CBAG

• Coronary arteries


  Arteries that carry blood to the heart muscle
• Coronary heart disease

  • Coronary arteries become clogged with calcium and fatty deposits
  • These deposits are called PLAQUES
  • Plaques narrow the arteries, reducing oxygen and nutrient supply to the heart muscle
• Reduced blood flow and oxygen to the heart muscle

  • Leads to ISCHEMIA (reduction in blood flow and oxygen)
  • Produces symptoms of Angina pectoris (chest pain)
• Severe consequences of coronary heart disease

  • Heart attack (myocardial infarction)
  • Heart failure
  • Rhythm abnormalities can cause sudden cardiac death
• Coronary Artery Bypass Grafting (CABG)


  A type of surgery that aims to improve blood flow to the heart by using arteries or veins from other parts of the body to bypass blocked or narrowed coronary arteries
• Purposes of CABG


  • Relief of Angina (Chest Pain)
  • Prevention of Heart Attack
  • Improvement of Heart Function
  • Long-Term Survival
  • Reduction of Symptoms
  • Prevention of Future Cardiac Events
  • Treatment of Left Main Coronary Artery Disease
• Left Main Coronary Artery (LMCA)


  Branches into the left anterior descending artery (LAD) and the left circumflex artery (LCx)
• Left Anterior Descending Artery (LAD)


  Supplies blood to the anterior walls of the left ventricle and the interventricular septum
• Left Circumflex Artery (LCx)


  Supplies blood to the lateral wall of the left ventricle
• Right Coronary Artery (RCA)


  Supplies blood to the right atrium, right ventricle, and the inferior wall of the left ventricle. Gives off the posterior descending artery (PDA) or posterior interventricular artery
• Veins


  • Great Cardiac Vein
  • Middle Cardiac Vein
  • Small Cardiac Vein
• Chambers of the Heart


  • Right Atrium
  • Right Ventricle
  • Left Atrium
  • Left Ventricle
• Heart Valves


  • Tricuspid Valve
  • Pulmonary Valve
  • Mitral Valve (Bicuspid Valve)
  • Aortic Valve
• Diagnostics and Laboratories Before Surgery

  • Electrocardiogram (ECG or EKG)
  • Echocardiogram
  • Exercise Stress Test
  • Nuclear Cardiac Stress Test
  • Cardiac Catheterization
  • X-ray Angiography or Computed Tomography (CT) Scan Angiography
  • Coronary Calcium Scan
  • Lab Tests
  • Urine Tests
• Preparation and Anesthesia


  1. You will be positioned in supine, padded under bony prominence to avoid pressure

  2. Next, strapped to ensure stability and avoid accidental movements

  3. Following that, draped and cleaned where chest is shaved and aseptic

  4. You will be given general anesthesia to ensure you are asleep and pain-free during the surgery

  5. You are intubated and ventilated

  6. Attached IV lines for meds and fluids as well as catheter
• Making the Incision

  The cardiothoracic surgeon makes a vertical incision down the center of your chest
• Accessing the Heart

  1. The surgeon splits your breastbone (sternum) to access the heart

  2. The rib cage is then gently spread and lifted to provide clear access to the heart
• Harvesting the Blood Vessel

  The surgeon selects and removes a healthy blood vessel, typically from your leg, arm, or chest, to be used as the bypass graft
• Attaching the Bypass Graft

  1. The surgeon attaches one end of the harvested blood vessel to your aorta, just outside the heart

  2. The other end of the graft is attached to the coronary artery below the site of the blockage
• Restoring Heart Function

  If your heart was stopped for the surgery, the surgeon will restart it, often with the help of a heart-lung machine that temporarily took over your breathing and blood circulation
• Closing the Chest

  1. The rib cage is carefully lowered back into place

  2. The sternum is wired together to ensure it heals properly
• Stitching the Incision

  The surgeon closes the initial chest incision using staples and sutures
• Post-Operative Care

  After the surgery, you will be taken to a recovery area where you will be closely monitored as you wake up from anesthesia
• Grafts Used in the Surgery

  • Internal thoracic arteries (also called internal mammary arteries)
  • Radial arteries
  • Saphenous veins
• Internal thoracic arteries (also called internal mammary arteries)


  Grafts under the left and right sides of the breast bone, with only the distal end separated from the chest wall
• Radial arteries


  Grafts taken from the inner forearm, with long-term outcome almost equivalent to internal thoracic artery
• Saphenous veins


  Grafts taken from the leg (calf or thigh), high risk for narrowing 50%
• Surgical room


  • Meticulously controlled environment equipped with advanced technology and specialized personnel to facilitate safe, sterile, and efficient surgical procedures, including coronary artery bypass grafting (CABG), while prioritizing patient well-being and surgical success
• Sterile drapes, gown, gloves


  Provide a sterile barrier to prevent contamination of the surgical site and maintain aseptic conditions during the procedure
• Cardioplegia


  A pharmacological therapy administered during cardiac surgery to intentionally and temporarily arrest the heart
• Cardiopulmonary bypass machine


  Takes over the jobs of the heart and lungs, including adding oxygen to blood, removing carbon dioxide, and pumping refreshed blood back into the body
• Endoscopic vein harvest scope


  Used to visualize harvesting of the greater saphenous vein
• Echocardiography ultrasound


  The use of ultrasound to examine the heart, a type of medical imaging
• Swan-Ganz catheter


  A thin tube passed into the right side of the heart and the arteries leading to the lungs to monitor the heart's function and blood flow and pressures
• Sternotomy saw


  Used to make the initial incision through the sternum (sternotomy) to access the heart and chest cavity
• Electrocautery


  Used to cut and coagulate tissues by applying high-frequency electrical current, helping to control bleeding during the surgery
• Coronary scissors


  Specifically designed scissors used for dissecting and manipulating coronary arteries during the grafting process
• Dissecting scissors


  General-purpose scissors used for dissecting tissues and creating surgical openings as needed
• Needle holders


  Instruments used to grasp and manipulate needles during suturing, facilitating precise and controlled stitching
• Straight forceps


  Used for grasping, holding, and manipulating tissues or surgical instruments during the procedure