Coronary Artery Bypass Graft (CABG)

(To read about one man's experience with Coronary Artery Bypass, click here.)
(To read about one woman's experience with Coronary Artery Bypass, click here.)

A coronary artery bypass graft (CABG) is a surgical procedure done to create a detour around a blockage in a heart artery. The bypass allows blood to flow freely to the heart muscle.

The surgical team for standard CABG includes two surgeons, an anesthesiologist, a cardiac perfusionist, two physician assistants, a nurse anesthetist, and two cardiac nurses.

The first step after opening the chest is to hook the heart up to the heart-lung machine. A bypass machine, or pump, circulates the patient's blood during the surgery. The bypass machine adds oxygen to the blood and pumps it out to the rest of the body, keeping the tissues and organs nourished and healthy until the grafting is done and the patient's heart can be released to beat on its own.

Next the surgeon clamps off the aorta and the heart-lung machine takes over, circulating cooled, oxygen-rich blood to the body. Cooling the blood cools the body and reduces the need for oxygen.

Meanwhile, the other half of the surgical team removes blood vessels from elsewhere in the body to be used as the grafts—the vessels that go around the blockages. Several vessels can be used. Arteries are preferred, because they are more durable than veins for grafting. The best is the mammary (breast) artery in the chest. Because it is so close to the heart, only the far end needs to be detached and grafted to the heart; the other end remains in place. It is used to bypass the most important heart artery, the left anterior descending (meaning it's on the left of the heart, on the front, heading downward).

The radial artery that runs down the forearm can also be used for a bypass.

If more vessels must be borrowed, the next vessel of choice is the saphenous vein—the vein that runs down the inside of the leg.

To create the bypass, one end of the borrowed vessel is stitched to the artery "downstream"—below the blockage. The other end is grafted, not "upstream" of the blockage, but directly to the aorta. Oxygen-rich blood then flows from the aorta through the borrowed vessel to the heart muscle, "bypassing" the blockage.

When the bypasses are complete, the clamp around the aorta is released so the heart can begin beating on its own, pumping blood out to the body. The chest is closed, and the CABG is over. Within a few hours or days, the patient will move on to the all important, ongoing cardiac rehabilitation phase of recovery, beginning with inpatient rehabilitation and going on to our Healthy Heart Program (formerly Outpatient Cardiac Rehab).