Having Off-Pump Coronary Artery Bypass (CABG) Surgery
Coronary artery bypass surgery is a type of heart surgery. It’s commonly known as CABG ("cabbage"). The surgery is done to bypass a blocked area in a coronary artery. This is known as coronary artery disease. The coronary arteries are blood vessels that supply blood to the heart muscle. They keep the heart muscle healthy so it can pump blood around the body.
What to tell your healthcare provider
Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs and other supplements, and recreational drug use. And tell your healthcare provider if you:
Have had any recent changes in your health, such as an infection or fever
Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)
Are pregnant or think you may be pregnant
Tests before your surgery
Before your surgery, you may need tests such as:
Electrocardiogram (ECG), to check the heart’s rhythm
Blood tests, to look at your general health
Echocardiogram, to view heart anatomy and blood flow through the heart
Cardiac stress testing, to check your heart’s activity during exercise
Getting ready for your surgery
Talk with your healthcare provider how to get ready for your surgery. You may need to stop taking some medicines before the surgery, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.
Also, make sure to:
Ask a family member or friend to take you home from the hospital. Don't drive yourself.
Plan some changes at home to help you recover. You may need help at home.
Follow any directions you are given for taking medicines and for not eating or drinking before surgery.
Follow all other instructions from your healthcare provider.
You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions if something is not clear.
On the day of surgery
Your procedure will be done by a cardiac surgeon. This is a doctor who treats diseases of the heart. He or she will work with a team of specialized nurses and operating room staff. The surgery can be done in more than one way. Some surgeons use robot-controlled arms to do the surgery. Talk with your doctor about the risks and benefits of this kind of surgery. The surgery will take several hours. In general, you can expect the following:
You will have general anesthesia, medicine that allows you to sleep through the surgery. You won’t feel any pain during the surgery.
Hair in the area of the surgery may be removed.
Your heart will keep beating during the surgery.
A healthcare team will watch your vital signs, like your heart rate and blood pressure, during the surgery.
Your surgeon will make an incision to remove a blood vessel from another part of your body. This is the graft. The graft vessel is most often taken from your chest wall, leg, or arm.
The surgeon will make an incision down the middle of your chest. He or she will then separate your breastbone to reach your heart.
If you are having a minimally invasive off-pump CABG, the surgeon will instead make a small incision down the middle of your chest. He or she will then separate a small part of your breastbone. He or she may use special tools and a tiny camera to do the surgery. The surgeon may make several small incisions in your chest, between the ribs.
The surgeon will attach the graft vessel to the aorta. The aorta is the main blood vessel leading from the heart out to the body. The surgeon will attach the other end of the graft vessel to the blocked coronary artery, to bypass the blockage.
The healthcare team wires your breastbone back together, if needed.
The team closes all incisions with stitches or staples. They put dressings on the incisions.
After your surgery
After surgery, you will be taken to a recovery room or directly to the intensive care unit (ICU). Nurses will check your breathing, heart rate, and blood pressure. You may have a tube draining fluid from your chest. You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. The tube is usually removed within 24 hours. You may stay in the hospital for up to 5 days.
You may have some pain at the incision site after surgery. You can take pain medicines to help relieve it. Only take pain medicine approved by your healthcare provider.
In a day or two, you should be able to sit in a chair and walk with help. You may need to do breathing therapy to help prevent or remove fluid building up in your lungs. You can go back to your normal food as soon as you feel able.
Make sure you have someone to help at home for a while. When you go home, it may take a little while for you to go back to your normal activities. Avoid vigorous exercise until your doctor says you are ready. Don’t lift anything heavy until your doctor says it’s OK. Ask your doctor when it is safe for you to drive.
You will probably have your stitches or staples removed in 7 to 10 days. Make sure you keep all of your follow-up appointments. Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
Your doctor may refer you to a cardiac rehab program. This is to help you regain your strength after heart surgery.
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Increase in pain, redness, bleeding, or fluid leaking from the incision
Other symptoms as advised
April 27, 2018
Aldea GS. Minimally invasive coronary artery bypass graft surgery: definitions and technical issues. UpToDate., Polomsky M, Puskas JD. Off-pump coronary artery bypass grafting: the current state. Circulation Journal. 2012;76:784-90., Stulak, JM. Off-pump and minimally invasive direct coronary artery bypass graft surgery: Outcomes. UptoDate.
MMI board-certified, academically affiliated clinician,Snyder, Mandy, APRN,Sudheendra, Deepak, MD,Turley, Ray, BSN, MSN