When the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle. These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.
Your heart is located in the center of your chest. It is surrounded by your rib cage and protected by your breastbone.
Your heart’s job is to keep blood continually circulating throughout your body.
The vessels that supply the body with oxygen-rich blood are called arteries.
The vessels that return blood to the heart are called veins.
Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood. The arteries that carry this blood supply to the heart muscle are called coronary arteries.
Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque.
Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger.
Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein.
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Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle.
These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.
One or more sections of blood vessel will be taken from the leg, thigh or chest wall and the incision at those points will be sutured and bandaged.
Then, your doctor will make a vertical incision in the center of the chest.
Skin and other tissue will be pulled back in order to expose the breast bone.
Your doctor will carefully divide the breast bone and a special instrument called a retractor will be used to hold the chest open.
Once your doctor has a clear view of the heart, he or she will make an incision in the pericardium – a thin membrane that encloses the heart.
Pulling the pericardium back will reveal the beating heart.
Next, the surgeon will gently rotate the heart to the right in order to allow access to the heart’s underside.
Using veins taken from another part of your body, the team will begin to build new paths for blood bypassing the blocked areas of the old artery or arteries. The team will attach as many new veins as needed to the underside of the heart.
Then, the doctor will gently rotate the heart back to its normal position.
To complete the bypass graft procedure, your doctor attaches the ends of the new veins on either side of the diseased area or areas of the old coronary artery. Blood can now flow freely avoiding the clogged areas that had caused your symptoms.
The pericardium can now be closed over the heart.
Your doctor will position two special drainage tubes in the chest cavity.
These tubes prevent fluid from building up around the heart during the healing process.
The breast bone is then closed with metal wire and the remaining tissue is closed with sutures.
Finally a sterile bandage is applied.
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Content
1.29 -> Your doctor has recommended a coronary artery
bypass graft procedure, also called CABG .
8.91 -> This video will review information about the
off pump CABG procedure.
14.309 -> Before we talk about this procedure, let’s
review some information about your body and
19 -> your medical condition.
21.36 -> The heart is in the middle of the chest, under
the ribs.
25.56 -> It is protected by the sternum, also called
the breastbone.
29.91 -> The heart is a muscle that pumps blood to
all parts of the body through blood vessels
34.64 -> called arteries.
36.68 -> Veins are vessels that carry blood back to
the heart.
41.96 -> The aorta is the largest artery in the body.
44.99 -> Two vessels that branch off from the aorta,
are the right and left coronary arteries.
51.62 -> They supply the heart muscle with the oxygen
rich blood that is necessary to keep it working.
58.4 -> Coronary arteries can become blocked by plaque,
fat and calcium deposits that build up over
63.96 -> years.
65 -> The result is coronary artery disease, also
called heart disease.
70.65 -> Severe blockages cause chest pain, heart attacks,
and sometimes death.
77.03 -> During a CABG procedure, new pathways called
bypasses are put in place to carry blood past,
83.7 -> and around blockages.
86.12 -> Healthier blood vessels from other sites in
the body are used to create each bypass.
92.59 -> A section of leg vein, or a piece of artery
from an arm, may be removed, and used to create
98.42 -> the bypass.
100.42 -> These transplanted vessels are called grafts.
104.35 -> The right and left internal thoracic arteries
are also commonly used as grafts.
110.17 -> These arteries naturally pass close to the
heart.
114.2 -> When creating a bypass with one of these vessels
often only one end of the vessel is moved
119.729 -> to the coronary artery, past the blockage.
124.02 -> Arteries or veins are moved or removed from
one body part to another, only when there
129.41 -> will still be enough blood supplied from other
nearby vessels.
135.389 -> There are two methods, for doing coronary
artery bypass graft surgery, called on pump
140.599 -> and off pump.
143.159 -> To help understand the off pump method, let’s
discuss what it means to be on pump.
150.5 -> During the several hours it takes to do an
on pump CABG surgery, the heart is stopped
155.92 -> for about 30 - 90 minutes.
159.45 -> This keeps the heart muscle still while the
surgeon sews vessels into place to create
164.049 -> the necessary bypasses.
167.239 -> While the heart is stopped, a special pump,
called a heart-lung machine, keeps blood oxygenated
173.53 -> and flowing through the body.
176.45 -> Blood is carried from the body through tubing
to a machine where it is mixed with oxygen,
181.719 -> then pumped back to the body.
184.489 -> After all of the grafts have been placed,
the heart is restarted, and the pump is disconnected.
193.019 -> During an off pump procedure, the heart is
not stopped, instead,
197.51 -> special tools steady areas of the heart while
the surgeon stitches grafts into place.
203.87 -> The pads and arms of the tools brace the moving
heart muscle to hold small sections still.
209.84 -> A heart-lung machine is kept on standby during
off pump surgery.
214.15 -> The pump can be necessary to help manage some
situations during surgery.
220.889 -> Individual surgical treatment decisions depend
on many factors, including the experience
226.26 -> of the surgeon, how many arteries are involved,
the location of the blockages, and their severity.
