield. CABG is the most common form of open-heart surgery in the United States. There are several types of CABG, ranging from traditional surgery to newer, less invasive methods.

Traditional CABG usually lasts three to six hours, depending on the number of arteries being bypassed. The patient is put under general anesthesia for the surgery. A cut is made down the center of the chest, and the surgeon opens the rib cage to reach the heart. Special medications stop the heart from beating, and a heart-lung bypass machine keeps oxygen-rich blood moving throughout the body.

An artery or vein from another part of the body, such as the chest or leg, is used as the bypass graft. The left internal mammary artery, which is located inside the chest, close to the heart, is most often used for an artery graft. The internal mammary artery is diverted to a branch of the left coronary artery.

The saphenous vein, a long vein running along the inner side of the leg, is typically used for vein grafts. This vein is removed from the leg, and one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery.

Once the grafting is finished and blood flow to the heart is restored, the heart usually begins beating again on its own. Sometimes mild electric shocks are needed to restart the heart. Wire is used to close the chest bone, and stitches or staples are used to close the skin incision.

Non-traditional CABG includes off-pump CABG and minimally invasive CABG. Off-pump CABG is similar to traditional CABG, but instead of stopping the heart and using a heart-lung bypass machine, the surgeon uses a mechanical device to steady the heart during surgery.

Minimally invasive direct coronary artery bypass, or MIDCAB, grafting is mainly used to bypass blood vessels at the front of the heart. Instead of opening the rib cage to reach the heart, small incisions are made between the ribs on the left side of the chest, directly over the artery that needs to be bypassed.

Recovery from CABG typically requires one to two days in the intensive care unit, or ICU, and another three to five days in the hospital after that. Full recovery from traditional CABG may take six to 12 weeks. Less recovery time is needed for non-traditional CABG.