How is a (CABG) Coronary Artery Bypass Graft Performed
3 min readApr 24, 2020
In the United States Coronary artery bypass graft which is a common kind of an open heart surgery if found to be executed in good numbers. Cardiothoracic surgeons are the doctors who are involved in performing the procedure on the concerned patients. This kind of procedure is very appropriate for coronary heart diseases which can become a life-threatening issue later.
How it is Performed
- In open-heart surgery general anesthesia is usually involved since it is considered as one of the major surgeries.
- An incision down the middle of the chest is made by the cardiac surgeon. He then uses a saw-like movement to access the breastbone or the sternum. This cutting of the middle of the sternum is referred to as median sternotomy.
- The heart has to be cooled with iced saltwater. Along with this, a preservative solution has to be injected in the arteries of the heart. This procedure is referred to as cardioplegia where damage is minimized due to reduced blood flow happening during the surgery.
- A cardiopulmonary bypass must be established before a bypass surgery can take place.
- For channelizing venous blood out of the body, plastic tubes must be placed in the right atrium. A membrane oxygenator which is like a plastic sheeting is employed to channelize it to the heart-lung machine.
- The oxygenated blood is then returned to the body. To allow the bypasses to connect with the aorta the main aorta is cross clamped during the surgery. This maintains a bloodless field.
- A saphenous vein from the leg is the commonly employed vessel for bypass grafting.
- Beyond the narrowing of the vessel or the coronary artery, the graft vessel is sewed to the coronary arteries. The other end of the grafted vein or vessel is made to attach with the aorta.
- Nowadays, chest wall arteries or more specifically the internal mammary artery is used commonly for the purpose of the bypass graft. The artery is then separated from the wall of the chest to connect to the left anterior descending artery. It can also be connected to one of the major branches which are beyond the blockage. Internal mammary arteries have an advantage over venous grafts is that it remains open for a longer period of time. The percentage rate of being open in case of venous grafts is 66% while for internal mammary arteries it is 90%. but then artery grafts are of a limited length and can hence be only employed to bypass diseases which are located near the proximal or beginning of coronary arteries. The time required in CABG where internal mammary arteries are employed is more since they must be separated from the chest wall. Hence they are not very suitable for emergency cases where blood flow must be quickly resolved to restore the condition of the coronary artery.
- The aorta must be clamped off for only 60 minutes while the body is supported by cardiopulmonary bypass for a period of 90 minutes. The use of 3, 4, or 5 bypasses have grown very common.
- After the end of the surgery, the sternum with the help of stainless steel is wired together while the incision made in the chest is sewn. Plastic tubes are kept undisturbed to allow any blood drainage from the region around the heart.
- Exploration may be required for 5% f patients within the first 24 hours to monitor bleeding after surgery. While chest tubes are removed right after surgery along with the breathing tube.
What are the alternatives for CABG?
The other alternatives for CABG can be balloon surgery or angioplasty which is a less invasive technique but then your cardiologist is the best person to decide which of the surgeries is best suited for the patient. Percutaneous coronary intervention can also be employed where a stent may be used to keep the artery open. This is also a less invasive technique.
