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Coronary Artery Bypass Graft (CABG)

Last updated May 18, 2018

Approved by: Maulik P. Purohit MD, MPH

Blausen.com staff. "Blausen gallery 2014

Coronary Artery Bypass Graft (CABG) is a surgical procedure, where a leg vein of the patient, or a healthy artery from the chest or forearm, or a graft, is used to replace a portion of the coronary artery system, affected with partial or complete blockage.

Background Information:

What are the other Names for the Procedure?

  • Bypass Surgery
  • Quadruple Bypass
  • Triple Vessel Bypass

What is Coronary Artery Bypass Graft surgical procedure?

Coronary Artery Bypass Graft (CABG) is a surgical procedure, where a leg vein of the patient, or a healthy artery from the chest or forearm, or a graft, is used to replace a portion of the coronary artery system, affected with partial or complete blockage.

What part of the Body does the Procedure involve?

A Coronary Artery Bypass Graft procedure involves, either a large vein in the leg (typically the greater saphenous vein), or an artery from the chest (internal mammary artery), or an artery from the forearm (radial artery), or a graft, the coronary artery, heart, and chest muscles.

Why is the Coronary Artery Bypass Graft surgical procedure Performed?

There could be various reasons for performing a Coronary Artery Bypass Graft surgical procedure. Some of these include:

  • Hardening or narrowing of the coronary arteries
  • Multiple blockages in the coronary system (typically, 3 or more blockages)
  • When there is a risk of heart failure
  • To restore blood supply to the heart, post heart attack
  • To treat ventricular arrhythmia (irregular heartbeat)
  • Aneurysm in the coronary system

What are some Alternative Choices for the Procedure?

Coronary angioplasty and stenting is a better, safe, and a less invasive alternative, to the procedure.

What are the Recent Advances in the Procedure?

The recent advances are the use of minimally invasive (percutaneous, endovascular) techniques to restore the blood supply, distal to the blocked portion of the coronary artery.

What is the Cost of performing the Coronary Artery Bypass Graft surgical procedure?

The cost of Coronary Artery Bypass Graft procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Coronary Artery Bypass Graft procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/risks.html (accessed on 17th July, 2012)

http://www.nhs.uk/Conditions/Coronary-artery-bypass/Pages/Risks.aspx (accessed on 17th July, 2012)

Prior to Coronary Artery Bypass Graft surgical procedure:

How is the Coronary Artery Bypass Graft surgical procedure Performed?

  • Before a Coronary Artery Bypass Graft surgery, the surgeon may remove a portion of the vein in the legs or internal mammary artery from the chest for bypass
  • Once the graft has been extracted, the surgeon makes a big incision in the breastbone
  • The chest muscle, tissues, and bones, are opened to locate and isolate the heart
  • Next, the heart is made to stop by reducing the heart temperature and using a chemical solution that causes the heart muscles to paralyze. A heart and lung machine is then connected to take over the circulation and breathing for the patient
  • The affected portion of the coronary artery is located and grafted with the vein or artery and placed in position with sutures
  • The blood is permitted to flow then through the graft. The surgeon may wait to check if the graft functions properly, before the heart is set to reheat slowly
  • Next, in order to help the heart resume beating, a mild electric shock is given and the heart and lung machine stopped
  • Lastly, the surgeon repositions the breastbone and closes it with sutures; followed by closing the muscles, tissues, and skin, with sutures as well

Where is the Procedure Performed?

A Coronary Artery Bypass Graft surgery is performed in a hospital. The individual gets admitted, undergoes the procedure, and is discharged, as per the instruction of the physician

Who Performs the Procedure?

The Coronary Artery Bypass Graft procedure is performed by a cardiovascular surgeon and an anesthesiologist, along with a team of healthcare providers, specialized in cardiovascular care.

How long will the Procedure take?

The procedure may take anywhere between 3 to 5 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Coronary Artery Bypass Graft procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Procedure?

The individual has to undergo certain tests prior to a Coronary Artery Bypass Graft procedure, such as:

  • Coronary angiography or coronary catheterization
  • Routine blood test
  • Electro cardiogram (ECG)
  • Chest x-ray (This may not be necessary)
  • Echocardiogram
  • The physician may suggest further tests depending on the health of the patient and their medical history. Do note that sometimes, only a few of the above mentioned tests, or all of the tests may have to be taken.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Coronary Artery Bypass Graft surgery?
  • Why is this procedure necessary?
  • What does the procedure involve?
  • How will this procedure help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Coronary Artery Bypass Graft surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure, the individual is administered general anesthesia.

How much Blood will you lose, during the Procedure?

Since, the procedure is an open heart surgery; the amount of blood lost could be considerable. However, if the amount exceeds the permissible level, the surgeon may put the patient on blood transfusion.

What are the possible Risks and Complications during the Coronary Artery Bypass Graft surgical procedure?

The possible risks or complications that may arise during the surgery are as follows:

  • Excessive bleeding
  • Infection
  • Accidental injury to the neighboring tissue or bone
  • Cardiopulmonary complications
  • Irregular heart beat
  • Blood clot formation
  • Anesthetic complications
  • Stroke

What Post-Operative Care is needed at the Healthcare Facility after the Coronary Artery Bypass Graft surgical procedure?

The healthcare facility must have a cardiac intensive care unit (ICU), where the patient may recover post-surgery. Apart from this no particular care is needed, unless any complications arise.

After the Coronary Artery Bypass Graft surgical procedure:

What are the possible Risks and Complications after the Coronary Artery Bypass Graft surgical procedure?

Post Coronary Artery Bypass Graft surgical procedure, the following complications may arise:

  • Infection of the surgical wound
  • Blockage of the graft used
  • Kidney problems
  • Heart attack
  • Stroke
  • Pain
  • Discomfort
  • Need for further procedures
  • Arrhythmia

What is the Prognosis after the Surgery?

The recovery from the procedure is generally good. But, this may vary, depending on the age and the comorbid conditions of the patient.

When do you need to call your Physician?

Do contact your surgeon/physician if you notice any of the following symptoms:

  • Pain around the surgical wound
  • Swelling and redness
  • Bleeding or drainage
  • Constipation
  • Pain in the legs
  • Irregular heart beat
  • Cough
  • Fever
  • Dizziness
  • Muscle ache
  • Nausea or vomiting
  • Signs of infection
  • If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Coronary Artery Bypass Graft surgical procedure?

At home, the following post-operative care is recommended, post Coronary Artery Bypass Graft procedure:

  • Complete the course of medication
  • Avoid strenuous exercises
  • Consume low fat, low salt, and high fiber diet, else follow physician instructions
  • Keep the incision site clean and dry
  • Wash the incision site with mild soap, while bathing
  • Elevate legs while resting
  • Resume daily activity only after you feel better
  • Avoid taking non-prescribed medications

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and is later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Coronary Artery Bypass Graft surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • The cardiovascular surgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Coronary Artery Bypass Graft procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 4, 2013
Last updated: May 18, 2018