Coronary Artery Bypass Graft: Before Your Surgery

What is coronary artery bypass graft surgery?

Coronary artery bypass graft (CABG) surgery is used to treat coronary artery disease. It helps blood flow around, or bypass, one or more narrowed or blocked coronary arteries. The arteries may have plaque buildup (atherosclerosis). These arteries are the blood vessels that bring blood to the heart muscle. This surgery is also called bypass surgery.

Your doctor will make the bypass with a healthy piece of blood vessel from another part of your body. Then the doctor will attach, or graft, the healthy blood vessel above and below the narrowed or blocked artery. Blood is redirected through the new blood vessel. This restores blood flow to the affected portion of the heart muscle.

The doctor usually makes a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart and coronary arteries. A heart-lung bypass machine is usually used during the surgery to add oxygen to the blood and move the blood through the body. The doctor will use blood vessels from your chest, arm, or leg to bypass the narrowed or blocked parts of your arteries. In some cases, the doctor may be able to do the surgery without using a heart-lung machine. This is called "off-pump" surgery.

The doctor may use wire to put your sternum back together. Stitches or staples will be used to close the incisions in the skin over your sternum and the arm or leg where your healthy blood vessel was taken. The wire will stay in your chest. The incisions will leave scars that may fade with time.

You will stay in the hospital for a few days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks you will avoid lifting heavy objects and doing things that strain your chest or upper arm muscles. At first you may notice that you get tired quickly. You may need to rest often. It may take 1 to 2 months before your energy is back to normal.

How do you prepare for surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Do not smoke or vape. Smoking or vaping can make your coronary artery disease worse. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.
• Be sure you have someone to take you home after your stay in the hospital. Pain medicine and any limits on your activities will make it unsafe for you to drive or get home on your own.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no surgical site errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 3 to 6 hours. This depends on the number of arteries that are bypassed and the type of surgery you have.
• You will go to the intensive care unit (ICU) right after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
• You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat may feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again. After the breathing tube is removed, you may wear a face mask or nasal cannula for several days for some extra oxygen. A nasal cannula is a thin, flexible plastic tube with two prongs that fit just inside your nose.
• You will have a thin plastic tube, called a catheter, in a vein in your neck. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
• You will also have a catheter in an artery in your arm. It is used to check your blood pressure and take blood samples. It is usually removed in 1 to 3 days.
• You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal and usually last only a few days. The chest tubes are usually removed in 1 or 2 days.
• You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.
• You will have a tube that drains urine from your bladder. This is called a urinary catheter. It is usually removed as soon as you can get up to use the bathroom.
• You may have a thin plastic tube in your nose that goes down the back of your throat into your stomach. It will drain stomach juices. It is usually removed in the days after surgery.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.