Coronary Artery Bypass Grafting

About Coronary Artery Bypass Grafting

Coronary artery bypass grafting, known as CABG, is an open heart operation that treats severe coronary artery disease by routing blood around narrowed or blocked coronary arteries. It is one of the most frequently performed major heart operations worldwide. Grafts are taken from the internal mammary artery inside the chest wall, the great saphenous vein of the leg or the radial artery of the forearm. The left internal mammary artery connected to the left anterior descending artery is regarded as the most durable graft, while vein grafts are more prone to narrowing over the years. Most operations are performed on pump, using cardiopulmonary bypass so that the heart can be stopped and the surgeon works on a still, bloodless field. Off pump coronary artery bypass, often abbreviated OPCAB, is performed on the beating heart, using stabilizing devices that hold the target vessel steady while it is sutured; it avoids the heart lung machine but is technically more demanding, and large randomized trials have generally found broadly similar overall outcomes for the two approaches. Off pump surgery may be favored for some patients with a heavily diseased aorta or other conditions that increase the risks of bypass. Typical indications include disease of the left main coronary artery and disease of multiple vessels, particularly in people with diabetes. Recognized complications include stroke, atrial fibrillation, wound infection including mediastinitis, kidney injury and cognitive changes. Minimally invasive direct coronary artery bypass and robot assisted techniques are used for selected patients. Recovery involves healing of the breastbone and cardiac rehabilitation over a period of weeks to months.