Coronary Artery Bypass Graft Surgery: How It Is Done - Topic Overview
During coronary artery bypass graft (CABG) surgery, your surgeon
will use a healthy blood vessel from another part of your body to create an
alternate route, or bypass, around narrowed or blocked sections of your
coronary arteries. This bypass surgery allows more blood to reach your heart
Your medical team will monitor your vital signs, such as blood
pressure, heart rhythm, and blood oxygen levels.
You can feel your heart thudding away every time you put your hand to your chest, but do you have any idea what’s really going on in there or what keeps your heart ticking as it should? WebMD the Magazine asked Richard Krasuski, MD, director of Adult Congenital Heart Disease Services and a staff cardiologist at the Cleveland Clinic, to help explain some amazing and little-known facts about the human heart.
Your surgeon will make a cut, or incision, in the middle or side of your chest. He or she may cut through your breastbone and spread apart your rib cage. The rib cage is opened
to expose all internal organs within your chest cavity (a process called a
sternotomy). Your surgeon next cuts through the saclike lining that protects
the heart (pericardium) to access the heart itself. Your coronary arteries lie
on both the front and back surfaces of the heart.
Harvesting a vein to use as a graft blood vessel
The surgeon can remove a
piece of healthy blood vessel from these places in the body:
The inside of your leg
Just behind your chest wall
These blood vessels will be used as bypass grafts around narrowed or
blocked portions of your coronary arteries.
Leg and arm. While your chest cavity is being
opened, the surgeon's assistant may begin to remove, or harvest, a healthy
blood vessel from your arm (radial artery) or leg (saphenous vein).
Using a chest-wall artery for a graft vessel
Besides your saphenous vein and radial arteries, other blood vessels
can be used as bypass grafts. In fact, given that they are located close to the
heart and coronary arteries, the left and right internal mammary arteries (LIMA
and RIMA) are actually favored by many doctors. These arteries have two
distinct advantages besides their location:
Mammary arteries are already attached to the main artery
(the aorta). This means that only its other end must be disconnected and
grafted onto the diseased coronary artery.
Because they are
arteries, the LIMA and RIMA are more accustomed to a forceful blood flow than a
saphenous vein. (Veins carry blood from the body back to the heart and aren't
under as much pressure.) So the LIMA or RIMA may prove to be more
durable in the years after your surgery.
Putting you on the heart-lung bypass machine
After your coronary arteries have been exposed and a usable blood
vessel segment has been harvested, your surgical team may
place you on a heart-lung bypass machine. Alternately,
your surgical team may do the operation while your heart is beating. If
you are placed on the heart-lung bypass machine, your heart will be temporarily
stopped during the surgery so your surgeon can perform surgery on
your coronary arteries. The heart-lung bypass machine does the work of your
heart and lungs so that all the parts of your body still receive the
oxygen-rich blood they need to survive.