The coronary artery provides essential blood flow to the heart muscle to allow it to pump blood throughout the rest of the body. Sometimes, this artery becomes blocked or partially blocked making it difficult for the heart to function properly. Coronary artery bypass surgery utilizes healthy blood vessels or grafts, to reroute blood around the blockage. Our surgeons utilize the latest and least invasive techniques possible to achieve less blood loss, reduced pain, and achieve a shorter length of stay and faster recovery.
Treatments
- Graft (CABG): Your surgeon may use a graft to bypass the blockage by attaching one end of the graft above the blockage, and the other end below the blockage. Blood is able to flow through the graft to reach the heart muscle.
- Off Pump (OPCAB): The off-pump procedure provides a safer alternative to the heart-lung machine. Surgeons attach the bypass graft to the blocked artery while the heart is beating. This is accomplished using state of the art devices to stabilize the heart.
- Minimally Invasive: The MIDCAB treats blockages in the left anterior descending artery (LAD) as well as its branches. (Right-sided blockage may be treated with a hybrid MIDCAB.) The surgeon makes a small incision between the ribs on the patient’s left side. Heart-lung equipment may or may not be used.
- Robotic-Assisted: The most recent technological advance, RACAB provides access to the coronary arteries without opening the sternum. The surgeon does not have direct contact with the patient but guides robotic instrumentation via a video monitor.
- Hybrid: Complex coronary blockages can be treated using a combination of the least invasive methods for revascularization (reestablishing blood flow to the heart). This can be performed in partnership with invasive cardiology whereby a single vessel coronary artery bypass can be performed using minimally invasive approaches with percutaneous approaches to other coronary blockages in the hybrid operating room.
During the Procedure
CAB is typically performed under general anesthesia and involves the following steps:
- Anesthesia: Local anesthesia is administered to numb the area. In some cases, mild sedation may be used to help you relax.
- Breathing Machine: A breathing tube may be placed in the mouth allowing a tube to flow to a breathing machine, or ventilator.
- Incision: A vertical or horizontal incision is made in the chest to access the heart.
- Cardiopulmonary Bypass (CPB): The patient is connected to a heart-lung bypass machine, which takes over the heart’s pumping function while blood circulation is maintained.
- Graft Placement: The surgeon attaches the grafts to bypass the blocked or narrowed coronary arteries, creating new routes for blood flow.
- Completion and Recovery: Once the grafts are in place, the heart is restarted, and the patient is gradually taken off the bypass machine. Chest incisions are closed with sutures or staples. Total time ranges from three to six hours.
After the Procedure
After CAB, patients are closely monitored in the intensive care unit (ICU) to ensure stable vital signs and proper recovery. The healthcare team will provide pain management, administer medications, monitor incision sites, and manage any potential complications. The length of ICU stay varies depending on the individual patient’s condition.
Advantages
- Restores Blood Flow: CAB bypasses blocked or narrowed coronary arteries, restoring blood flow to the heart muscles and relieving symptoms.
- Long-Term Effectiveness: CAB has shown to provide long-lasting symptom relief and improved survival rates in individuals with severe coronary artery disease.
- Potential for Complete Revascularization: CAB allows for multiple grafts to be placed, enabling complete revascularization of the heart.
Risks and Complications
While CAB is generally considered safe, potential risks and complications include:
- Bleeding: Excessive bleeding can occur at the surgical site or from the grafts.
- Infection: Infection at the incision sites or within the chest cavity may occur.
- Arrhythmias: Irregular heart rhythms may develop during or after surgery.
- Stroke: In rare cases, a stroke may occur due to interruption of blood flow to the brain.
- Kidney Problems: Temporary kidney dysfunction can occur after CAB.
- Complications related to anesthesia or the use of the heart-lung bypass machine.
Typical Recovery Time
The recovery time after CAB varies depending on the individual patient, the complexity of the procedure, and any associated complications. In general, patients can expect a hospital stay of 3 to 7 days. It may take several weeks or months to fully recover, and most individuals can return to normal activities within 6 to 12 weeks. Cardiac rehabilitation programs are often recommended to aid in recovery, improve cardiovascular health, and provide guidance on lifestyle changes.
Results and Post-Procedure Care
CAB can significantly improve quality of life, relieve symptoms, and reduce the risk of heart attack. After the procedure, post-operative care typically involves:
- Medications: Prescription medications to manage pain, prevent infection, control blood pressure, and reduce the risk of blood clots may be prescribed.
- Wound Care: Proper care of the incision sites, such as keeping them clean and dry, is important to prevent infection.
- Cardiac Rehabilitation: Participation in a cardiac rehabilitation program, which includes exercise, education, and counseling, is highly beneficial for recovery and long-term heart health.
- Lifestyle Modifications: Adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, smoking cessation, stress management, and medication adherence, is crucial for long-term success.
If you have specific concerns about a procedure or your health, please consult a physician.