U-M Health's 3-star rating for isolated coronary artery bypass graft surgery (CABG) is the Society of Thoracic Surgeons' highest possible rating for the procedure.
What is coronary artery bypass grafting (CABG)?
Coronary artery bypass grafting (CABG) is a procedure used to treat coronary artery disease (CAD) and improve blood flow to the heart. CABG is also known as bypass surgery, coronary artery bypass surgery and heart bypass surgery.
During the CABG procedure, a healthy artery or vein is taken from another part of the body and joined, or grafted, to the obstructed coronary artery. The grafted artery or vein sidesteps (bypasses) the blocked portion of the coronary artery, allowing the new channel to detour oxygen-rich blood to the heart muscle.
What results can I expect at the University of Michigan Health's Frankel Cardiovascular Center?
Coronary artery bypass grafting is the most common type of open-heart surgery in the US, with nearly 400,000 procedures completed each year. At the University of Michigan, we perform nearly 300 CABG surgeries every year.
CABG surgery candidates usually have excellent results. Symptoms are significantly improved in 85 percent of patients; there is a reduced chance of future heart attacks, and a decreased risk of dying within 10 years following surgery.
Repeat CABG surgery may be needed in patients where grafted arteries or veins become obstructed again, or if new blockages develop in arteries that weren't blocked before. However, by taking prescribed medicines and maintaining an active and healthy lifestyle, you can reduce the chances of a graft becoming blocked.
Who needs coronary artery bypass grafting?
CABG is typically performed only on patients with severe blockages in the large coronary arteries. Based on a number of factors, your doctor will decide if you are a candidate for CABG. Determining factors include presence and intensity of CAD symptoms, as well as the location of plaque buildup. In certain instances, such as during, or in case of an imminent heart attack, CABG may be performed on an emergency basis.
To decide whether CABG is necessary, your doctor will evaluate the state of your cardiovascular system, focusing on your heart, lungs, and pulse. Your doctor will ask about any symptoms you might have, including chest pain or shortness of breath, as well as the length, frequency, and severity of symptoms. To determine which arteries are blocked, the extent of blockage, and whether there is any heart damage, medical tests like EKG, stress test, echocardiogram and angiography will be performed.
Most people with less severe types of CAD are treated with regiments such as lifestyle changes, medicines, and angioplasty, first. For patients who have limited success with the alternative choices, CABG is an effective and viable option.
What to expect before coronary artery bypass grafting?
Your doctor might order a number of tests before your CABG procedure. These may include blood tests, EKG, echocardiogram, chest x ray, cardiac catheterization, and angiography.
You will receive detailed instructions from your doctor on how to prepare for CABG surgery. Instructions will include information on what you can eat or drink, what medicines you can take, and what activities to stop (ex: smoking). Most patients are admitted to the hospital on the same day as the surgery.
What to expect during coronary artery bypass grafting?
A diverse team of experts is involved in the performance of coronary artery bypass grafting procedure. A cardiothoracic surgeon performs the surgery with support from an anesthesiologist, physician assistant, perfusionist (heart-lung machine specialist), as well as other surgeons, and nurses.
CABG procedures require general anesthesia and last typically 3 to 5 hours, depending on the number of arteries being bypassed. Before surgery, anesthesia is administered to put you to sleep. During the length of the procedure, the anesthesiologist monitors your heartbeat, blood pressure, oxygen levels, and breathing. A breathing tube, placed in your lungs through your throat, and connected to a ventilator, helps you breathe.
What are different types of coronary artery bypass grafting?
There are several distinct types of CABG. Coronary artery bypass grafting procedures range from traditional methods to less invasive surgeries to a robot-assisted technique that allows the surgeon to perform the operation with remotely controlled surgical instruments.
In deciding on the best match between the patient and the type of coronary bypass procedure, the surgeon considers a number of factors. Factors include patient's age, build, weight, as well as the location and magnitude of plaque buildup. Presence of other illnesses, such as lung disease or hardened arteries, is also considered.
