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The heart surgery experts at »ªÌå»á Bluhm Cardiovascular Institute offer the complete range of surgical options for coronary artery bypass grafts. We are among the for open-heart surgery and offer minimally invasive heart graft procedures, including robotic surgery.

We specialize in the care of patients who have complex heart issues and who are at high risk for heart surgery. No matter your condition, your care team will develop a personalized plan designed to help you get the best possible outcome.

What Is Coronary Artery Bypass Graft Surgery?

Coronary artery bypass graft, or CABG, is a type of cardiac surgery, sometimes called open-heart surgery. It is one of several treatment options for coronary artery disease.

Coronary artery disease is caused by plaque that builds up in the arteries of the heart, called .

• Over time, these deposits of fat, cholesterol and calcium can narrow or block your arteries. This is called , or hardening of the arteries.
• When arteries narrow, less blood and oxygen can reach your heart muscle.
• This can lead to symptoms like chest pain (called angina pectoris) and shortness of breath. It can even cause a heart attack.

Our team offers several treatment options for coronary artery disease:

• Medication
• Lifestyle modifications
• Percutaneous coronary intervention (PCI)
• CABG

The choice of treatment depends on:

• How severe your blockages are
• Where the blockages are located
• Your overall health
• Your preferences

CABG creates a new path for blood flow. Your surgeon does this by using a piece of healthy blood vessel, called a graft, from somewhere else in your body. They use the healthy blood vessel to create a bypass, or a detour, that allows the blood to flow around the blockage in your coronary artery.

Commonly used grafts are:

• Veins from your legs (saphenous veins)
• Arteries from your chest wall (mammary arteries)
• Arteries from your wrist (radial arteries)

The choice of graft depends on:

• How severe the blockage is
• Where the blockage is located
• The presence of certain other medical conditions, like diabetes and peripheral vascular disease

In many cases, grafts made from arteries offer long-term advantages over vein grafts.

After the graft is chosen, a heart surgeon attaches one end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle.

Traditional open-heart surgery is still commonly performed. In many cases, it may be the best approach. At »ªÌå»á, we also offer newer and less-invasive methods to bypass blocked coronary arteries. Robotic procedures, which are done by a surgeon with the aid of a moving mechanical device, may be used for patients who qualify.

Reasons for CABG Surgery

CABG is done to treat a blockage or narrowing of one or more of the coronary arteries. Surgery can alleviate symptoms of coronary artery disease, and reduce the risk of heart attack and death.

Symptoms of coronary artery disease may include:

• Chest pain
• Fatigue
• Heart palpitations (feeling like your heart is racing, fluttering or pounding)
• Abnormal heart rhythms
• Shortness of breath
• Swelling in the hands and feet
• Indigestion

Some people with coronary artery disease do not have any symptoms. However, in certain cases, we still may recommend surgery to reduce the risk of heart attack and death. For example, we may recommend surgery regardless of symptoms for patients who have:

• Coronary artery disease that affects the left main coronary artery
• Three-vessel coronary artery disease, which affects all three of the main coronary artery branches
• Diabetes
• Severe coronary artery disease

Your cardiologist and cardiac surgeon can help you decide whether to have CABG. They will talk to you about your options and answer your questions.

Reasons to choose CABG over other options, including medical therapy and PCI, include:

• Location and how serious your blockage is
• Your age and overall health
• Presence of other diseases, such diabetes
• If the blockage cannot be treated with a less-invasive procedure, like PCI

Risks

In most cases, the complications from CABG are rare. Possible risks of CABG include:

• Bleeding during or after the surgery
• Infection at the incision site
• Pneumonia
• Breathing problems
• °­¾±»å²Ô±ð²â f²¹¾±±ô³Ü°ù±ð
• Abnormal heart rhythms
• Failure of the graft
• Heart attack
• Stroke
• Death

You may have other risks depending on your medical condition. Be sure to discuss any concerns with your healthcare team before the procedure.

Procedure Details

Your healthcare team will provide information about how to prepare for your surgery. Generally, CABG follows this process:

