Coronary Artery Bypass Surgery (CABG)
Coronary Artery Bypass Surgery is a type of heart surgery. It's sometimes called CABG ("cabbage"). The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow, thereby increasing the amount of oxygen brought to the heart.
Why this surgery is done
Just like all the other organs in your body, your heart needs blood and oxygen to do its job. The arteries that bring blood to the heart muscle are called coronary arteries. Coronary arteries snake across the surface of your heart, delivering a constant supply of blood and oxygen to the heart muscle. When one or more of these arteries become narrowed or blocked, blood and oxygen are reduced and heart muscle is damaged. They can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the arteries, causing chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.
How bypass surgery is done
Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. Most coronary bypass surgeries are done through a large incision in the chest while blood flow is diverted through a heart-lung machine (called "on-pump coronary bypass surgery").
The surgeon makes an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over blood circulation to the body.
The surgeons take a segment of a healthy blood vessel (vein or artery) from another part of the body and makes a detour around the blocked part of the coronary artery. For example, the surgeon often takes the internal mammary artery from the chest wall, and attaches the ends above and below the blocked area. Alternatively, the surgeon may take a piece of a long vein in your lower leg and use that for the bypass. Either way, blood will now flow along this new path to your heart muscle, and will be diverted (bypassed) around the narrow or blocked portion of the artery.
At the time of the bypass surgery, a patient my undergo 1, 2, 3 or more bypass grafts, depending on how many coronary arteries are blocked.
There are other methods your surgeon may use if you're having coronary bypass surgery:
- Off-pump or beating-heart surgery. This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize or quiet the area of the heart the surgeon is working on. This type of surgery is challenging because the heart is still moving. Because of this, it's not an option for everyone. The long-term outcome of this type of procedure is not yet known, and there have been no proven benefits of this technique over standard coronary bypass using the heart-lung machine in the average patient.
- Minimally invasive surgery. In this procedure, a surgeon performs coronary bypass through a smaller incision in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area. Variations of minimally invasive surgery may be called port-access or keyhole surgery.
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