It Was A Three Hour Procedure
Coronary artery bypass surgery, also coronary artery bypass graft (CABG pronounced cabbage) surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.
Coronary artery bypass surgery during mobilization (freeing) of the right coronary artery from its surrounding tissue, adipose tissue (yellow). The tube visible at the bottom is the aortic cannula (returns blood from the HLM). The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom.
Excellent Video's Of The Procedure
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Heart Bypass Surgery - Part One
Heart Bypass Surgery - Part Two
The Procedure In Text Form...
- The patient is brought to the operating room and moved on to the operating table.
- An anaesthetist places a variety of intravenous lines and injects a painkilling agent (usually fentanyl ) followed within minutes by an induction agent (usually propofol ) to render the patient unconscious.
- An endotracheal tube is inserted and secured by the anaesthetist or assistant (e.g. respiratory therapist or nurse anaesthetist ) and mechanical ventilation is started. General anaesthesia is maintained by a continuous very slow injection of Propofol .
- The chest is opened via a median sternotomy and the heart is examined by the surgeon.
- The bypass grafts are harvested - frequent conduits are the internal thoracic arteries , radial arteries and saphenous veins . When harvesting is done, the patient is given heparin to prevent the blood from clotting.
- In the case of " off-pump " surgery, the surgeon places devices to stabilize the heart.
- If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia (a special Potassium-mixture, cooled) to stop the heart and slow its metabolism. Usually the patient's machine-circulated blood is cooled to around 84 °F (29 °C)
- One end of each graft is sewn on to the coronary arteries beyond the blockages and the other end is attached to the aorta .
- The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In cases where the aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
- Protamine is given to reverse the effects of heparin .
- The sternum is wired together and the incisions are sutured closed.
- The patient is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately one day), the person is transferred to the cardiac surgery ward until ready to go home (approximately four days).