CORONARY ARTERY BYPASS GRAFT (CABG)

DEFINITION INDICATION

Coronary artery The average age for people who have CABG
bypass grafting surgery is around 66 years old. About 72% of
(CABG), also the people who undergo it are men.
known as heart
bypass surgery,  Left Main Coronary Artery Disease
is a procedure  Multivessel Coronary Artery Disease
to restore blood
flow to areas of the heart. Artery blockages  Stable Angina
can cut off blood flow, causing heart attacks
 Left Ventricular Dysfunction
or heart attack-like symptoms. CABG
restores blood flow by using blood vessels  Acute Coronary Syndrome
from other parts of your body to create a
 Failed Percutaneous Coronary
detour around blockages. Intervention (PCI)
TYPES of Coronary Bypass CONTRAINDICATIONS

 Severe Lung Disease

 Severe Kidney Disease
 Severe Liver Disease
 Poor General Health
 Advanced Age
 Refusal of Surgery
RISK/COMPLICATIONS

Possible complications of coronary artery

bypass surgery are:
Traditional. This is the procedure used most
often. The chest is cut open and heart is  Bleeding
stopped, with a machine circulating the blood  Heart attack due to a blood clot after
during the surgery. surgery
 Infection at the site of the chest
Off-pump. Chest is still open, but the heart is wound
left beating. The area being worked on is kept  Long-term need for a breathing
still by special equipment. machine
 Irregular heartbeats, called
Minimally invasive. This is also called a arrhythmias
keyhole procedure. In this, the surgeon makes  Kidney disease
small cuts between the ribs to get access to the  Memory loss or trouble thinking
heart. They'll use cameras to guide the clearly, which often is temporary
 Stroke
instruments, or it may be done robotically.

Jenny G. Taopa
BSN-4D I GROUP 3
 CORONARY ARTERY BYPASS GRAFT (CABG)

Note: The risk of complications is higher if compared to another set taken when
the surgery is done as an emergency treatment. your heart is at rest.
Having the following medical conditions
increases the risk of complications:  Cardiac catheterization. A surgeon
inserts a thin tube into a blood vessel
 Blocked arteries in the legs. and threads it through to your heart,
 Chronic obstructive pulmonary where they inject a special dye. Then
disease (COPD). they make an image called an
 Diabetes. angiogram that shows how your
 Kidney disease. blood is moving and where there are
blockages.

BEFORE the Procedure  CT scan. Another way to get a look at

how your blood is flowing is using a
EDUCATION: Before coronary artery computer that turns X-rays of your
bypass surgery, activities, diet and medicines heart into a 3D picture.
may change.
 Coronary calcium scan. This is
Patient must undergo lab and imaging tests another kind of CT scan that
to check overall health and to see which measures the amount of calcium in the
arteries are blocked. Which are: walls of your coronary arteries, which
is an indication of disease.
 Chest X-ray.
 Blood tests. Your doctor will check
 Electrocardiogram (EKG). A machine
your levels of white and red blood
records the heart's electrical activity.
cells, cholesterol, blood sugar, and
 Echocardiogram. Sound waves create other things.
a moving picture of the heart to show
 Urine test. This shows how well the
its size and shape.
kidneys are working.
 Exercise stress test. Doctor records
MEDICATION: Medicines to control
your heart activity, blood pressure,
bleeding and blood pressure and to prevent
and other physical data while you
infection are typically given before surgery to
raise your heart rate by walking on a
reduce the risk of complications. If you have
treadmill or using a stationary bike.
diabetes, you may get medicine to control
 Nuclear cardiac stress test. You may blood sugar during surgery. Patients may be
have special pictures taken of your instructed to stop taking certain medications
heart after taking a stress test. (e.g., blood thinners) a few days before
Radioactive material is injected into surgery
your vein that helps show how well
HOSPITAL ADMISSION: The patient is
blood is flowing in your heart and
admitted the day before or the morning of the
whether parts of the heart muscle are
surgery. Fasting is required for 8–12 hours
damaged. The pictures will be

Jenny G. Taopa
BSN-4D I GROUP 3
 CORONARY ARTERY BYPASS GRAFT (CABG)

