Coronary Artery Bypass Grafting

Coronary Artery Bypass Grafting (CABG) also referred to as Bypass Surgery is a procedure performed on people who are suffering from severe heart conditions, such as coronary atherosclerosis or acute coronary syndrome. This condition results in building a substance called plaque (plak) inside the coronary arteries. The plaque build-up overtime on the inner artery walls. This hardened and narrow or block the coronary arteries which reduce blood flow to the heart muscle and are not able to expand to their fullest capacity to allow the blood flow through into the heart. In CABG, a healthy/normal artery is taken from your leg, arm, chest or abdomen and connects it to the other arteries in your heart, bypassing the narrowed or blocked section. This can be performed by 2 techniques

  • Off-Pump or Beating Heart Surgery
  • On–Pump or Cardiopulmonary Bypass Surgery


Just like the other organs in your body, the heart also requires a constant supply of blood and oxygen supplied through the left and right coronary arteries. This supply of blood can develop a condition known as atherosclerosis, in which these arteries become hardened or narrowed due to fatty-acid buildup. Your cardiologist may recommend you CABG in the following situations:

  • When your heart muscles fall short of oxygen supply with even the lightest form of activity or at rest – Angina is severe.
  • When the arteries are blocked and could not be treated with medication or artery-opening procedures like angioplasty or you have been through a previously unsuccessful angioplasty.
  • There may be blockages in more than one artery supplying blood to the heart.
  • It is done on an emergency basis, such as during a heart attack.


To decide whether you’re a candidate for CABG your doctor will first guide you through necessary medication, restrictions on diet and changes lifestyle ahead of your surgery so that you can decide if you’re ready for the surgery or not. He will also ask you about any symptoms you have, such as chest pain or shortness of breath Various Tests like the electrocardiogram (ECG), coronary angiogram, chest X-rays and blood tests will be performed to find out which arteries are clogged, how much they’re clogged, and whether there’s any heart damage.


During the surgery, your surgeon will first remove a segment of a healthy artery or vein (graft) from another part of your body. These grafts are usually taken from the leg (saphenous vein), inside the chest (internal mammary artery) or the arm (radial artery). Once the graft is ready, the surgeon will make an incision in the center of the chest, along with the breastbone, and spreads open the rib cage to access the heart. Based on the technique used by the surgeon, CABG can be Beating Heart Surgery or Cardiopulmonary Bypass Surgery.

It takes about 3 to 6 hours for an off – Pump or Beating Heart Surgery to lasts but It may vary depending on the severity and number of blockages in the heart. The surgery is often done under the effect of general anesthesia. With a stabilization device, the area of the heart that is to be operated upon is immobilized and stabilized for the duration of the surgery. The surgeon will then stabilize the area of the heart to be worked on using a stabilization device. The device the gently attaches itself to the surface of the heart through small suction pods that will steady the heart’s movement in that area.

In an On – Pump or Cardiopulmonary Bypass Surgery the heart is temporarily stopped and circulation of blood to the body is done through the heart-lung machine. In the next step, one end of the graft is attached to the area that lies just above the blockage in the heart artery. Another end is attached to an area below the blockage. Once the graft is successfully implanted over the blocked blood vessel your surgeon uses electrical signals to restore your heartbeat and attaches a temporary pacemaker to make your heart beat normally.


Coronary Artery Bypass Grafting is a major procedure. The patient is kept and monitored in the intensive care unit (ICU) for a day or two post the surgery before being transferred to regular hospital care room for some more time, It largely depends on patient’s response to the procedure. It takes a week or two to get the discharge, but it will take another six weeks to get back to your normal routine and be able to resume some of your daily activities.

  • You will be recommended to attend a cardiac rehabilitation programme for recovery through exercise and education therapy by your surgeon.
  • Regular Follow-ups as directed by your hospital will help monitor your progress and take note of any relapse in treatment.
  • There may be lifestyle changes that will be recommended by your surgeon after CABG.
  • You will be given medications that will help to lower your blood cholesterol, avoid blood clot and help your heart function as well as possible.


Coronary Artery Bypass Grafting is very major surgery. Thus, it can pose complications during and/or after the procedure, which you will be told beforehand.  Though the risks and complications largely depend on the status of your health prior to the surgery, the risk is higher if the surgery is carried out as an emergency. Possible risks from a coronary bypass surgery may include:

  • Heart rhythm problems or stroke
  • Chest wound infection
  • Beating heart CABG procedure results in shorter post-operative stays
  • Disruption of cognitive abilities and memory loss
  • Arrhythmias
  • low fever and chest pain or post-pericardiotomy syndrome



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