From the Guidelines
The steps of a CABG procedure involve anesthesia administration, incision, cardiopulmonary bypass, harvesting of blood vessels, graft attachment, and closure of the sternum and chest incision. The procedure begins with anesthesia administration and preparation of the patient 1. Next, the surgeon makes an incision in the chest and opens the sternum to access the heart. The patient is then placed on a cardiopulmonary bypass machine, which takes over the function of the heart and lungs during surgery. The surgeon harvests blood vessels, typically the saphenous vein from the leg and/or the internal mammary artery from the chest wall, to use as grafts.
Key Considerations
- The choice between on-pump and off-pump CABG depends on various factors, including the patient's risk profile and the surgeon's preference 1.
- The use of cardiopulmonary bypass (CPB) is associated with certain perioperative complications, including myonecrosis, cerebrovascular accidents, and renal dysfunction 1.
- Off-pump CABG may be beneficial in patients with extensive disease of the ascending aorta, as it avoids manipulation of the aorta and reduces the risk of neurological complications 1.
Graft Harvesting and Attachment
- The surgeon harvests blood vessels, typically the saphenous vein from the leg and/or the internal mammary artery from the chest wall, to use as grafts 1.
- The internal mammary artery should be harvested using the skeletonization technique to reduce the risk of sternal wound complications 1.
- The radial artery graft should be used to target vessels with subocclusive stenoses, and its use should be avoided in patients with chronic kidney disease and a high likelihood of rapid progression to hemodialysis 1.
Postoperative Care
- Recovery involves intensive care monitoring for 1-2 days, followed by several days in a regular hospital room, with complete recovery taking 6-12 weeks.
- The patient should be closely monitored for complications, such as bleeding, renal dysfunction, and neurocognitive dysfunction 1. The entire procedure typically takes 3-6 hours, depending on the number of bypasses needed, and is effective in improving cardiac function and reducing symptoms like chest pain.
From the Research
Steps of a CABG Procedure
The steps of a Coronary Artery Bypass Graft (CABG) procedure are not explicitly outlined in the provided studies. However, the studies discuss various aspects of CABG surgery, including the choice of graft conduit and the outcomes of different conduits.
Graft Conduits
- The choice of graft conduit is crucial to the success of CABG surgery, as the patency of the conduit is closely associated with an uneventful postoperative course and better long-term patient survival 2.
- The standard conduits used for CABG are the greater saphenous vein (GSV) and the internal thoracic artery (ITA) 2.
- Arterial grafts, including the left and right internal thoracic arteries and the radial artery, have improved patency rates compared to the saphenous vein graft (SVG) 3.
- The radial artery has been shown to be associated with a significantly lower incidence of graft failure and repeat coronary operation compared to the saphenous vein 4, 5.
Surgical Techniques
- Total arterial revascularization using a Y- or T-composite graft based on the in situ ITA increases the length of the arterial graft and allows the extensive use of arterial conduits to revascularize both the left and right coronary territories 6.
- The use of the saphenous vein as part of a composite graft based on the in situ left ITA has been discussed as a recent surgical strategy 6.