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Alternative Names Return to topOff-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery
Definition Return to top
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. It is done to fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked.
Description Return to top
Before your surgery you will receive anesthesia. This will make you unconscious and unable to feel pain. The effects of the anesthesia will last the entire procedure.
Once you are unconscious, the heart surgeon will make a 10-inch-long incision (cut) in the middle of your chest. Then your breastbone will be separated to create an opening that allows the surgeon to see your heart and aorta (the main blood vessel leading from the heart to the rest of your body).
Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump.
A newer method does not use the heart-lung bypass machine. The bypass is created while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB. This method may be used for patients who could have problems from being on the heart-lung machine.
During this surgery, the doctor takes a vein or artery from another part of your body and uses it to create a detour (or graft) around the blocked area in your artery.
After the graft has been created, your breastbone will be reconnected with wire, and your incision will be sewn closed. The wire will remain inside you.
This surgery can take 4 to 6 hours. After the surgery, you will be taken to the Intensive Care Unit.
Why the Procedure is Performed Return to top
Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.
When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease, or coronary artery disease (CAD). It can cause chest pain (angina).
Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have tried to treat you with medicines only. You may have also tried cardiac rehabilitation.
CAD varies a lot from person to person, so the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It will be right for some people, but others may have other kinds of treatment.
Risks Return to top
Risks for any surgery are:
Possible risks from having coronary bypass surgery are:
Before the Procedure Return to top
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.
During the days before your surgery:
The day before your surgery:
On the day of the surgery:
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure Return to top
After the operation, you will spend 5 to 7 days in the hospital. You will spend the first few hours in an intensive care unit (ICU).
Two to 3 tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.
You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV) lines for fluids. There will be monitors that give information about your vital signs (pulse, temperature, and breathing). Nurses will watch your monitors constantly.
Usually within 24 hours, you will be moved to a regular or a transitional care unit in the hospital, and you will slowly resume some activity. You may begin a cardiac rehabilitation program within a few days.
It takes 4 to 6 weeks to start feeling better after surgery.
Return to top
Recovery from surgery takes time, and you may not see the full benefits of your surgery for 3 to 6 months. In most people who have heart bypass surgery, the grafts remain open and working well for many years.
But, this surgery does NOT prevent the coronary artery blockage from coming back. You can do many things to slow it down. Not smoking, eating a heart-healthy diet, getting regular exercise, and treating high blood pressure, high blood sugar (if you have diabetes), and high cholesterol will all help and are very important.
You may be more likely to have problems with your blood vessels if you have kidney disease or some other medical problems.
References Return to top
Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.
Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331-341.Update Date: 12/13/2008 Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.