Our Summary

Coronary artery bypass grafting (CABG) is a common heart surgery in adults used to alleviate chest pain and extend a patient’s life when they are suffering from restricted blood flow to the heart due to coronary artery disease. Typically, a vein from the leg (the saphenous vein) is used for this procedure. However, it’s considered best practice to use the left internal thoracic artery for bypassing the left anterior descending artery, especially in younger patients for better long-lasting results.

While a traditional on-pump coronary bypass provides the most thorough restoration of blood flow to the heart, off-pump and minimally invasive procedures are better options for patients who cannot undergo a large chest incision and cardiopulmonary bypass.

To improve the success of the surgery and increase the long-term effectiveness of the graft, various strategies are used. These include: monitoring blood flow during surgery, accelerating recovery post-surgery, and intensive use of anti-platelet therapy along with other secondary prevention measures.

Despite the maturity of the coronary artery bypass grafting surgery, there is still a need for more large-scale, forward-looking, multi-center randomized trials to provide additional evidence-based medical proof to address common clinical issues. This will help to achieve the best short and long-term results for patients.

FAQs

  1. What is Coronary Artery Bypass Grafting (CABG) and why is it performed?
  2. What is the “golden standard” for bypassing the left anterior descending artery, and why is it more recommended for young patients?
  3. What are the benefits of using on-pump coronary bypass, off-pump, and minimal invasive coronary bypass?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart bypass surgery is to follow a healthy lifestyle after the procedure. This includes maintaining a balanced diet, engaging in regular exercise, quitting smoking, and managing stress. These lifestyle changes can help improve the success of the surgery and promote long-term heart health. Additionally, it is important for patients to take their prescribed medications, attend follow-up appointments, and communicate any concerns or symptoms with their healthcare provider. By actively participating in their recovery and ongoing care, patients can enhance their overall well-being and reduce the risk of future heart issues.

Suitable For

Heart bypass surgery, or coronary artery bypass grafting (CABG), is typically recommended for patients with coronary artery disease, which is characterized by a buildup of plaque in the coronary arteries that supply the heart with blood. This can result in myocardial ischemia, a condition where the heart muscle doesn’t get enough oxygen and nutrients.

Patients who are recommended for this procedure are typically those experiencing severe chest pain (angina), who have a blockage in more than one coronary artery, have not responded to other treatments, or are in the midst of a heart attack.

It is also often recommended for patients who are at high risk of having a heart attack, especially those with left main coronary artery disease or multiple blockages in the coronary arteries.

In some cases, younger patients may be recommended to have more arterial grafts for better long-term results. Off-pump and minimally invasive coronary bypass procedures may be reserved for patients who may not be suitable for mid sternotomy and cardiopulmonary bypass.

Timeline

Before heart bypass surgery:

  1. Patient undergoes diagnostic tests such as electrocardiogram (ECG), stress test, and coronary angiography to determine the extent of coronary artery disease.
  2. Patient may undergo medical management with medications to control symptoms such as chest pain and high blood pressure.
  3. Patient may undergo lifestyle changes such as diet modification and exercise to improve heart health.
  4. Patient meets with a cardiac surgeon to discuss the need for bypass surgery and the risks and benefits involved.

After heart bypass surgery:

  1. Patient is monitored closely in the intensive care unit (ICU) for the first few days post-surgery.
  2. Patient may experience pain, swelling, and discomfort at the incision site.
  3. Patient undergoes cardiac rehabilitation to improve heart function and physical strength.
  4. Patient is prescribed medications such as blood thinners and cholesterol-lowering drugs to prevent complications.
  5. Patient may need to make long-term lifestyle changes such as quitting smoking, maintaining a healthy diet, and regular exercise to prevent future heart problems.
  6. Follow-up appointments with the cardiac surgeon and cardiologist are scheduled to monitor the progress of the bypass grafts and overall heart health.

What to Ask Your Doctor

Some questions a patient should ask their doctor about heart bypass surgery may include:

  1. What are the risks and benefits of coronary artery bypass grafting (CABG) surgery for my specific condition?
  2. What type of graft material will be used for the procedure and why?
  3. What is the recommended approach for my surgery - on-pump, off-pump, or minimally invasive?
  4. How will my recovery process look like and what lifestyle changes will be needed post-surgery?
  5. What medications will I need to take after the surgery, especially in terms of anti-platelet therapy?
  6. What is the expected success rate of the surgery in terms of long-term graft patency?
  7. Are there any alternative treatment options to consider before proceeding with CABG surgery?
  8. How often will follow-up appointments be necessary after the surgery to monitor my progress?
  9. What are the potential complications or side effects of the surgery that I should be aware of?
  10. Are there any specific questions or concerns I should discuss with the anesthesiologist or other members of the surgical team before the procedure?

Reference

Authors: Chen X. Journal: Zhonghua Wai Ke Za Zhi. 2020 May 1;58(5):321-325. doi: 10.3760/cma.j.cn112139-20200203-00057. PMID: 32392997