B Y P A S S S U R G E R Y
Coronary artery bypass surgery (or "CABG" pronounced "cabbage"), has been around since the 1970's. It revolutionized the treatment of coronary artery disease, and continues to be a workhorse in decreasing symptoms and prolonging the life of patients with coronary artery disease.
"Bypass" surgery does just that. In order to supply blood to the heart muscle beyond blockages in the coronary arteries, blood is shunted to the same artery beyond the blockage. The bypass "grafts" most often used are veins from the legs (the "saphenous" veins). These are attached to coronary artery beyond any blockages. Many people think that the blockage is cut out, but it is left in place, and blood is simply shunted around it.
During this procedure, the patient is under general anesthesia. The chest is opened using a saw through the mid portion of the breastbone (the "sternum"). An assistant often "harvests" the vein grafts from the leg while the primary surgeon does this portion of the procedure. In order to attach the grafts, the heart is stopped and placed on a bypass pump so that the sewing can be done. After all of the grafts are placed, the heart is taken off of the bypass machine, and is restarted. The chest is closed using wire. The skin is closed using a variety of techniques and materials according to surgeon's preferences. The whole procedure lasts several hours.
After surgery is completed, the patient is transferred to an intensive care unit. Intravenous medications are required, sometimes including drugs to help control the blood pressure (which may be either too high or too low), the heart rate (which may be either too fast or too slow), or a variety of other parameters. The tube in the patient's windpipe ( the "endotracheal tube") will remain in place and a mechanical ventilator will be used until it is felt the patient can breath safely and adequately on his or her own.
The patient will be transferred out of the intensive care unit generally within a day or two after surgery. They will be monitored closely for complications, and be encouraged to take deep breaths to keep their lungs clear. Walking is generally encouraged early and often. The patient is generally ready for dismissal in 3-7 days, but will require assistance at home for another week or two. For those who work, they generally may return in 4-6 weeks.
Bypass surgery is a big procedure, but once completed, patients generally feel a sense of relief and accomplished sensing "that is taken care of". Indeed, a lot has been accomplished with this procedure. Don't forget however that in some ways, it's just the beginning. Important changes to the patient's lifestyle must be understood, started, and maintained. Medications will still be needed in every case, and follow-up with a physician will be required. Plenty of great times are left, you'll just need to make a priority of taking care of yourself!
©COPY;1997 HeartPoint Updated July 1997
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