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Home Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting (CABG) is a major cardiac surgical procedure designed to restore normal blood flow to the heart by bypassing blocked coronary arteries. This surgery is essential for patients with severe coronary disease, including atherosclerosis, and is an alternative to angioplasty when the latter is ineffective or inappropriate.
Why undergo coronary artery bypass grafting?

Coronary arteries supply oxygen and nutrients to the heart muscle. Over time, they can become narrowed (coronary stenosis) or blocked due to the build-up of fatty plaques, a phenomenon known as atherosclerosis. This narrowing limits the blood supply to the heart, causing chest pain (angina pectoris) and increasing the risk of heart failure and myocardial infarction.

Coronary artery bypass grafting is indicated in a number of cases:

  • Severe narrowing or multiple obstructions of the coronary arteries.
  • Failure of stent or angioplasty treatment.
  • Occlusion of the main left coronary artery supplying a large part of the heart.
  • Persistent symptoms despite optimal drug treatment.
What happens during the procedure?

Coronary artery bypass surgery takes place under general anesthesia and lasts between 3 and 6 hours. The duration varies greatly depending on the number of bypasses to be performed. Depending on the condition of the coronary arteries, a patient may require a single bypass or several. This is referred to as double/triple/quadruple bypass surgery. The greater the number of bypasses required, the more complex and time-consuming the procedure.

It involves several key stages:

1. Graft harvesting: A healthy blood vessel is harvested from another part of the body, often a leg vein (great saphenous vein), a chest artery (internal mammary artery) or an arm artery (radial artery).


2. Graft connection: The graft is sutured to the aorta and coronary artery downstream of the blockage, enabling blood to bypass the obstruction.

3. With or without extracorporeal circulation:

  • With extracorporeal circulation: The heart is temporarily stopped, and a heart-lung machine takes over.
  • Without extracorporeal circulation: The operation is performed on a beating heart, thus limiting certain post-operative risks.


Focus on Mini-Left Coronary Artery Bypass Grafting (MIDCAB)

Mini-left-thoracotomy coronary artery bypass grafting (MIDCAB) is a minimally invasive technique that enables revascularization of the heart without completely opening the sternum. This approach, performed mainly on the beating heart (off-pump), is indicated for certain patients suffering from localized coronary artery disease, particularly when only the anterior interventricular artery (AIA) is involved.

Unlike conventional bypass surgery, MIDCAB is performed through a 10 cm incision on the left side of the chest. This technique enables a graft, usually the left internal mammary artery (LIMA), to be implanted on the affected coronary artery, without the need for extracorporeal circulation. In some cases, a composite graft may be used to revascularize other arteries.

Not all patients with coronary problems are candidates for this technique. The surgeon will assess each clinical situation to determine the most appropriate intervention.

Benefits of coronary bypass surgery

After surgery, the majority of patients experience a significant reduction in chest pain and an improvement in their quality of life. Bypass surgery also reduces the risk of future heart attacks, and can extend the life expectancy of patients with advanced coronary artery disease.

Within 10 years of bypass surgery, patients regain a life expectancy identical to that of people without coronary disease. However, this surgery does not constitute a definitive cure for coronary disease. Without proper management, such as a healthy lifestyle and rigorous medical follow-up, the grafted arteries themselves can become blocked over time.

Risks and possible complications

Like all major surgery, coronary artery bypass surgery carries certain risks:

  • Infections and complications related to healing.
  • Cardiac arrhythmias, particularly atrial fibrillation.
  • Kidney failure, particularly in patients with a history of kidney disease.
  • Temporary memory loss and cognitive impairment after surgery.
  • Risk of recurrence: Over time, obstructions may develop in the new blood circulation pathways.


Recovery and rehabilitation

After the operation, a 1-2 day stay in intensive care is often necessary before transfer to the cardiology department. Total hospital stay varies between 6 and 10 days, depending on the patient's condition.
Full recovery may take 6 to 12 weeks, with a gradual resumption of daily activities. A cardiac rehabilitation program is generally recommended to optimize recovery and reduce the risk of complications.

Conclusion

Coronary artery bypass grafting (CABG) is an essential surgical procedure for patients with advanced coronary artery disease. Thanks to medical advances, this surgery is now safer and more effective, offering patients a better quality of life. However, it must be accompanied by rigorous medical follow-up and lifestyle changes to maximize its long-term benefits.

FAQ on coronary artery bypass grafting

What are the benefits of coronary artery bypass surgery?

Coronary artery bypass grafting improves blood circulation, reducing chest pain and the risk of heart attack. It increases life expectancy, which remains similar to that of a person without coronary pathology for 10 years after the operation. It also enables a return to a more active lifestyle

How long is hospitalization after bypass surgery?

Most patients remain in hospital for between 6 and 12 days, depending on their recovery

Can bypass grafts become blocked over time?

Yes, grafts can gradually become clogged, especially in the absence of preventive measures

What's the difference between a bypass and a stent?

A stent is a less invasive option that widens a blocked artery. Bypass surgery is preferred for multiple or severe obstructions

When can I return to normal activity after bypass surgery?

Resumption of activity takes place gradually. It generally takes 6 to 12 weeks before a return to normal life is possible

Who should I see about these symptoms?

We recommend that you see the following health professional(s) :
PD Dr. med.
Aristotelis Panos
Cardiovascular surgeon
Hôpital de La Tour
Dr. med.
Thomas Syburra
Cardiovascular surgeon
Hôpital de La Tour

Specialties involved

Heart surgery