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What Happens During a CABG?

Clip Number: 8 of 33
Presentation: CABG
The following reviewers and/or references were utilized in the creation of this video:
Reviewed By: Arthur Schoenstadt, MD
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Now let's discuss your procedure.
After your anesthesia takes effect, the surgical area will be scrubbed with a special disinfectant soap and may also be shaved.
Your surgeon will then make a 6-8 inch incision down the middle of your chest. Your breastbone is then separated, the heart sac is carefully pulled back, and your heart is examined.
At this point, your doctor will remove the necessary graft vessels for the artery bypass. Most commonly an artery from the chest called the mammary artery and/or a vein from your leg are used. However, an artery from your arm or wrist may also be used.
Once this is done, the bypass procedure can continue. At this point, your heart will need to be cooled to keep it still. During this time, your heart will be connected to the heart-lung bypass machine.
After giving you a large dose of a blood-thinning medicine, called heparin, to make sure that your blood does not clot, your surgeon will connect your heart to the heart-lung bypass machine with a plastic tube. Blood from your heart is then sent to the bypass machine through this tube. The machine supplies your blood with oxygen, and then pumps it back to the rest of your body through the other tube. While connected, your blood simply bypasses your heart and your lungs, but still reaches the rest of your body.
After you are successfully connected to the heart-lung bypass machine, each of your blocked coronary arteries will be carefully inspected. Your surgeon will determine the ideal place to attach the new vessel or vessels. Usually the vessel is sewn into an area below the blockage, and then into a location in the aorta.
After the grafts are in place and your heart regains strength, you will slowly be removed from the heart-lung bypass machine. You will be completely free of the machine when your heart resumes its normal function and can support your body with its own pumping ability. Because everyone's heart is different, the time it takes to be removed from the bypass machine varies.
If your heart is slow to return to its normal function, several options are available to help it regain strength. These include medication through your IV, or small, thin wires, called pacing wires which may be placed directly onto the surface of your heart. These provide electrical stimulation to help your heart beat normally after you have been removed from the bypass machine. These wires will be left inside your chest throughout your immediate recovery. Usually these are temporary, but in some patients, the wires may need to be replaced by a permanent pacemaker.
Several chest tubes will also be placed inside your chest to collect any fluid that drains into the spaces around your heart and lungs. These help to ensure that your lungs and heart are working properly.
Lastly, your breastbone is brought back together with thick steel wire. These help your breastbone to heal and prevent movement as you become active again. Your skin incision is then closed with stitches and a sterile bandage is applied.
 

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