prior to the operation. A surgeon makes an incision down

the chest, splitting the breastbone to
DURING the Procedure access the heart.
Anesthesia and life support The heart is stopped temporarily, and
Medicines. A combination of medicines is a heart-lung machine maintains blood
given through the IV and a face mask. These circulation. (In some cases, “off-
medicines put the patient in a pain-free, sleep- pump” bypass surgery avoids
like state. This is called general anesthesia. stopping the heart.)
(General anesthesia is administered, rendering After the surgery is done, the
the patient unconscious) healthcare team restores the heartbeat
Breathing machine. A healthcare professional in the operating room and stops the
puts a breathing tube into patient's mouth. heart-lung machine. The surgeon uses
This tube attaches to a breathing machine wire to close the chest bone. The
called a ventilator. The machine breathes for sternum is wired back together, and
the patient during and immediately after the the incision is stitched or stapled. A
surgery. temporary chest tube is placed to
drain fluids. The wire stays in in the
Heart-lung machine. During surgery, a heart- patient's body after the bone heals.
lung machine keeps blood and oxygen flowing
through your body. This is called on-pump AFTER the Procedure
coronary bypass. 1. Hospital Recovery:
A healthy blood vessel (often from the leg,
 Patients are monitored in the intensive
arm, or chest) is grafted to bypass the blocked
care unit (ICU) for 1–2 days.
coronary artery.
 Pain management, oxygen therapy,
Blood vessel harvesting
and medications are provided.
CABG involves creating a bypass for blood to
 The patient is transferred to a regular
use to reach blocked areas of the heart.
room to continue recovery for 4–7
Creating that bypass, where healthy blood
days.
vessel (often from the leg, arm, or chest) is
grafted to bypass the blocked coronary artery. 2. Physical Recovery:
In cases where there’s more than one blocked
artery, multiple bypasses may be necessary.  Gradual physical activity is
These are double (2), triple (3) and quadruple encouraged. Breathing exercises and
(4) bypasses. cardiac rehabilitation programs are
introduced to restore strength.
Surgery
 Patients should avoid heavy lifting
The surgery typically lasts 3–6 hours, and strenuous activity for 6–8 weeks.
depending on the number of bypasses
needed. It usually takes about 6 to 12 weeks to get

Jenny G. Taopa
BSN-4D I GROUP 3
 CORONARY ARTERY BYPASS GRAFT (CABG)

better after coronary artery bypass surgery. If for long-term success.

advised by the healthcare team, patient can
usually drive, return to work or the gym, and  Don't smoke
have sex after 4 to 6 weeks. But everyone
 Eat healthy foods
recovers differently. Ask healthcare
professional for guidance.  Manage weight

3. Follow-Up Care:  Exercise and stay active

 Regular checkups are scheduled to  Manage stress

monitor progress.
 Get good sleep
 Medications such as blood thinners,
cholesterol-lowering drugs, or beta- 5. Potential Risks:
blockers may be prescribed.
After surgery and when you're at home, you
 You may be prescribed dual need to watch for symptoms of complications.
antiplatelet therapy. This means you Call your healthcare team if you have:
may be treated with two types of
 Fever
medicine to prevent blood clots.
 Rapid heart rate
 Aspirin.  Pain around your chest wound that is
new or gets worse
 P2Y12 Inhibitor. Maybe taken for a  A change in skin color around your
year and then stop but aspirin therapy chest wound
is continued.  Bleeding or other discharge from your
chest wound
 Other medications maybe prescribed:
• Common complications include infection,
Arrhythmia medications. Abnormal
bleeding, arrhythmias, or blood clots.
heart beats can develop after CABG.
However, most patients experience significant
These medications keep heart beating
symptom relief and improved quality of life.
normally. Diuretics. These medicines
help remove extra fluids from your NURSING CONSIDERATIONS
body. Statins. These medications
reduce "bad" LDL cholesterol levels 1. Monitor Vital Signs and Hemodynamics
that can cause more plaque. Blood
Continuously monitor blood pressure, heart
pressure medications. These lower
rate, central venous pressure (CVP), and
blood pressure to a healthy range.
oxygen saturation to detect complications like
hypotension, hypertension, or arrhythmias
early.
4. Lifestyle Changes:
2. Pain Management
Adopting a heart-healthy diet, regular
exercise, and stress management are critical Administer prescribed analgesics and assess
for pain regularly to ensure patient comfort
Jenny G. Taopa
BSN-4D I GROUP 3
 CORONARY ARTERY BYPASS GRAFT (CABG)

and reduce stress on the heart considering any dietary restrictions due to
comorbidities like diabetes or hypertension.
3. Pulmonary Care
10. Patient and Family Education
Encourage deep breathing exercises, use
incentive spirometry, and assist with early Teach the patient and caregivers about
ambulation to prevent atelectasis and activity restrictions, medication regimens,
pneumonia. Extubate as early as possible signs of complications, and the importance of
once stable. follow-up appointments.

4. Fluid and Electrolyte Balance

Monitor fluid intake and output, as well as Thank you!

electrolyte levels, to prevent imbalances that
could lead to complications like arrhythmias

5. Wound Care

Inspect surgical sites daily for signs of

infection (redness, swelling, drainage) and
educate the patient on proper wound hygiene

6. Management of Cardiac Output

Administer medications like inotropes or beta

-blockers as needed and monitor for signs of
decreased cardiac output, such as low blood
pressure or diminished urine output.

7. Neurological Assessment

Regularly assess for cognitive changes, such

as confusion or delirium, which may occur
postoperatively due to hypoperfusion or
embolism

8. Preventing Deep Vein Thrombosis (DVT)

Use sequential compression devices,

encourage early ambulation, and administer
anticoagulants as prescribed to prevent
thromboembolic events.

9. Nutritional Support

Provide adequate nutrition to promote

healing and prevent complications,

Jenny G. Taopa
BSN-4D I GROUP 3