Coronary artery bypass graft (CABG) is a surgical procedure to bypass a blocked artery of the heart. This surgery may be combined with heart valve repair or replacement if the patient also has a malfunctioning heart valve.
The valves of the heart control the flow of blood and help it to move in one direction through the four heart chambers. Abnormalities in the valve impair the uni-directional flow of blood. If a valve does not close properly or is narrowed due to deposition, blood flow is restricted or may leak between the chambers. Severe heart valve damage necessitates surgical repair or replacement of the malfunctioning heart valve.
Procedure
A long incision is made down the centre of the chest. The breast bone is divided into 2 halves and separated to expose the heart. The blood is first diverted into a cardiopulmonary bypass machine which performs the function of the heart. The heart is stopped from beating by injecting a cold solution so that the movement does not interfere with the surgery.
For the bypass part of the surgery, your doctor will harvest a healthy artery or vein to construct a bypass by sewing one end of the harvested vessel graft to a small opening made in the aorta (largest artery in the body), and the other end of the graft to an opening made in the coronary artery just below the block.
If valve surgery is also necessary, your doctor will either repair or replace the malfunctioning valve with an artificial valve. In cases of valve repair, your doctor may separate a fused valve or repair a torn valve.
After establishment of the bypass graft and following replacement or repair of the valves, blood flow through the bypass machine is disconnected and circulation will be restarted through the heart. Your doctor monitors the heart for proper functioning of the valves. The breastbones are re-joined and sewn together with wire and the incisions are closed with sutures. Tubes are inserted into the chest to drain out excessive blood. A sterile bandage is applied over the incision.
Post-Operative Care
After the surgery, you will be shifted to the ICU and will remain on a ventilator until you are stable enough to breathe on your own. Your vitals are monitored continuously. Once the ventilator is removed you may start a liquid diet and gradually advance to solid foods. You will then be able to gradually resume your normal activities.
Complications
Risks and complications of combined bypass + valve surgery include:
- Bleeding during or after the procedure
- Infection
- Breathing problems
- Pneumonia
- Blood clots that can cause heart attacks, stroke or lung problems
