What is Coronary Artery Bypass Grafting?

My name is Dr. Scot Denmark, and I'm a cardiovascular surgeon and I do heart surgery here at the Atrium Medical Center.

CABG, the acronym is C-A-B-G, and that stands for Coronary Artery Bypass Grafting.

Patients that, that come for coronary artery bypass grafting or coronary bypass surgery have significant blockages in several of their coronary arteries.  Physicians take care of patients such as that with atherosclerosis, hardening of the arteries in the heart 3 major ways:  One is medication and that's, that's always present.  It's part of everybody's regimen that has this disease atherosclerosis, coronary artery disease.  Um, the second technique for taking care of blocked arteries is angioplasty and stenting and that's what cardiologists do. 

And the third method of taking care of people with this problem is coronary artery bypass surgery, or bypass grafting.  Some people need a combination of the techniques, some people need one technique more than the other, and the important decision then is one of which therapy is most appropriate for each patient.  In general, patients that come to surgery are people that have blockages in, usually, 2 or 3 or more arteries.  If the patient has only one artery or possibly 2 that are blocked, then the cardiologist usually takes care of that with angioplasty and stenting.  One of the major differences between what we as surgeons do, and what cardiologists do with people that have blocked arteries, is that the cardiologists go directly for the area that is blocked.

What we do as surgeons, is instead of going directly for the area that's blocked, we go downstream on the artery where it is open and that's the place where we make a tiny incision and we will sew in a bypass graft.

A patient goes to sleep with a general anesthetic and they have a breathing tube in place.  Once they are completely anesthetized, then we get access to the heart by making an incision through the middle of the breast bone or the sternumat the same time as the chest is being opened, usually an assistant is working on the leg and removing the vein, or harvesting the vein. The surgery itself usually takes somewhere between 3 and 4 hours.

Most patients are in the hospital less than a week – we usually say 4 to 7 days.  The first couple of days are in more of an intensive care setting and then as the patient continues to recover from the surgery, the intensity of the care is reduced.  We set things up here at the Atrium such that the patient does not really leave the unit that they've come to.  We keep the patients there, many of them, if they're elsewhere in the hospital, will be transferred to that unit the night before surgery so they can become acquainted with the nurses and with the, the location.

If a person was relatively vigorous and active before surgery, they're generally up and about, you know, the day or so after surgery, at least in a chair, moving around the room, and then with each day, their activity increases, so that when they go home, they're able to go up and down steps, usually slowly, you know, one flight at a time, but certainly they are able to do that. We do place certain activity restrictions on patients in terms of allowing their breast bone to heal after the surgery.  That usually takes about 8 weeks. 

We generally see patients back in our office about a month after they've been discharged from the hospital, at which time, if all their incisions are healing well, we usually give them permission to start driving a car.

Cardiac rehab usually starts right after surgery, um, or right after the patient is off the, the breathing machine.  It starts with the physical therapist, as well as nurses:  Just getting the patient from the bed to the chair, that's a form of physical therapy.  And then they take a few steps in the room, and with each passing day, their level of activity increases but most patients do go through some form of a formal rehab program.