Centres of Excellence

Diagnostic tests have helped your heart doctor identify the location, type and extent of your coronary artery disease. The results of these tests, the structure of your heart, your age, the severity of your symptoms, the presence of other medical conditions, and your lifestyle will help your cardiologist, surgeon and you determine what type of treatment is best.

After general anesthesia is administered, the surgeon removes the veins or prepares the arteries for grafting.

As with any surgery, there are risks involved. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation. Your cardiologist will discuss these risks with you before surgery; please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are.

Surgical Procedure

To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The graft is sewn into the opening, redirecting the blood flow around this blockage.
The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery.
At our center all coronary bypass is done on a healthy heart.

Minimally Invasive Technique

Minimally invasive coronary artery bypass (MIDCAB) surgery is an option for some patients. We also carry out CABG by Minimally Invasive Technique.
The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Other possible benefits may include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital (3 to 5 days) and decreased recovery time.

 

Traditional incision	Minimally invasive incision

The surgical team will carefully compare the advantages and disadvantages of minimally invasive CABG surgery versus traditional CABG surgery. Your surgeon will review the results of your diagnostic tests before your surgery to determine if you are a candidate for any of these minimally invasive techniques.
 

The surgery generally lasts from 3 to 5 hours, depending on the number of arteries being bypassed.

After Surgery

The patient is transferred to an intensive care unit for close monitoring for about one to two days after the surgery. The monitoring during recovery includes continuous heart, blood pressure and oxygen monitoring and frequent checks of vital signs and other parameters, such as heart sounds.
Once the patient is transferred to the step-down nursing unit, the hospital stay is about 3 to 5 more days.

For a while after the surgery, you may feel worse than you did before surgery. This is normal and is usually related to the trauma of surgery. It may take you from 4 to 10 weeks to fully recover from surgery.
How you feel after surgery depends on your overall health, the results of the surgery, and how well you take care of yourself after surgery. After recovering from surgery, most patients do feel better. To some extent, how you feel will depend on how you felt before surgery.
Patients with more severe symptoms before surgery may experience a greater sense of relief after surgery. Call your doctor if you are concerned about your symptoms or rate of recovery.

Recovery

Full recovery from coronary artery bypass graft surgery takes about 2 months, or may be sooner if minimally invasive surgery techniques were used. Most patients are able to drive in about 3 to 8 weeks after surgery. Your doctor will provide specific guidelines for your recovery and return to work, including specific instructions on activity and how to care for your incision and general health after the surgery.

Follow Up Care

During the first few months after surgery, you will probably need to visit a few times with the doctor who referred you for surgery. You will need to schedule regular appointments with your cardiologist (even if you have no symptoms).
Your follow-up appointments may be scheduled every year, or more often, as recommended by your doctor. Your appointments should include a medical exam. Diagnostic studies (such as an echocardiogram) may be repeated at regular intervals.
You should call your doctor if your symptoms become more severe or frequent. Don’t wait until your next appointment to discuss changes in your symptoms.

Importance of Making Lifestyle Changes

Coronary artery bypass graft surgery increases the blood supply to your heart, but it does not cure coronary artery disease. You will still need to decrease your risk factors by making lifestyle changes, taking medications as prescribed and following your doctor’s recommendations to prevention future disease.  Lifestyle changes include:

• Quitting smoking
• Treating high cholesterol
• Managing high blood pressure and diabetes
• Exercising regularly
• Maintaining a healthy weight
• Eating a heart-healthy diet
• Controlling stress and anger
• Taking prescribed medications as directed
• Participating in a cardiac rehabilitation program, as recommended
• Following up with your doctor for regular visits

Information on prevention and making lifestyle changes can be found at Heart and Vascular Health and Prevention.