• A healthcare professional will insert an IV (intravenous) line into a vein in your arm or hand. Other catheters (thin plastic tubes) will be used to monitor your heart and blood pressure during surgery.â€�
• The anesthesiologist will keep track of your heart rate, blood pressure, breathing and blood oxygen level during the surgery.
• Once you are put into a deep sleep, a breathing tube will be put into your throat. You will be connected to a ventilator, which will breathe for you during the surgery.
• Once all the tubes and monitors are in place, your surgeon will make incisions in one or both of your legs, or one of your wrists. This is to access the blood vessel(s) to be used for the grafts. They will remove the vessel(s) and close those incision(s).
• Your surgeon will make an incision over your sternum, or breastbone.
• The surgeon will cut the sternum in half lengthwise. They will separate the halves of the breastbone and spread them apart to expose your heart.
• To sew the grafts onto the small coronary arteries, your surgeon will need to stop your heart temporarily. Tubes will be put into the heart so that your blood can be pumped through your body by a heart-lung bypass machine. (In certain cases, CABG can be done without stopping your heart.)
• Once the blood has been diverted into the bypass machine for pumping, your surgeon will stop the heart by injecting it with a cold solution.
• When the heart has been stopped, the surgeon will perform the bypass graft procedure.
• You may need more than one bypass graft done, depending on how many blockages you have and where they are located.
• Once the bypass grafts have been checked, the surgeon will allow blood to flow back into the heart, which will allow it to start beating again.
• Your surgeon will remove the tubes for the heart-lung bypass machine.
• They will sew the sternum together with small wires (like those sometimes used to repair a broken bone).
• They will insert tubes into your chest to drain blood and other fluids from around your heart.â€�
• Your surgeon will sew the skin over the sternum back together.
• They will then apply a sterile bandage or dressing.

Robotic-Assisted CABG

During robotic-assisted CABG, the surgeon uses a sophisticated machine to perform surgery through small incisions. If your physician says you need a surgery called a left internal mammary artery to left anterior descending artery graft, or LIMA-LAD, you may qualify for a robotic procedure.

If vessels other than the left anterior descending artery are also involved, your physician may recommend a hybrid procedure, which includes a robotic LIMA-LAD followed by for the other diseased vessels. These procedures are typically done during separate visits a few weeks apart.

In robotic-assisted CABG, sometimes called minimally invasive direct coronary artery bypass, or MIDCAB:

• Your surgeon will use robotic surgical instruments to prepare the left internal mammary artery inside your chest through three small (8 millimeter) incisions between the ribs.
• They will extend one of these incisions to approximately 5 centimeters.
• They will perform a coronary artery bypass (LIMA-LAD) under direct vision.

In this procedure, your surgeon does not need to divide the sternum or cut any bones.

Robotic-assisted CABG is typically done "off-pump." That means that your heart continues to beat throughout the procedure. Your care team uses special instruments to help keep the heart still to allow your surgeon to perform the bypass procedure.

Benefits for a robotic-assisted CABG, compared to a traditional CABG, include:

• Shorter recovery time
• Less likelihood of some complications, like a blood transfusion and atrial fibrillation
• Not having a scar in the middle of the chest

Behind BCVI: Exploring Our Robotic CABG Program

After Surgery

After CABG, you will need to stay in the hospital at least several days.

After surgery, you will be taken to the intensive care unit, or ICU. The care team there will monitor you closely. Machines will constantly display your heart rhythm, blood pressure, other pressure readings, breathing rate and your oxygen level.

You will likely have a tube in your throat to help with breathing through a ventilator (breathing machine). You will be sedated while you have a breathing tube. When you are awake enough to breathe completely on your own, your physician will remove the breathing tube.

After the breathing tube is out, a nurse will help you cough and take deep breaths every couple of hours. Your nurse and ICU team will make sure you are comfortable enough to do this.

The surgical incision may be tender or sore for several days after the procedure. You may take pain relievers as recommended by your physician.

Your physician may deliver medications through the IV to help your blood pressure and your heart, and to control any problems with bleeding. As your condition becomes stable, they will gradually decrease and then stop these medications.

Once you are awake enough to swallow safely, you can start taking liquids and then solid food. It is normal to not feel very hungry early after surgery.

After surgery, your nurse will work with the physical and occupational therapy teams to help you out of bed and to a chair. As soon as you are strong enough, they will help you walk and participate in physical and occupational therapy.

When your physician determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue there.

On this unit, you will slowly increase your activity as you get out of bed and walk around for longer periods. This helps prevent complications from the surgery, such as pneumonia or blood clots in your legs.

You will keep working with the physical and occupational therapists. They will help you recover and assess your progress.

• In some cases, your therapists may recommend more therapy at home or in a rehabilitation hospital.
• If you need this type of care, our team will help arrange it.

A member of your care team will arrange for you to go home.

• They will give you instructions about your recovery. Follow all the instructions your healthcare team gives you.
• They will teach you about your medications, exercise, diet and wound care.
• They also will schedule a follow-up visit with your physician.

When your recovery time ends, your surgeon may advise that you start a cardiac rehabilitation program. This helps you get back to a normal lifestyle. Cardiac rehab starts in the hospital with simple walking. It also helps you create an exercise routine and a healthy diet to help prevent heart problems in the future.