Coronary Artery Bypass Graft (CABG off-pump)

Your doctor has recommended that you have coronary artery bypass surgery. But what does that actually mean? Your heart is located in the center of your chest. It is surrounded by your rib cage and protected by your breastbone. Your heart's job is to keep blood continually circulating throughout your body. The vessels that supply the body with oxygen-rich blood are called arteries. The vessels that return blood to the heart are called veins. Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood.

The arteries that carry this blood supply to the heart muscle are called coronary arteries. Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque. Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger. Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient's leg or chest, most probably the left internal mammary artery and the saphenous vein. Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle. These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.

On the day of your operation, you will be asked to put on a surgical gown. You may receive a sedative by mouth and an intravenous line may be put in. You will then be transferred to an operating table. The anesthesiologist will begin to administer anesthesia - most probably general anesthesia by injection and inhalation mask. The surgeon will then apply an antiseptic solution to the skin and place a sterile drape around the operative site. One or more sections of blood vessel will be taken from the leg, thigh or chest wall and the incision at those points will be sutured and bandaged.

Then, your doctor will make a vertical incision in the center of the chest. Skin and other tissue will be pulled back in order to expose the breast bone. Your doctor will carefully divide the breast bone and a special instrument called a retractor will be used to hold the chest open. Once your doctor has a clear view of the heart, he or she will make an incision in the pericardium - a thin membrane that encloses the heart. Pulling the pericardium back will reveal the beating heart. Next, the surgeon will gently rotate the heart to the right in order to allow access to the heart’s underside. Using veins taken from another part of your body, the team will begin to build new paths for blood – bypassing the blocked areas of the old artery or arteries.

The team will attach as many new veins as needed to the underside of the heart. Then, the doctor will gently rotate the heart back to its normal position. To complete the bypass graft procedure, your doctor attaches the ends of the new veins on either side of the diseased area or areas of the old coronary artery.

Blood can now flow freely avoiding the clogged areas that had caused your symptoms. The pericardium can now be closed over the heart. Your doctor will position two special drainage tubes in the chest cavity. These tubes prevent fluid from building up around the heart during the healing process. The breast bone is then closed with metal wire and the remaining tissue is closed with sutures. Finally a sterile bandage is applied.