The heart is a hollow, muscular organ with four chambers.
- The top two chambers are called the left and right atrium. The right atrium receives blood from the body. The left atrium receives blood from the lungs.
- The bottom two chambers are called ventricles. The right ventricle receives blood from the right atrium and pumps it out to the lungs. The left ventricle receives blood from the left atrium and pumps it out to the rest of the body.
Just like other muscles in our body, the heart muscle needs its own blood supply to work properly.
- The arteries that supply the heart muscle with blood are called the coronary arteries.
- The two main coronary arteries are the left and right coronary arteries. The left main coronary immediately splits into two major branches. Therefore, cardiologists talk of three coronary arteries, the right and the two branches of the left.
- Coronary artery disease refers to blockages in one or more of the coronary arteries.
- The larger the coronary artery, the more heart muscle at risk if a blockage occurs.
A coronary artery bypass graft is also known as a CABG. A CABG involves taking a blood vessel (an artery or vein) from one part of the body. The blood vessel is then used to create a flow of blood around a blocked coronary artery (i.e., a bypass).
- Depending on the number of blockages, more than one blood vessel, or "graft," may be needed.
- At the start of surgery your heart may be stopped. If your heart is stopped a heart-lung machine will be used to put oxygen into your blood and pump it throughout your body.
- Your surgeon will perform the necessary grafts while your heart is not moving. Your heart will usually start beating on its own after the surgery is done. If it doesn't, it will be restarted with an electrical shock.
If you have chest pain or other symptoms of coronary artery disease, your healthcare provider may refer you to a cardiologist for evaluation. This evaluation may include an angiogram, which is a special x-ray of the arteries that supply your heart muscle with blood (coronary arteries). If the coronary angiogram shows you have coronary artery disease, your healthcare provider may recommend one of several treatments. The treatment recommended for you will depend on your overall health, the severity of your symptoms and the extent of the coronary artery disease seen on your angiogram. Treatment may include:
- An angioplasty, which is when a special catheter is inflated inside a blocked coronary artery. A stent (metal tube or coil) may then be placed to keep the artery open.
- A coronary artery bypass graft (CABG), which is when a blood vessel is used to great a flow of blood around a blockage.
It is important to know that the majority of people who have coronary artery disease can be successfully treated with medication and following a healthy lifestyle.
CABG surgeries are typically performed for life-threatening coronary artery diseases, such as:
- Significant disease in the left main coronary artery
- Disease in three vessels, especially if the left ventricle is also not functioning properly
- Disease in two vessels, depending on the location of the narrowing or blockage, and any other heart disease
- When a blockage is accompanied by diabetes and/or a weakened heart muscle
Coronary artery bypass surgery is performed when symptoms of coronary artery disease (e.g., chest pain) cannot be controlled by any other means, such as medication. The surgery can be completed by:
- Standard open heart surgery (either with or without a heart-lung machine)
- Minimal invasive surgery (performed without a heart-lung machine through a smaller incision)
- Robotic surgery
- There are advantages and disadvantages to each type of surgery. You should discuss all options with your surgeon. Based on your circumstances one or more options may not be right for you.
This care path includes the cost of a CABG by standard open heart surgery.
A CABG can be effective at controlling the symptoms of active people with coronary artery disease (i.e., angina and shortness of breath).
- It may also be done in others when it will improve symptoms and decrease the risk of death.
- A CABG is favored over an angioplasty, with or without stents, if multiple arteries are blocked or a significant amount of heart muscle is at risk. Also, people who have diabetes may do better after a CABG than an angioplasty.
Having a CABG does not prevent future blockages. In order to prevent future blockages:
- Eat a heart-healthy diet
- Get regular exercise
- Do not smoke
- Follow the recommendations of your healthcare provider
Prior to surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery and get clear instructions on what you need to do. These may include:
- Medications you should not take before the surgery, such as blood thinners
- Regular medications you should continue to take on the day of your surgery
- How many hours you should stop eating and drinking before the surgery
- Special skin care and washing
If you are a smoker, you should quit smoking, as it can interfere with your recovery.
During your surgery, you will receive general anesthesia to keep you comfortable and pain free. General anesthesia is when you are put into a deep sleep and are unable to see, hear or feel anything. After surgery:
- You will be in the intensive care unit for a period of time after surgery. You will remain in the hospital for about a week.
- Your nurse will help you get out of bed as soon as possible after surgery. This will help decrease the risk of post-operative complications (i.e., blood clots and infection).
- Pain medication and help at home will be needed while you recover.
- You may need to take medication to stop your blood from forming clots.
If your healthcare provider recommends a CABG, ask the following questions:
- What is my diagnosis and reason for the surgery? Are there any alternatives to surgery? Why are you recommending one treatment over another?
- What are potential complications if I decide against surgery?
- What are the possible complications of this surgery?
- How will I feel after the surgery? Will I have to modify my activity?
- Do I need any special tests? What are the benefits and risks of having the tests?
- Will the tests change your treatment recommendations? If not, is there a need for them?
- After surgery, what symptoms should I be concerned about? What precautions do I need to take?
- Can my symptoms be controlled with medications? If so, are their Tier 1 or Tier 2 medications on my Prescription Drug List that I should take? How long will I need to take these medications? What are the side effects of my medications?
- How many years have you been doing this type of surgery and what are your typical results 1 year and 5 years after surgery?
- Is your facility designated as a Center of Excellence for cardiac surgery? If so, by whom?
Prior to discharge, you should understand all home care instructions. This includes:
- Symptoms to report before your next appointment
- Medications and their side effects
- Follow-up plans
Don't forget to make arrangements for transportation to and from the facility and help at home.