Interestingly, for many patients with more acute conditions, traditional heart surgery may be the safest option.
How is traditional coronary artery bypass grafting performed?
Traditional coronary bypass surgery involves an incision through the breastbone and the use of a heart-lung machine. The chest bone is cut and ribcage opened so that the surgeon can get to the heart. During this time, the heart is temporarily stopped while a heart-lung machine circulates oxygen-rich blood throughout your body.
Once grafting is completed, your heart is restarted with mild electric shocks. You are disconnected from the heart-lung machine, and the fluid drainage tubes are inserted into your chest. The surgeon then uses wires to enclose your chest bone and stitches or staples to close the skin incision. Once you are able to breathe on your own, the breathing tube is removed.
How is off-pump coronary artery bypass grafting performed?
Off-pump coronary artery bypass grafting can be used to bypass any of the coronary arteries. During this procedure the heart isn’t stopped, nor is a heart-lung machine utilized. Instead, the part of the heart where grafting is taking place is steadied with a mechanical device. As a result, off-pump coronary artery bypass grafting is also called beating heart bypass grafting.
Because a heart-lung machine is not used during off-pump CABG, fewer complications tend to occur. This is especially true in people who had suffered a stroke or "mini-strokes" in the past, who are over 70 years of age, or patients afflicted with diabetes, lung disease, or kidney disease. Other advantages of off-pump CABG include decreased bleeding during surgery, smaller likelihood of infection and other complications and faster recovery.
What to expect after coronary artery bypass grafting?
After your coronary artery bypass grafting procedure, you will generally spend 1 to 2 days in an intensive care unit. Your heart rate and blood pressure will be closely monitored and you might be given intravenous medicines to regulate your blood circulation and blood pressure. When your condition has stabilized, you will be moved to a less intensive care area of the hospital for 3 to 5 days of monitoring.
For your recovery time at home, your doctor will provide you with detailed instructions. These will include guidance on caring for your healing incisions, recognizing signs of infection or other complications and knowing when to call the doctor immediately.
Instructions will also be provided on how to manage common surgery after-effects which generally disappear within 4 to 6 weeks after the operation. After-effects may involve one or more of the following symptoms:
- Irritation or itching from healing incisions
- Swelling of the area where an artery or vein was taken for grafting
- Muscle ache or tightness in the shoulders and upper back
- Fatigue, mood swings, or depression
- Difficulty sleeping
- Loss of appetite
- Chest pain around the site of the chest bone incision (this is more frequent with the traditional surgery)
Complete recovery from traditional CABG may take 6 to 12 weeks or longer. Nontraditional CABG patients usually have a shorter recovery time.
You will receive instructions from your doctor on when to resume regular physical activities. Although time-frames vary between patients, most people can resume sexual activity within 4 weeks and driving after 3 to 8 weeks. Most patients return to work after 6 weeks, unless their job involves strenuous physical labor. Some people may be advised to consider changing to less physically demanding type of work, permanently; others, to work a reduced schedule at first.
What kind of ongoing care should I expect after coronary artery bypass grafting?
Ongoing care after CABG will include intermittent checkups with doctors. Tests (EKG, stress testing, and echocardiogram) may be performed during these visits, to see how your heart is functioning.
CABG is not a cure for coronary artery disease so you and your doctor may look at other options for staying healthy and reducing the chances of CAD worsening. Options may include developing a long term care plan that involves lifestyle changes like quitting smoking, following a healthy diet rich in fruits and vegetables, getting regular exercise, and managing stress.
Some patients might be referred by their doctor to a cardiac rehabilitation (rehab) program. After surgery, rehab programs can bolster you strength and energy through exercise training, and help you return faster to your daily routine. Also, through supervised physical activity and education, rehabilitation will guide you in pursuing healthier lifestyle choices that considerably reduce the risks of future heart problems.
Taking medicines as prescribed by your doctor is another essential component of post-surgery care. Medicines may be prescribed to manage pain through recovery; to lower cholesterol or blood pressure; to reduce the chance of developing blood clots; to treat diabetes; to alleviate depression.
