Coronary Artery Bypass Graft (CABG off-pump) Heart Surgery PreOp® Patient Education #heart
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.
Before the graft vessel or vessels can be attached, a heart-lung machine must be connected, A heart lung machine takes over the job of circulating and oxygenating the blood so that your doctor will be free to stop your heart for the length of the operation. To connect the heart-lung machine, one tube is placed into the aorta and a second tube is placed into the right atrium of the heart. One or two smaller tubes are then inserted into the heart. These will carry a special solution that helps preserve the hearts temperature. When all the tubes are in place, the surgical team will turn on the bypass machine. It will begin to circulate the blood as the heart cools. When the temperature of the heart muscle has reached the proper level, a clamp is placed on the aorta. At that point, blood will no longer flow through the heart and it can be safely stopped and repaired.
To complete the bypass graft procedure, your doctor attaches the ends of the new vessels on either side of the diseased area or areas of the old coronary artery. Once the grafts have been completed, the clamp on the aorta is removed and the heart is allowed to begin beating again. As the temperature and the rhythm of the heart slowly return to normal, the heart-lung machine is disconnected. 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.
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