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Coronary Arterial Bypass Graft (CABG)


When there are multiple blockages in the coronary arteries a Coronary Arterial Bypass Graft (CABG) is performed. The diagram below shows a heart with two blockages. Below the blockages (marked in yellow) the arteries have a reduced blood flow, starving the heart muscle of oxygen.

Narrowed section of artery Narrowed section of artery Narrowed section of artery Narrowed section of artery Circumflex artery Right Coronary Artery Left Anterior Descending Coronary Artery Aorta

Click here to see more on the anatomy of the heart.Click here to see more on the anatomy of the heart.

The aim of bypass surgery is to circumvent the affected area by routing blood from the aorta to an area of the artery below the blockage, where the heart is starved of blood. Several grafts may be needed.

 

Harvested veins (white) are attached from the main blood supply to below the blocked artery.
The blood vessel used for the graft, is harvested from the patient. The most common areas to take a vessel from is the leg or from within the chest area - the internal mammary artery.



Here the surgeon uses a keyhole technique to harvest a blood vessel from the leg.

 

The heart is reached by opening the centre of the chest. The breastbone is then exposed. The breastbone is then split down the middle (along the axis indicated on the diagram. The ribs are then held apart using special clamps. The surgeon can then expose the heart. At this point the surgeon may feel that it is necessary to stop the heart before proceeding with the graft procedure. In this event a heart-lung machine is connected. The surgeon is now free to start the bypass procedure. After the grafts have been applied the chest is closed, the ribs are wired back together and the wound stitched. A long scar will remain along the length of the breastbone.
The patient is then transferred to the Intesive Care Unit for up to 48hrs, before being tranferred to a ward. As this is a highly invasive procedure the recovery, discomfort will be felt in the days following the operation. Pain diminishes over the following weeks. Also if a vein has been harvested from a leg there will be some swelling and discomfort in that area.

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