Coronary Artery Bypass Graft

Coronary artery bypass graft
Coronary artery bypass graft surgery usually lasts 3 to 6 hours. But it may take
longer depending on how many blood vessels are being attached.
Blood vessels can be taken from the leg (saphenous vein), inside the chest (internal
mammary artery), or the arm (radial artery).
Other blood vessels in these areas are able to compensate for the loss of these
blood vessels after the operation.
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The number of blood vessels used will depend on how severe the coronary heart
disease is and how many of the coronary blood vessels have become narrowed.
If you need 2, 3 or 4 grafts, you may hear your operation referred to as a double,
triple or quadruple bypass.
CABG X 1 CABG X 2 CABG X 3 CABG X 4
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One of the graft vessels is usually taken from the chest (internal mammary artery).
Surgeons prefer to use this vessel because it doesn't narrow over time, unlike the
blood vessels taken from the leg or arm.
Once all the graft vessels have been removed, the surgeon will make a cut down the
middle of the chest so they can divide the breastbone (sternum) and access the
heart.
During the procedure, the blood may be rerouted to a heart-lung bypass machine.
This takes over from the heart and lungs, pumping blood and oxygen through the
body.
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The heart will be temporarily stopped using medication while the surgeon attaches
the new grafts to divert the blood supply around the blocked artery.
After the grafts have been attached, the heart will be started again using controlled
electrical shocks.
The breastbone will then be fixed together using permanent metal wires and the skin
on the chest sewn up using dissolvable stitches.
Newer surgical techniques:

Off-pump coronary artery bypass surgery (OPCAB)
More surgeons are now performing off-pump coronary artery bypass surgery
(OPCAB), which is a variation of the conventional procedure.
A coronary artery bypass graft is often described as on-pump surgery because it

involves using a heart-lung bypass machine to pump blood and oxygen around the
body during the procedure, while the heart is temporarily stopped.
During OPCAB, the heart is still beating while the new blood vessel grafts are
attached and a heart-lung bypass machine isn't used.
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The benefits of OPCAB are:
• it often takes less time to perform than the conventional procedure

• it can reduce your chance of bleeding during the surgery
• it may be less likely to develop certain serious complications after surgery,
such as a stroke
• the stay in hospital will usually be shorter
The main disadvantage is that OPCAB is more technically demanding because the
grafted vessels have to be delicately connected while the heart is beating.
This means the procedure may be too difficult to perform if a large number of blood
vessels need to be grafted.
For the same reason, if emergency surgery is required, there may not be ready
access to a surgeon with the training required to perform an OPCAB.
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Endoscopic vein (vessel) harvesting (EVH)
Endoscopic vein harvesting (EVH) is a less invasive method of removing the veins
from the legs.
Rather than making a large cut in the leg, the surgeon makes a number of small
ones near the knee. This is known as keyhole surgery.
A special device called an endoscope will be inserted into the cut.
An endoscope is a thin, long flexible tube with a light source and video camera at
one end, so that images of the inside of the body can be relayed to an external
television monitor.
The endoscope allows the surgeon to locate the saphenous vein.
Surgical instruments can also be passed along the endoscope to remove a section
of the vein.
Nearby tissue is then sterilised with antibiotic fluid and the cut is healed.
The main advantages of this technique are that there's likely to be a:
• shorter hospital stay

• lower risk of leg wound infections
• quicker recovery from CABG
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Totally endoscopic robotically assisted coronary artery bypass (TECAB)
grafting
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Totally endoscopic robotically assisted coronary artery bypass (TECAB) grafting is a
newer technique in heart surgery.
It's a minimally invasive (keyhole) method of performing a heart bypass.
During a TECAB grafting procedure, the surgeon deflates the lungs and makes a
number of small cuts between the ribs.
Robotic arms, controlled by the surgeon, are used to carry out the surgery.
An endoscope is attached to the robotic arms so the surgeon can see inside the
body and view the results of the surgery on a screen.
TECAB grafting can be carried out using a heart-lung bypass machine, or it can be
done off-pump.
There are lower rates of wound infection with this type of surgery, plus minimal
scarring and a faster recovery time.
But as this is a new technique that's only been carried out on a small number of
people, it's difficult to assess how effective and safe it is in the short and long term,
and how the outcomes compare with other types of surgery.
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Coronary Artery Bypass Graft

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Coronary Artery Bypass Graft

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Coronary artery bypass graft

CABG X 1 CABG X 2 CABG X 3 CABG X 4

Newer surgical techniques:

A coronary artery bypass graft is often described as on-pump surgery because it

• it often takes less time to perform than the conventional procedure

A special device called an endoscope will be inserted into the cut.

The endoscope allows the surgeon to locate the saphenous vein.

The main advantages of this technique are that there's likely to be a:

• shorter hospital stay

It's a minimally invasive (keyhole) method of performing a heart bypass.

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