Coronary artery bypass surgery is a procedure to treat coronary artery disease (CAD), the narrowing and hardening of arteries caused by plaque accumulation. Less invasive alternatives exist, including the hybrid bypass, which uses a smaller incision through the rib cage, and totally endoscopic coronary bypass surgery, during which robotic arms are inserted through small incisions in the chest. While these procedures are safer and provide a faster, easier recovery period, they are not yet widely available. The more invasive coronary artery bypass graft (CABG), the most common form of coronary artery bypass surgery, is likely to be required for most patients.
When detected early, coronary artery disease can often be treated successfully with dietary changes, smoking cessation, regular exercise, and medication. Even more advanced disease can be treated by the addition of less aggressive procedures such as angioplasty to clear the blockage, and placement of a stent to keep the artery open. If these measures fail or the disease is already advanced when it is discovered, then CABG is often performed.
Coronary artery bypass surgery is a highly invasive procedure that requires general anesthesia. Throughout the operation, medications are administered to help protect the patient and ensure surgical success. The surgeon opens the chest using a long midline incision, divides the sternum, and places surgical implements to pry the muscles and bones apart and allow full access to the heart.
The surgeon harvests a donor vessel from the patient's leg or chest and prepares the patient's heart for placement on the heart-lung bypass machine. While the patient is on the bypass machine, the heart is stopped. The surgeon grafts in the donor vessel around the area of the blockage in the artery. The grafted vessel bypasses the damaged artery so that oxygen-rich fresh blood can be delivered to the heart.
Once the grafts are complete, measures are then taken to start the heart pumping again. The chest is then closed, which involves reconnecting the sternum and wiring it into place. The wound is stapled and/or sutured and bandaged.
The hospital stay is usually five to seven days. Recovery from the surgery can take several months, but most patients can return to work in four to six weeks. Most patients experience relief from CAD-related chest pain and shortness of breath, but some continue to experience these symptoms. Coronary artery bypass surgery cannot prevent recurrence of CAD. Lifestyle changes and medication are still needed.