Coronary artery bypass surgery (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Atif Mohammad, MD
amohammad@perfuse.org
617-632-7593

Research Fellow
PERFUSE Core Angiographic Lab
Division of Cardiology
Beth Israel Deaconess Medical Center,
Harvard Medical School,
Boston , MA 02215

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'Synonyms and keywords: Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with Coronary Angiography (CAG).

Overview

Coronary Artery Bypass Graft (CABG) which is pronounced as "Cabbage", is a surgical procedure done to restore blood flow to the heart.The arteries of the heart get blocked due to calcium and fat deposits in the arteries which cause the blockage and eventually lead to a heart attack.CABG uses a vein from the legs,arm,chest or abdomen and forms a "bypass" over the blocked artery to restore blood flow to the heart which can prevent form further heart attacks.This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. However, recent advances allow the procedure to be performed with the heart beating and through smaller incisions.The first attempt to perform a CABG procedure was performed by Dr. Robert Goetz in 1960 in Albert Einstein College of Medicine, Bronx. But the first real successful procedure was performed in 1967 by Dr. Favaloro in the Cleveland Clinic by using a Saphenous Vein graft which is the most common method of performing the procedure today.

The decision to do a CABG procedure is made by the cardiologist,primary care doctor and the cardiac surgeon who jointly decide along with the patient whether it is beneficial to have a bypass procedure done or not.This decision is dependent on several factors like age,heart disease risk factors(cholesterol,smoking,hypertension, diabetes,arteries blocked) and current physical status of the patient.Approximately,448,000 cardiac CABG operations were done in the United States in 2006.

Terminology

CABG means Coronary Artery Bypass Graft.CAGS means Coronary Artery Graft surgery which is similar and should not be confused with Coronary Angiography.Similar Aortocoronary bypass (ACB) is also being used nowadays.

The terms double bypass, triple bypass,quadruple bypass means only the number of arteries that are being bypassed or which are blocked in the heart.It does not imply to how sick a person is.That is totally dependent on the coronary angiogram which the doctor checks to see where are the blockages in the heart and makes the decision of bypass surgery accordingly.

Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts - one to the right coronary artery (RCA) system and one to the obtuse marginal (OM) system

Indications

Coronary Artery Bypass Graft surgery is usually performed for following conditions:

• Heart Attack (Stable Angina, Unstable Angina, Myocardial Infarction) .This is the most common and important reason for having a CABG procedure done and the reason for having CABG done depends upon the whole clinical status of the patient.

• To prevent future risk of heart attacks-Patients may be identified on having future risk of a heart attack depending on cardiac performance on Exercise test,Myocardial perfusion and blocked arteries on Coronary Angiography.

• After a heart attack-Patients may have CABG done if their heart attack was not relieved by Angioplasty or they are having a second heart attack.Again , the decision depends on the clinical status of the patient, picture of arteries on angiogram and cardiac risk factors.