What is coronary artery bypass graft surgery?

Coronary artery bypass graft (CABG) is surgery to treat coronary artery disease. The surgery helps blood make a detour, or bypass, around one or more narrowed or blocked coronary arteries. Coronary arteries are the blood vessels that bring blood to the heart. This surgery is also called coronary artery bypass or bypass surgery.

Your doctor will create a bypass using a healthy piece of blood vessel from another part of your body. Then he or she will attach, or graft, the healthy blood vessel to the narrowed or blocked artery. The new blood vessel bypasses the diseased artery to increase blood flow to the heart muscle.

The doctor will make 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. The doctor may connect you to a heart-lung bypass machine. It adds oxygen to the blood and moves the blood through the body. This machine will allow the doctor to stop your heartbeat while he or she works on your arteries. The doctor will use blood vessels from your chest, arm, or leg to bypass the narrowed or blocked parts of your arteries. When the blood vessels are in place, the doctor will restart your heart. In some cases, the doctor may be able to do the operation without using a heart-lung machine. This is called "off-pump" surgery.

The doctor will use wire to put your sternum back together, and stitches or staples to close the incisions in the skin over your sternum and where your healthy blood vessel was taken. The wire will stay in your chest. The incisions will leave scars that may become less noticeable with time.

You will stay in the hospital for 3 to 8 days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for 2 to 3 months you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months before your energy is back to normal.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking, or your surgery may be cancelled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using 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.
• Remove all jewellery, piercings, and contact lenses.
• Leave your valuables at home.

At the hospital or surgery centre

• 
  Bring a picture ID.
• Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery may be marked.
• A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
• 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 will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
• As you wake up in the ICU, the nurse will check to be sure you are stable and comfortable. It is important for you to let your doctor and nurse know how you feel and ask questions about any concerns you may have.
• 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 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.

Going home

• 
  Be sure you have someone to drive you home.
• You will be given more specific instructions about recovering from your surgery. They will cover things like medicines, diet, wound care, follow-up care, cardiac rehab, driving, and getting back to your normal routine.