Coronary Artery Bypass Graft Surgery

Open Heart Coronary Artery Bypass Graft Surgery

Open heart coronary artery bypass graft (CABG) surgery is among the prominent procedures classified under heart surgeries. It is abbreviated as “CABG”. The primary reason for this surgery is to protect the patient from heart attacks that can cause severe symptoms such as shortness of breath and chest heaviness. This is due to the occurrence of blockage or hardening in the coronary arteries. Such arterial blockages are treated either through catheterization and stent placement or through open-heart surgery. The first open heart coronary artery bypass graft surgery was performed in the early 1960s in the United States, followed by significant developments in these types of surgeries, resulting in excellent outcomes.

What are the steps for performing open heart coronary artery bypass graft surgery?

Preoperative stage of open heart coronary artery bypass graft surgery:

• The doctor orders a series of tests and examinations for the patient to ensure the overall condition and to avoid any complications or negatives during the surgery.
• It is important for the patient to abstain from smoking and alcoholic beverages before open heart coronary artery bypass graft surgery, as they affect blood pressure levels, leading to an increase in heart rate and the possibility of complications during the procedure.
• It is preferable for a relative of the patient to donate blood before the surgery, storing it for use if needed during the operation.
• The surgeon performing the open heart coronary artery bypass graft surgery should refrain from taking blood-thinning medications such as aspirin for at least a week.
• The patient should fast for eight hours before the surgery, as this reduces the likelihood of dizziness and nausea during anesthesia.

Intraoperative stage of open heart coronary artery bypass graft surgery:

• The patient is transferred to one of the adjacent preparation rooms to the operating room at least an hour before the coronary artery bypass graft surgery, where the anesthesiologist injects the patient with local anesthesia through the neck area.
• A large catheter is then inserted into the jugular vein, as well as another catheter into one of the arteries. The purpose of this is to monitor blood pressure levels in the arteries and to obtain blood samples to ensure blood oxygenation during the procedure. Typically, these catheters are placed in an artery of the wrist, often the radial artery. However, in cases where the surgeon uses the radial artery as a graft to repair the narrowed coronary arteries during the coronary artery bypass graft surgery, the other wrist artery can be used. Additionally, the catheter can be placed in one of the thigh arteries, with a catheter placed in the urinary system for urine drainage, which also helps monitor kidney activity during the open heart coronary artery bypass graft surgery.
• After the patient is prepared, they are taken to the main operating room. Initially, the patient is fully anesthetized, with an artificial respiration device placed in the trachea. Blood pressure monitoring device is then connected, with all devices linked to a monitor to monitor the patient's condition.
• Next, the surgeon uses Betadine to sterilize the chest and thighs, covering the patient with sterilized drapes. The surgeon then prepares the vein to be used as a graft to repair the narrowed coronary arteries.
• The surgeon makes a surgical incision in the patient's chest area, followed by separating the fatty layer and muscles beneath the skin to expose the chest bone. A medical saw is used, and in a subsequent stage, the surgeon opens the outer membrane of the heart (pericardium). Subsequently, the heart is connected to tubes made of plastic, which are then connected to the heart-lung machine that acts as a substitute for the lungs during coronary artery bypass graft surgery, with the heart muscle movement stopped.
• The surgeon then opens the arteries after the area where the blockage is located, connecting them to the vein or the previously prepared artery for grafting, using surgical sutures. This is followed by connection to the aorta.
• Subsequently, the surgeon closes the outer membrane of the heart and disconnects the heart-lung machine. In most cases, the patient regains normal heart rhythm as soon as the blood passes through, although in some cases, electrical pulses may be required to stimulate heart muscle activity.