A bypass graft, more commonly called coronary artery bypass grafting (CABG), is a surgical procedure that restructures the blood flow to the heart. It may be necessary for patients with advanced cases of coronary artery disease, in which high cholesterol leads to plaque accumulation in the arteries. This dangerously restricts the volume of blood that can flow to the heart, potentially causing a heart attack. A bypass graft is usually performed as an open surgery, which will require a recovery time of about a week in the hospital, followed by four to six weeks of rest at home.
Candidates for a bypass graft procedure have already tried to treat their condition with a low-fat diet, regular exercise, and medication. Their doctors will first explore the possibility of using less invasive treatments, such as an angioplasty, which can improve blood circulation through the use of special balloons inserted into the arteries. Patients with other medical conditions, such as diabetes or heart valve disease are more likely to undergo a bypass graft. Those with weakened heart muscle and two or more blocked arteries are also candidates for this procedure.
Before undergoing a coronary artery bypass grafting, patients must discuss post-operation lifestyle changes with their doctors. This procedure is not a cure for artery hardening and narrowing, and so patients must be committed to healthy lifestyle changes to encourage the success of the surgery. Patients will undergo a series of tests prior to the bypass graft, such as an electrocardiogram (EKG), imaging tests, and blood tests. They will need to stop eating and drinking for a brief period of time, and tobacco users will need to quit smoking.
To begin the bypass graft, the patient will first be rendered unconscious with general anesthesia. A ventilator and breathing tube are used to facilitate breathing. The surgeon will make a large incision in the chest and open up the breastbone to allow access to the heart. Usually, this surgery is performed with a heart-lung bypass machine, which means that tubes are hooked up to the major arteries and the blood is pumped by the machine instead of by the heart. This allows the surgeon to temporarily stop the heart with medications to facilitate the surgery.
The surgeon will then remove a vein or an artery from the patient, typically from a leg, arm, or the chest. This artery or vein is used as a graft to reroute the blood. It will be reattached to both the heart and the blocked artery at a point past the blockage. The blood can then flow through the newly attached artery, around the blockage, and to the heart. Once the heart begins to pump again, the surgeon will suture the breastbone and close the incision.
After a bypass graft surgery, the patient will likely stay in the intensive care unit (ICU) of the hospital for one to two days for close monitoring. He will then be moved to another area of the hospital for the next three to eight days for initial recovery. Patients should expect to recover at home for the next four to six weeks. They should not drive or exercise for the first two to three weeks. A typical rehabilitation routine includes physical therapy, occupational therapy, and consultations with a nutritionist.
Before undergoing a bypass graft, patients should be aware of the potential risks, which are relatively uncommon. Blood clots, infection, and shortness of breath may occur. Abnormal heartbeats, swelling of the legs, and problems concentrating have also been reported. In very rare cases, deaths have occurred from a reaction to the anesthesia or because the heart would not restart.