What are the risks of coronary artery bypass grafting?
Even though complications from coronary artery bypass grafting are uncommon, risk is a part of every surgical procedure. Potential risks include wound infection and bleeding, adverse reactions to anesthesia, fever, pain, stroke, heart attack, or even death.
Some patients may develop a fever 1 to 6 weeks after surgery. This can be due to inflammation of the lung and heart sac, after surgeries that involve cutting through the pericardium (the outer covering of the heart). Symptoms range from chest pain to irritability and decreased appetite. This is usually a mild, self-limited illness, but a small number of patients may develop fluid buildup around the heart that necessitates further treatment.
Use of the heart-lung machine can also lead to complications. Some patients have experienced side effects like memory loss, difficulty concentrating or thinking clearly. These developments are more likely to occur in older people, patients with high blood pressure or lung disease, or those who consume excessive amounts of alcohol. These reactions mostly disappear several months after surgery.
The heart-lung machine can also raise the risk of blood clots. Clots can form in your blood vessels, then travel to the brain, lungs or other parts of the body, blocking blood flow and causing a stroke or other problems. Latest technical enhancements in heart-lung machines are lowering the risks of blood clots.
In most cases, the risk of complications are higher when CABG is done in an emergency situation (ex: if performed during a heart attack), if you are over 70 years old, or if you have a history of smoking. Your risks also rise if you have other diseases or conditions such as diabetes, kidney disease, lung disease, or peripheral vascular disease.
Recovering from a coronary artery bypass graft procedure takes time and everyone recovers at slightly different speeds. Generally, you should be able to sit in a chair after 1 day, walk after 3 days, and walk up and down stairs after 5 or 6 days. Most people make a full recovery within 12 weeks of the operation.What should you not do after CABG? ›
Do not drive for at least 4 to 6 weeks after your surgery. The twisting involved in turning the steering wheel may pull on your incision. Ask your provider when you may return to work, and expect to be away from work for about 6 to 8 weeks. Do not travel for at least 2 to 4 weeks.How many times can you do CABG? ›
Second time bypass has become a very standard procedure nowadays. As many of the patients are operated in late 60's and 70's so the need for a second bypass surgery arises. There is no specific limit of times that a person can undergo bypass surgery.How long do CABG grafts last? ›
Results. After surgery, most people feel better and might remain symptom-free for as long as 10 to 15 years. Over time, however, it's possible that other arteries or even the new graft used in the bypass will become clogged, requiring another bypass or angioplasty.How many hours is CABG surgery? ›
During the operation
Coronary artery bypass graft surgery usually lasts 3 to 6 hours. But it may take longer depending on how many blood vessels are being attached. Blood vessels can be taken from your leg (saphenous vein), inside your chest (internal mammary artery), or your arm (radial artery).
Upright: The recommended sleeping position for the first few weeks after the surgery is an upright position, while the chest bone heals. You can sleep in a recliner or a foldable bed as they are quite comfortable. Use a neck pillow to support your neck and spine.Can you live a normal life after CABG? ›
Although CABG is a major operation, most people make a good recovery, and 95 percent of people have no serious complications. Heart surgeons go through years of specialized training. They work with teams of skilled nurses and other specialists to get their patients safely through surgery and back to a normal life.How is the heart stopped during CABG? ›
Coronary artery bypass graft surgery--on-pump procedure
Tubes will be put into the heart so that your blood can be pumped through your body by a heart-lung bypass machine. Once the blood has been diverted into the bypass machine for pumping, your doctor will stop the heart by injecting it with a cold solution.
10 to 14 days after chest surgery or a coronary artery bypass graft. 10 days after more complicated abdominal surgery.Can a CABG surgery fail? ›
Saphenous vein graft (SVG) failure is a common finding in patients following coronary artery bypass graft (CABG) surgery. In the literature SVG failure rates have been reported from 25 to over 50% within 10 years.
