Open Heart Bypass Surgery
Frequently referred to as “CABG Surgery” or “open heart surgery”, Coronary Artery Bypass Graft surgery is the surgical treatment of choice for blocked arteries surrounding the heart.
The heart pumps blood for the entire body but still depends on a series of blood vessels called the coronary arteries for its own blood supply. If the arteries become severely blocked, a condition known as coronary artery disease, oxygen does not reach the heart muscle and damage occurs. Open heart surgery, or bypass surgery, is considered the "gold standard" treatment of coronary artery disease.
To prevent damage to the heart, flow through the coronary arteries must be increased. During an open heart surgery the blocked arteries are removed or bypassed with blood vessels taken from another part of the body. In most surgeries, two to four coronary arteries are grafted to ensure adequate flow to the heart.
Indications for Open Heart Bypass Surgery:
Major diet changes, smoking cessation and exercise have not improved the coronary artery disease.
Angioplasty is unsuccessful, not appropriate or the artery is becoming blocked again after angioplasty.
Severe chest pain with activity.
Testing shows severe disease in the left main coronary artery.
Testing shows severe disease in multiple arteries.
Stents did not work, could not be placed or are needed again.
The left ventricle is not working properly due to coronary artery disease.
There is an imminent risk of heart damage.
Preparing for Open Heart Bypass Surgery:
Many cardiac surgeons order extensive testing before proceeding with a CABG to determine which arteries are obstructed and the severity of the blockage. An angiogram is one outpatient test that uses x-rays to determine the severity of coronary disease.
A stress test, electrocardiogram (EKG) and blood tests are usually done in advance of the surgery. Blood tests may be repeated immediately prior to surgery to determine if the patient is likely to bleed during surgery, along with their general health.
A surgeon may have very specific instructions for a patient scheduled for bypass surgery. These instructions may include changes in prescription medications, diet and drinking and smoking habits
Recovery From Open Heart Surgery:
In many surgeries, drugs are given to wake the patient immediately after the incision is closed. Most surgeons opt to allow CABG patients to wake slowly, to prevent any stress on the heart that might happen when waking abruptly.
The patient will be taken to the recovery area, usually a cardiac or surgical intensive care unit, for care while coming out of anesthesia. The critical care environment is necessary to provide the patient with one on one nursing care and constant monitoring. At this time the ventilator will remain in use, providing breathing support while the patient remains sedated.
One or more chest tubes, large tubes that are inserted around the surgical site, help remove any blood that may have collected around the heart. A large IV called a Swan-Ganz will also be in place, allowing staff to monitor critical heart functions and infuse medications.
Once the anesthesia drugs wear off and the patient is awake, the breathing tube is removed (a process called extubation) and the patient is able to breathe on their own. Immediately after extubation supplemental oxygen may be given by nose, to assist with breathing. Oxygen levels and breathing will be closely monitored and if a patient cannot breathe adequately without the ventilator, the breathing tube will be reinserted.
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