Who Needs Coronary Artery Bypass Surgery?

Patient vitals are monitored during the entire procedure.

The procedure starts with the following:

1. A urinary catheter is inserted.
2. General anesthesia is administered intravenously.
3. A breathing tube attached to a ventilator is inserted through the mouth. The ventilator breathes for the patient during and immediately after the surgery. 
4. The surgical site is cleaned with an antiseptic solution.
5. Depending upon the patient's condition, one of the following two procedures is adopted by the surgeon:
   1. On-pump procedure
   2. Off-pump procedure

On-pump & Off-pump CABG Surgery:

1. The surgeon will access the blood vessel to be used for the grafts by making an incision in either the leg(s) or wrist. After the removal of the blood vessel, the incision is closed. 

2. An incision is made from below Adam’s apple to just above the navel (i.e. incision from just below the neck till slightly above the belly button).

3. The sternum (breastbone is cut in half lengthwise, and halves are separated to expose the heart.

4. In the case of On-pump CABG Surgery: The heart is placed on a heart-lung bypass machine that pumps blood like an artificial heart. The heart is stopped temporarily by injecting a cold solution. 

In the case of Off-pump CABG Surgery: The heart is not stopped. Instead, a unique instrument is used to stabilize the area around the artery to be bypassed.

5. One end of the graft is sewn over a tiny opening made in the aorta, and the other end over a tiny space made just below the block. (If the internal mammary artery is used as a graft, the lower end of the artery is cut and sewn below the blockage). 

6. Depending on the number of arteries blocked, more than one bypass graft may be done. 

7. Grafts are checked as blood runs through them.

8. In the case of On-pump CABG Surgery: Blood circulating through the bypass machine is let into the heart. The heart may restart on its own, or a mild electric shock may be used to restart it. Temporary wires may be put in for pacing the heart.

9. The sternum is stitched with small wires.

10. To drain fluids from around the heart, tubes are inserted into the chest.

11. A tube is placed into the stomach through the mouth or nose to drain stomach fluids. 

12. To cover the surgical site, a sterile bandage is used.