During the Procedure
Coronary artery bypass graft surgery requires a stay in a hospital.
Procedure may vary depending on your condition and your physician's practices.
Generally, a coronary artery bypass surgery follows this process:
- You will be asked to remove any jewelry or other objects that
may interfere with the procedure.
- You will be asked to
remove your clothing and will be given a gown to wear.
- You
will be asked to empty your bladder prior to the procedure.
- An intravenous (IV) line will be started in your arm or hand.
Additional catheters will be inserted in your neck and wrist to
monitor the status of your heart and blood pressure, as well as for
obtaining blood samples. Alternate sites for the additional
catheters include the subclavian (under the collarbone) area and the
groin.
- You will be positioned on the operating table, lying
on your back.
- The anesthesiologist will continuously
monitor your heart rate, blood pressure, breathing, and blood oxygen
level during the surgery. Once you are sedated, a breathing tube
will be inserted through your throat into your lungs and you will be
connected to a ventilator, which will breathe for you during the
surgery.
- A catheter will be inserted into your bladder to
drain urine.
- The skin over the surgical site will be
cleansed with an antiseptic solution.
- Once all the tubes
and monitors are in place, an incision may be made in one of your
legs to obtain a section of vein to be used for grafts.
- The
physician will make an incision (cut) down the center of the chest
from just below the Adam's apple to just above the navel.
- The sternum (breastbone) will be divided in half with a special
operating instrument. The physician will separate the two halves of
the breastbone and spread them apart to expose the heart.
- In order to sew the grafts onto the very small coronary
arteries, the heart must be stopped to allow the physician to
perform the very delicate procedure. Tubes will be inserted into the
heart so that the blood can be pumped through your body by a
cardiopulmonary bypass machine.
- Once the blood has been
diverted into the bypass machine for pumping, the heart will be
stopped by injecting it with a cold solution.
- When the
heart has been stopped, the physician will perform the bypass graft
procedure by sewing one end of a section of vein over a tiny opening
made in the coronary artery just above the blockage, and the other
end over a tiny opening made in the coronary artery just below the
blockage. If the internal mammary artery inside your chest is being
used as a bypass graft, the lower end of the artery will be cut from
inside the chest and sewn over an opening made in the coronary
artery below the blockage.
- You may have more than one
bypass graft performed, depending on how many blockages you have and
where they are located. After all the grafts have been completed,
the physician will examine them to make sure they are working.
- Once the bypass grafts have been completed, the blood
circulating through the bypass machine will be allowed back into
your heart and the tubes to the machine will be removed. Your heart
will be restarted.
- Temporary wires for pacing may be
inserted into the heart. These wires can be attached to a pacemaker
and your heart can be paced, if needed, during the initial recovery
period.
- Once the chest has been opened, the area around the
artery to be bypassed will be stabilized with a special type of
instrument.
- The rest of the heart will continue to function
and pump blood through the body.
- The cardiopulmonary bypass
machine and the perfusionist who runs it may be kept on stand-by
should the procedure need to be completed on bypass.
- The
physician will perform the bypass graft procedure by sewing one end
of a section of vein over a tiny opening made in the coronary artery
just above the blockage, and the other end over a tiny opening made
in the coronary artery just below the blockage.
- You may
have more than one bypass graft performed, depending on how many
blockages you have and where they are located.
- Before the
chest is closed, the physician will examine the grafts to make sure
they are working.