Third, patients presenting with bypass graft failure are often old (mean age was 68–70 years in this study) and have worse baseline left ventricular function, hence may be at increased risk for heart failure or arrhythmias, and for developing noncardiac disease, such as infections and cancer.How much can you lift after CABG? ›
For at least the first six weeks after your surgery, you should not lift anything that is over 10 pounds. Your sternum (chest bone) will need this time to heal. As you return to physical activity, walking is an excellent choice for gradually rebuilding your activity level.Why do CABG grafts fail? ›
After grafting, the implanted vein remodels to become more arterial, as veins have thinner walls than arteries and can handle less blood pressure. However, the remodeling can go awry and the vein can become too thick, resulting in a recurrence of clogged blood flow.How often do CABG grafts fail? ›
Approximately 50% of saphenous vein grafts (SVGs) fail by 5 to 10 years post-coronary artery bypass grafting (CABG) and between 20–40% fail within the first year (1,2). While SVG failure can sometimes be silent, when symptomatic events occur, SVG percutaneous coronary intervention (PCI) is often performed.Can you have a CABG twice? ›
Sometimes, a coronary artery bypass graft may need to be repeated or you may need a procedure to widen your arteries using a small balloon and a tube called a stent (coronary angioplasty).How painful is CABG surgery? ›
You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. These symptoms usually get better after 4 to 6 weeks. The incision in your chest and the area where the healthy blood vessel was taken may be sore or swollen.How long do you stay in ICU after CABG? ›
While you are still unconscious, you will probably be taken to the intensive care unit, a special ward reserved for people who have just had significant surgeries. You might be in this unit for 1 to 3 days. A longer stay does not mean that your CABG surgery was not successful.Can you shower after CABG? ›
Shower every day, washing the incision gently with soap and water. DO NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Follow a heart-healthy diet.How do you sit after bypass surgery? ›
To stand up:
- Scoot to the front of the chair.
- Place one foot slightly in front of the other.
- Put your hands on your thighs.
- Bend forward from the hips and push your body up with your legs.
Pace yourself when climbing stairs. Exercising in cold and windy or hot and humid weather puts stress on your heart. If temperatures outside are below 40 degrees or above 75 degrees, then exercise indoors. Riding a stationary bike or walking on a treadmill is an acceptable alternative to walking.
However, the mortality rate is low, and according to one report, only 2–3 percent of people who undergo heart bypass surgery die as a result of the operation.Can you get heart failure after CABG? ›
Follow-up care is of great importance since people who have had bypass surgery have a significantly increased risk of more cardiac events, including recurrent chest pain, heart attack, heart failure, and an increased risk of dying.Does CABG improve quality of life? ›
Coronary artery bypass grafting (CABG) is an important surgical procedure for patients with coronary artery disease, which improves the symptoms, survival and quality of life.Which incision is used for CABG surgery? ›
The usual incision for coronary artery bypass grafting (CABG) is a midline sternotomy (see the image below), although an anterior thoracotomy for bypass of the left anterior descending (LAD) artery or a lateral thoracotomy for marginal vessels may be used when an off-pump procedure is being performed.What meds are you on after a CABG? ›
Current guidelines recommend that after CABG, statins and antiplatelet agents should be given to all patients with no contraindications, renin–angiotensin–aldosterone system (RAAS) inhibitors (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers) should be given to patients with reduced left ...What do you wear after open heart surgery? ›
Comfortable, loose clothes are best.How many bypass grafts can you have? ›
The number of blood vessels used will depend on how severe your coronary heart disease is and how many of the coronary blood vessels have become narrowed. Most people will need 3 or 4 vessels grafted. If you need 2, 3 or 4 grafts, you may hear your operation referred to as a 'double', 'triple' or 'quadruple' bypass.What are the signs of graft failure? ›
- corneal edema.
- keratic precipitates (KPs) on the corneal graft but not on the peripheral recipient cornea.
- corneal vascularization.
- stromal infiltrates.
- a Khodadoust line.
- an epithelial rejection line.
- subepithelial infiltrates.
