Coronary Artery Bypass Grafting

We encourage you to talk to your cardiologists and surgeons and discuss about the need and outcome of the surgery and at the same time understand its benefits and risks.

You should talk them about what medications can be taken on the day of the surgery, what pills need to be stopped and when. You will be hospitalized one or two days before the surgery giving enough time to have all the required pre-operative tests.

Laboratory tests (Blood and Urine analysis), Chest X-Ray, Electrocardiogram, Echocardiogram and breathing test (spirometry) will be done. Recent angiogram will always be required before having bypass surgery.

It is normal for all to be nervous and anxious before surgery. An anesthesiologist usually visits you the day before the procedure. He will discuss the plan and the postoperative pain management. He might prescribe an anti-anxiety medication as a part of the hospital's routine procedure. You will not be able to eat or drink anything from the evening or midnight before surgery. This is called "NPO" or nil per oral. You can take your medications with sips of water.

Prior to the procedure all personal belongings will be removed and handed over to your family member. Hair from chest and legs will be shaved off and you may be asked to shower with antiseptic soap to reduce the risk of infection. You will have Intravenous lines in one or both hands and one arterial line will be added in the operation room.

Inside the Operation Room

Once the anesthesia is administered a tube will be inserted into your windpipe through your mouth, which will be connected to a ventilator to assist your breathing. The general anesthesia helps you fall into deep sleep so that you feel no pain during surgery. The nurse then cleans the chest and the graft site (from where the vein or artery will be removed) with spirit and iodine. You will be completely covered with sterile drapes, exposing only the chest and the graft site (legs in case of vein graft).

The number of grafts that you will need depends on the number of blockages or obstructions in the coronary arteries. One of the branches of the left main artery called as the "Left anterior descending" artery is usually grafted with an artery called "Left Internal Mammary artery". Another artery graft that can be used for CABG is the "Radial artery". The "ulnar artery" maintains the blood supply to the forearm when the radial artery is removed.

Artery supplying to the stomach "Gastroepiploic artery" and abdominal wall "Inferior epigastric artery" are less commonly used. However the most commonly used vessel is not an artery but a vein called the "Saphenous vein" from the thigh. This vein is usually removed from the groin to the knee or feet, in one or both legs depending on the number of grafts required.