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Coronary
Artery Bypass Surgery (CABG)
What does "bypass surgery" mean?
Bypass surgery can be performed on any artery in the body,
but most often involves the coronary arteries (the arteries
that supply blood to the heart muscle itself). During bypass
surgery, a graft vein or artery is taken from a healthy blood
vessel in the body. The graft is then surgically attached
above and below an obstructed or poorly functioning artery.
After surgery, the blood will flow thru the graft vessel,
avoid or "bypass" the blocked vessel, and provide
oxygen and nutrients necessary for survival to the area of
tissue beyond the blockage.
 Why
is the doctor performing this surgery?
To bypass, or go around, the obstruction caused by a coronary
(heart) artery filled with a clot or with plaque (atherosclerosis).
If the obstruction is not bypassed, the heart muscle beyond
the obstruction is denied oxygen and nutrients leading to
heart damage (heart attack or pain).
What is the surgery?
There are two types of Coronary Artery Bypass Surgeries (CABGs)
performed routinely at Sparrow:
- On Pump: On Pump CABG is also known
as "Traditional Bypass Surgery". The pumping and oxygenation
function of the heart is taken over by a heart-lung machine
during the surgery, and medications are given that briefly
paralyze the heart (cardioplegia). This way, the heart is
completely at rest while the surgeon performs the bypass
surgery.
- Off Pump/Beating Heart: Off Pump CABG is also known as
"Beating Heart Bypass Surgery" and is another
method of bypass surgery. A heart-lung machine is not used,
and the heart is not stopped with medications. Instead,
the heart continues to perform its pumping and oxygenation
functions while the surgeon works. The surgeon stabilizes
just the portion of the heart where the bypass is needed,
while the remainder of the heart continues to function normally.
According to the Journal of the American Heart Association,
off-pump bypass, in the appropriate patients, is as safe
and effective as standard on-pump coronary bypass surgery,
and many healthcare professionals, including our surgeons
believe it may reduce the risk of stroke, bleeding and renal
failure. Off-pump bypass is not for everyone, and there
is no long-term data available about outcomes…yet.
However, it is a highly effective surgical option which
you can discuss with your doctor.
There are four sources used during bypass surgery for the
healthy graft blood vessel:
- Endoscopic Vein Harvesting: The
saphenous vein in the leg is the most common vein used as a
bypass graft. Traditionally, the saphenous vein was obtained
via a long incision in the leg, from groin to ankle.
Contrary to popular perception, this usually presents the
highest degree of post-procedural pain from coronary bypass
surgery. Sparrow Hospital has employed a new endoscopic
technique, which requires only two or three 1-inch long
incisions in the leg. An endoscope connected to a video
camera is then inserted into the smaller incisions and the
saphenous vein is removed with far less scarring and trauma.
This technique is only available in select centers
throughout the US including Sparrow Hospital.
- Arterial Bypass: There are several
arteries that can be used as grafts for bypass surgery, but
the most common is the left internal mammary artery (LIMA).
The right internal mammary artery (RIMA) may also be used as
a graft. These arteries are accessed thru the same chest
incision used to access the heart. Occasionally, the radial
(in the arm) or the gastroepiploic (near the stomach)
arteries may be used, each accessed thru separate incisions.
- Sutureless Anastomic Device:
Occasionally, surgeons at Sparrow use a sutureless device,
which can be used for the part of a vein graft that is
attached to the aorta. The saphenous vein is loaded onto a
device that is inserted into a small hole the surgeon has
cut in the patient's aorta. The surgeon then pushes a
button, releasing a tiny web of wires, which unfold to form
a star-shaped rivet. Your doctor can determine if this is an
option for you.
- Donor Saphenous Vein: This is a vein that has been cryopreserved
and stored in a tissue bank. It is blood type specific for
the patient.
Where is the surgery performed?
Both On-Pump and Off-Pump/Beating Heart surgeries are performed
in the Operating Room (OR), and under general anesthesia.
 How
long does this surgery take?
The length of time surgery takes will vary based on the number
of vessels being bypassed, the graft location, On-Pump vs.
Off-Pump/Beating Heart procedure, the patient's associated
medical problems, etc, but usually an On-Pump or Off-Pump/Beating
Heart surgery will take between 3-6 hours.
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