The major complications associated with CABG are death, myocardial infarction, stroke, wound infection, prolonged requirement for mechanical ventilation, acute kidney injury, and bleeding requiring transfusion or reoperation [1-4].Which graft is best for CABG? ›
As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up.
Despite the advantages, reports indicate CABG procedures significantly increase the risk of cerebral impairment and/or injury, which can present itself in the form of memory loss. Older individuals tend to be at higher risk for memory loss than other age groups.Is CABG open heart surgery? ›
During the procedure, a surgeon cuts through the breastbone and spreads the ribcage to access the heart. Open-heart surgery may include CABG (bypass surgery), heart transplant and valve replacement.Do and don'ts after cardiac surgery? ›
avoid lifting, pushing, or pulling anything heavier than 10 pounds for six weeks after surgery. this includes carrying children, grocer- ies, suitcases, mowing the grass, vacuuming, and moving furniture. Don't hold your breath during any activity, especially when lifting anything or when using the rest room.What are CABG precautions? ›
Sternal precautions might vary depending on your surgeon or rehabilitation facility, but they typically include instructions such as: Don't reach both arms overhead. Don't reach both arms out to the side. Don't reach behind your back. Don't lift more than 5 to 8 pounds.What should I monitor after CABG? ›
Monitor chest tube drainage (generally serosanguineous) and report drainage of over 100 ml/hour. Watch for signs of bleeding by checking the patient's hemoglobin and hematocrit levels at least every 4 hours. Administer blood if ordered. Monitor the patient's electrolytes and report abnormal values.How do you sit after heart surgery? ›
To keep the swelling down:
- Keep your feet up when you sit or lie down. ...
- Do the ankle-pumping exercises you were taught in the hospital.
Climbing stairs is OK, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to. Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be OK.How much can I lift after CABG? ›
While the sternum (breastbone) is healing, avoid lifting greater than 10 pounds, or pushing/pulling activities with your arms. Showers are permitted but tub baths are discouraged for 4-6 weeks or until your incisions are healed. Avoid extremely hot water which may cause you to feel dizzy or weak.What medications should be stopped before CABG? ›
- Beta blockers. ...
- ACE inhibitors and angiotensin receptor blockers. ...
- Calcium channel blockers. ...
- Nitrates. ...
- Alpha 2 agonists. ...
- Aspirin, Clopidogrel. ...
- Oral anticoagulants (Warfarin) ...
As with all types of surgery, a coronary artery bypass graft carries a risk of complications. These are usually relatively minor and treatable, such as an irregular heartbeat or a wound infection, but there's also a risk of serious complications, such as a stroke or heart attack.
You will probably feel very groggy. Anesthesia can make you feel nauseated, so your stomach may feel queasy. You may also notice immediately that you cannot swallow or speak because of the tube placed in your throat to help you breathe.How do I prepare for CABG? ›
- Remind the person who will drive you to the hospital what time you need to be there. ...
- Follow the instructions about exactly when to stop eating and drinking. ...
- Relax, but do not drink alcohol. ...
- Use disinfecting solution (that your doctor may have given you) to clean your skin.
It's well known in cardiac circles, says Rade, that more than half of venous grafts will be completely blocked off within 10 years after the surgery. It also turns out, according to the new Hopkins-led study results, that one in five vein grafts blocks off within six months of surgery, usually because of blood clots.What medications are used during CABG? ›
Coronary Artery Bypass Grafting Medication: Anxiolytics, Benzodiazepines, Opioid Analgesics, Anesthetic Agents, Neuromuscular Blockers, Nondepolarizing, Anticoagulants, Hematologic.Why is heart rate high after CABG? ›
Some people who have a coronary artery bypass graft develop atrial fibrillation, a condition that causes an irregular and often abnormally fast heart rate. But this isn't usually serious if found early and can normally be easily treated with a course of medicine.
You may also have some tests such as a chest X-ray, blood tests and an electrocardiogram (ECG). During an ECG, small electrodes are put on your arms, legs and chest to record the electrical signals produced by your heart. You'll usually be told more about the operation during your visit to the pre-admission clinic.