OP-CAB Patient Information

Coronary artery bypass graft surgery (CABG) is a surgical procedure that restores blood flow to the heart by bypassing blocked heart arteries. In CABG, the surgeon uses a piece of artery or vein from another part of your body. This “harvested” blood vessel is then attached to the blocked heart artery above and below the blockage, allowing blood to flow around the blockage and reach your heart. Traditional CABG requires the surgeon to open the chest by separating the breast bone, still the heart, and connect the patient to a heart-lung machine. Although overwhelmingly safe and effective, traditional CABG can have serious side effects and complications. Boston Medical Center’s Cardiac Surgery Program specializes in minimally invasive off-pump (also called “beating-heart”) CABG procedures that offer advantages over traditional CABG.

What happens during OP-CAB?

OP-CAB is performed under general anesthesia. Once you have been anesthetized, a tube will be inserted through your mouth to help you breath during the procedure. To begin the procedure, the cardiac surgeon will make an incision of about 2 to 4 inches, which could be located along the upper part of the breast bone, the lower part of the breast bone, or between two ribs on the right side of your chest, depending on the location of the arteries the surgeon will bypass. You will be given medication to slow your heart rate and the surgeon will use specialized tools that allow him or her access to the blocked arteries. With one part of the heart stabilized, the surgeon can perform the bypass while the rest of the heart pumps oxygen-rich blood to your body.

Depending on the artery or arteries to be bypassed, the surgeon may use the internal thoracic artery (also called the mammary artery located in your chest), an artery from your arm, or a vein from your leg for the bypass. The surgeon will then connect one end of the bypass vessel to the blocked artery above the blockage and one end below the blockage. If the surgeon is using a chest artery for the bypass, he or she may disconnect only one end and attach it below the blockage in the bypass artery. Once the graft is secure and blood is flowing through it, the surgeon closes the incision and the procedure is complete. OP-CAB can take between 3 and 6 hours to complete.

What are the advantages of OP-CAB?

Compared to traditional open CABG surgery, OP-CAB offers the following advantages:

• Shorter recovery time;
• Smaller incision and scar;
• Less infection risk;
• Less bleeding risk;
• Lower stroke risk;
• Less risk of kidney failure; and
• Less risk of cognitive (mental) problems.

How do I prepare for OP-CAB?

Prior to the procedure, your surgeon will perform a physical examination and review your medical history. Your surgeon will give you any specific instructions about dietary or activity restrictions. You’ll also undergo several pre-operative tests, including an electrocardiogram (ECG), blood tests, chest x-ray, and an angiogram, in which a physician examines the arteries that deliver blood to your heart by injecting a contrast agent and then taking x-rays.

Be sure to bring a list of any medications, dietary supplements, or herbal supplements that you take with you to your doctor’s appointment. Tell your doctor if you have any allergies to medication.

Although your surgeon will give you specific instructions, typically patients are instructed to stop taking blood-thinning medications like warfarin (Coumadin) before surgery to lower the chance of bleeding complications. Your surgeon may also instruct you to stop smoking before the procedure. In addition, you may be asked to refrain from eating or drinking after midnight the night before your procedure. Your surgeon will instruct you about whether you should take your regular medications the day of the procedure. Most people are admitted to the hospital the day of the surgery.

What happens after OP-CAB?

Immediately following your procedure, you will be taken to an intensive care unit. As soon as you are awake and able to breathe on your own, the breathing tube will be removed. The medical staff will monitor your heart, blood pressure, breathing, and other vital signs. You will be walking within 24 hours and will be discharged within a week as long as you experience no complications.

Recovery expectations

Patients should expect to stay in the hospital for 3 to 5 days, but full recovery can take up to 12 weeks. Before you are discharged from the hospital, you will receive specific instructions about how to care for your incision. Typically, you should keep the incision clean and dry, using only soap and water to clean the area.

You should notify your physician if you notice any signs of infection, including:

• Increased drainage or oozing from the incision;
• Redness or warmth around the incision; and
• Temperature of more than 101 degrees.

Even though most people feel symptom relief after OP-CAB, the underlying coronary artery disease remains, and you will be asked to make lifestyle changes to help improve your heart health and eliminate the need for more procedures. For most people, CABG surgery is followed by a tailored cardiac rehabilitation program to help them make the necessary lifestyle changes.