Coronary Artery Bypass Surgery (CABG) introduction, purposes, indication, contraindication and procedure.

1. Prepared
by:
PRABITA SHRESTHA

3.  Coronary artery bypass surgery, also known
as coronary artery bypass graft surgery, and
colloquially heart bypass or bypass surgery, is
a surgical procedure performed to
relieve angina and reduce the risk of death
from coronary artery disease.
 Arteries or veins from elsewhere in the patient's
body are grafted to the coronary arteries to bypass
atherosclerotic narrowings and improve
the blood supply to the myocardium.

4.  Coronary artery bypass graft surgery is a surgical
procedure in which one or more blocked coronary
arteries are bypassed by a blood vessel graft to
restore normal blood flow to the heart.
 These grafts usually come from the patient's own
arteries and veins located in the leg, arm, or chest

5.  Coronary artery bypass graft surgery is performed
to restore blood flow to the heart.
 This relieves chest pain and ischemia, improves the
patient's quality of life, and, in some cases, prolongs
the patient's life.
 The goals of the procedure are to relieve symptoms
of coronary artery disease, enable the patient to
resume a normal lifestyle, and to lower the risk of a
heart attack or other heart problems.

6.  Left main coronary artery stenosis of 50% or greater
 Proximal vessel disease
 Multivessel disease and decreased left ventricular
function.
 Chronic stable angina that is life style limiting and
unresponsive to medical therapy or PTCA and
stenting.

7.  Small coronary arteries distal to the stenosis.
 Severe aortic stenosis.
 Severe left ventricular failure with co-existing
pulmonary,renal,carotid,and peripheral vascular
disease.

8.  The patient is brought to the operating room and
moved on to the operating table.
 An anaesthetist places a variety of intravenous lines
and injects a painkilling agent followed within
minutes by an induction agent (usually propofol) to
render the patient unconscious.
 An endotracheal tube is inserted and secured by the
anaesthetist and mechanical ventilation is started.
General anaesthesia is maintained by a continuous
very slow injection of Propofol.

9.  The chest is opened via a median sternotomy and
the heart is examined by the surgeon.
 The bypass grafts are harvested – frequent conduits
are the internal thoracic arteries, radial
arteries and saphenous veins. When harvesting is
done, the patient is given heparin to prevent the
blood from clotting.
 In the case of "off-pump" surgery, the surgeon
places devices to stabilize the heart.

10.  If the case is "on-pump", the surgeon
sutures cannulae into the heart and instructs
the perfusionist to start cardiopulmonary
bypass(CPB).
 Once CPB is established, the surgeon places
the aortic cross-clamp across the aorta and instructs
the perfusionist to deliver cardioplegia (a special
potassium-mixture, cooled) to stop the heart and
slow its metabolism. Usually the patient's machine-
circulated blood is cooled to around 84 °F.

11.  One end of each graft is sewn on to the coronary
arteries beyond the blockages and the other end is
attached to the aorta.
 The heart is restarted; or in "off-pump" surgery, the
stabilizing devices are removed. In cases where the
aorta is partially occluded by a C-shaped clamp, the
heart is restarted and suturing of the grafts to the
aorta is done in this partially occluded section of the
aorta while the heart is beating.

12.  Protamine is given to reverse the effects
of heparin.
 Chest tubes are placed in the mediastinal and
pleural space to drain blood from around the
heart and lungs.
 The sternum is wired together and the
incisions are sutured closed.
 The patient is moved to the intensive care
unit (ICU) to recover.

13.  Nurses in the ICU focus on recovering the patient by
monitoring blood pressure, urine output and
respiratory status as the patient is monitored for
bleeding through the chest tubes. If there is chest
tube clogging, complications such as cardiac
tamponade, pneumothorax or death can ensue.Thus
nurses closely monitor the chest tubes and under take
methods to prevent clogging so bleeding can be
monitored and complications can be prevented.
 After awakening and stabilizing in the ICU
(approximately one day), the person is transferred to
the cardiac surgery ward until ready to go home
(approximately four days).

16.  Death
 MI
 STROKE
 Wound infection
 Acute kidney failure
 Blood clots
 Postoperative bleeding
 Multiple organ system failure

17.  Lippincot , Manual of Nursing Practice , 8th
edition , Page no. 371 to 372
 Brunner and Suddarth , Medical and Surgical
Nursing ,10th edition , Page no . 715 to 720
 Black hawks , Medical and Surgical Nursing ,
7th edition , Page no . 1641 to 1642
 en.wikipedia.org/wiki/Coronary_artery_bypas
s_surgery