Coronary artery bypass grafting (CABG) is a surgical option for people who have severe coronary artery disease (CAD), a condition in which plaque builds up in the coronary arteries and reduces blood flow to the heart muscle.  It is performed for heart attack patients only when other treatments, such as medicine or angioplasty, are not useful because of the location or extent of the blockage. 

During CABG, a healthy vein or artery from another part of the body is “grafted” to the blocked artery, creating a new passageway for oxygen-rich blood to reach the heart.  This vein or artery may be removed from the leg, chest, or forearm.  It is then attached to the aorta on one end and the diseased coronary artery on the other end, just past the blocked area.  Blood is then redirected through the graft, detouring the diseased section and increasing blood flow to that area of the heart. 

CABG typically requires the chest to be opened surgically, and a heart-lung bypass machine is used to circulate the blood and add oxygen while the heart is stopped during the grafting procedure. 

For some patients, so-called “off pump” surgery may be an option.  With this less invasive technique, the heart muscle is slowed with medication but is still beating during the procedure, circulating blood and oxygen on its own without the need for a heart-lung bypass machine. 

Gary Allen, M.D., F.A.C.S., Florida Hospital Waterman’s Cardiothoracic Surgeon, is trained and highly skilled with extensive experience in both techniques.  After assessing the health status of each patient, he determines which procedure is best suited for them based on their individual needs.

Who Qualifies For Off-Pump Bypass Surgery?
For patients with lung problems, a history of stroke, or those who may have difficulty tolerating the heart-lung bypass machine, off-pump bypass surgery may be the best option.   

Other candidates for off-pump surgery include those who have undergone conventional CABG surgery and have recurring or new blockages in the grafts, patients who have recurring problems after angioplasty, and patients who cannot tolerate more invasive surgery. 

Is Off-Pump Bypass Surgery Better Than Traditional Open Surgery? 
The primary benefit of off-pump bypass surgery is decreased recovery time, which may range from 3 to 4 weeks compared to 4 to 6 weeks for traditional CABG surgery.  A further benefit is that patients are awake and alert much earlier after surgery, with decreased likelihood of cognitive impairment.  Additionally, the risk of stroke, bleeding and kidney failure and the need for blood transfusions is significantly reduced.  

What Are The Risks of CABG?
Like angioplasty, CABG often relieves symptoms of chest pain and reduces the risk of a future heart attack.  While the long-term outcomes of CABG and angioplasty are similar, CABG may offer the benefit of greater durability and more complete return to normal blood flow, particularly for patients with diabetes, disease of the left main coronary artery, and/or valve disease.  

Nevertheless, the immediate risks of CABG surgery are much greater than angioplasty.  Risks of bypass surgery may include heart attack, stroke, excessive bleeding, infection, death, or problems with long-term memory, comprehension and concentration. 

For those with severe coronary artery disease, there is an increased risk of death within one year of CABG; however, 5 to 10 years after surgery the risk of death from CAD is less compared to those who are treated with medicine. 

Is CABG The Best Treatment Choice For Me?
Patients should talk with their doctor to determine whether CABG is preferred over medicine or angioplasty to treat their specific condition.  In some cases, surgery is clearly needed; in other cases, patients may want a second opinion to determine if CABG is their best treatment option. 

All patients should be aware that CABG will not cure CAD, nor will it prevent future hardening and narrowing of the arteries.  The key to successful long-term results for all patients is controlling high blood pressure, lowering high cholesterol, quitting smoking, and controlling diabetes.

What Should I Expect After Surgery?
During surgery, a tube is inserted into the trachea to assist with breathing during anesthesia.  A central line (a narrow catheter) is inserted through a vein in the neck or chest to the heart. Monitoring information is obtained and intravenous fluids, nutrition and medications are administered through this line.  A small plastic tube inserted into an artery provides continuous blood pressure readings and to obtain lab work. A tube is inserted into the stomach to remove secretions until eating is resumed.  A chest tube drains fluid and blood from the chest cavity and a urine catheter is inserted  into the bladder.

Immediately after surgery, aspirin is given to prevent complications that can affect the heart, brain, kidneys and intestines.  Pain medication is administered as needed.  Patients are admitted to the Cardiovascular Intensive Care Unit (CVICU) to recover from anesthesia.  All activity is monitored continuously by means of the catheters and lines placed while under anesthesia.

With traditional open CABG surgery, the tracheal tube that was inserted prior to surgery will temporarily remain in place after surgery to help with breathing; however, this tube is usually removed in the recovery unit if the patient had off-pump bypass surgery.

A multidisciplinary team of clinicians that includes the cardiac surgeon monitor the patient’s progress.  Information and education is provided before and after surgery to the patient and their family members.  

Patients usually stay in the hospital for 3 to 8 days following CABG surgery.  The length of stay depends on the patient’s state of health, whether the surgery was open or off-pump, and whether any complications develop after surgery. 

While recovering in the hospital, patients receive physical therapy, respiratory therapy, occupational therapy, and nutritional counseling.  After discharge from the hospital, recovery occurs over  4 to 6 weeks.  Exercise and driving can be resumed after 2 to 3 weeks.  All patients are enrolled in the Cardiac Rehabilitation program to guide and support recovery.