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Coronary Artery Bypass Graft – CABG

Coronary Artery Bypass Graft – CABG

Coronary Artery Bypass Graft or CABG (pronounced ‘cabbage’) is the most commonly performed cardiac operation. It is indicated for severe obstructions of the coronary arteries. It aims to decrease symptoms, increase survival or both.  CABG was introduced worldwide in the late 60’s. Since then, many techniques and equipment have been refined. Today it is understood as a well-established operation.

The goal of the technique is to use the patient’s own vessels (grafts) to bypass coronary artery obstructions, therefore feeding the heart muscle with blood.

NOTE: Angina or heart attack are caused by decreased/interrupted blood supply to the heart muscle.

The Surgery

Conventionally, the heart is accessed via a vertical incision over the breastbone (called ‘sternum’). The grafts are harvested by surgeon and team. The most commonly used vessels are the internal thoracic arteries (ITA, also called IMA – ‘internal mammary arteries’, LIMA – left IMA or RIMA – right IMA) on either side of the breastbone; the long saphenous vein, along lower legs and thighs; and the radial arteries, on the forearm. Extra incisions are made to harvest these vessels.

Cardiopulmonary Bypass (hyperlink ‘Cardiopulmonary Bypass and the Heart-Lung Machine’) and cardiac preservation (hyperlink ‘Cardiac Preservation’) are then established.

The grafts are connected to the coronary arteries beyond the obstruction with fine suture material. Normally, the ITA is fed from its natural origin, and the veins are fed by the ascending aorta.

NOTE: CABG does not cure coronary artery disease, but it will give the patient a chance to control risk factors and get her/his health back on track.

NOTE: The goal of CABG is to provide more blood to the heart muscle. Small arteries cannot be bypassed as they can cause the graft to clot. Therefore, angina can still occur after CABG in a limited number of patients.

The blood supply to the heart is resumed and it starts to beat again. Sometimes, a small electric shock is used to re-establish normal rhythm. Finally, the heart takes over the circulation again and the heart-lung machine is disconnected.

Afterwards, the surgeon controls potential sites of bleeding and inserts chest drains. A temporary pacemaker wire is also inserted. Drains and wires are removed in ICU or ward when no longer required.

The breastbone is closed with stainless steel wires. They will remain in your bone and should not activate metal detectors.

Alternatives to CABG

OFF-PUMP CABG (OP-CAB)

This technique does not use the Heart-Lung machine for grafting. Instead, the heart is kept beating and sustaining the circulation during the procedure. It relies on different anaesthetic strategies and careful positioning of heart. It is not applicable to all patients.

ROBOTIC CABG

This technique consists in the surgeon inserting robotic arms in the chest to harvest IMA and grafting of coronary arteries. It is not applicable to all patients. There is a limited availability of robotic equipment due to costs, and lengthy procedures.

Commonly Associated Procedures with CABG

Aortic Valve Replacement, Mitral Valve Surgery, Myectomy and Tricuspid Valve Surgery.

Associated Risks

Cardiac surgery is routinely performed all over the world. Australia ranks very well internationally, reflecting a high standard of care from both the operative setup and the hospital systems. As with any medical procedure, in a small number of cases, complications (adverse events) may occur.

The 5 major risks are bleeding and blood transfusion, mediastinitis (infection deeper to the chest bone), heart attack, stroke and even death. Other risks include need for pacemaker and organ failure (e.g. heart, lungs, kidneys).

The risk of infections, heart and lung problems and thrombosis increases with diabetes, obesity and smoking.

Please speak to your surgeon regarding your individual circumstances and any questions or doubts you may have.

For information about associated risks of cardiac surgery, please click here.


For an appointment or seeking a second opinion with Dr Provenzano, please contact:

Gold Coast Private Specialist Suites 14 Hill Street, Southport

P: (07) 5699 8258   F: (07) 5676 6784

Dr Sylvio Provenzano

MD, MSc, FRACS


Dr Sylvio Provenzano is an exam-qualified Cardiothoracic Surgeon by the Royal Australasian College of Surgeons (RACS). He specialises in cardiac, thoracic and congenital cardiac surgery.

Opening Hours

Gold Coast Private Specialist Suites


14 Hill Street, Southport 4215
9:00 – 16:00
 
Phone: (07) 5699 8258
Fax: (07) 5676 6784
 
Correspondence:
PO Box 809, Southport BC, Qld 4215