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OnPump
OPCAB
WHAT IS CORONARY ARTERY BYPASS GRAFTING (CABG)?
Coronary artery bypass grafting or "CABG" (often pronounced
"cabbage") is the most commonly performed "open heart" operation in
the United States. Cardiothoracic surgeons perform the procedure to
bypass blockages or obstructions of the coronary arteries. The
coronary arteries are the blood vessels that supply the heart with
oxygen and nutrients. The heart relies on these fuels as it works
constantly to pump blood through the body. The heart never rests
like the other muscles in the body, and it demands a constant supply
of fuel day and night. The term ischemic heart disease refers to
this condition, when the heart does not get these fuels. When the
heart is sufficiently ischemic (when the shortage of fuel is
critical enough), the muscle begins to die. This is a "heart attack"
or myocardial infarction.
HOW IS THIS OPERATION PERFORMED?
Coronary Artery Bypass Grafting is a procedure performed exclusively
by cardiothoracic surgeons. The traditional technique involves an
incision down the front of the chest through the breastbone or
sternum. This incision is called a median sternotomy. Through this
incision the surgeon can see the heart and the aorta. The procedure
as traditionally performed requires that the patient be connected to
the heart lung machine while the bypasses are being performed. The
heart can then be stopped using a special mixture of chemicals
called cardioplegia. After the bypasses have been performed the
patient is taken off of the machine and their own heart takes over
once again.
All bypasses were originally performed using saphenous vein from the
leg to carry blood around the obstruction. The vein was attached at
one end to the aorta and at the other end to the coronary artery
beyond the blockage. In the 1970's and 1980's, cardiothoracic
surgeons discovered that an artery from the inside of the chest
wall, the internal thoracic artery (also called the internal mammary
artery), could be used instead of vein for the bypass grafts and
that it stayed open longer than saphenous vein grafts. Today most
CABG operations are performed using a combination of bypass grafts
including this artery and some saphenous vein.
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This illustration shows a
heart with a saphenous vein graft. The surgeon connects
the vein to the aorta (upper left) and to the coronary
artery at the (lower right). |
This illustration shows a
heart with the left internal thoracic artery grafted to
the anterior descending coronary artery (bottom right). |
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