Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease.

1. Presented By:
MR.ABHAY RAJPOOT
M.SC.Nsg. FINAL Year

2. The heart contains 4 chambers: the right atrium, left
atrium, right ventricle, and left ventricle. The atria are
smaller than the ventricles and have thinner, less
muscular walls than the ventricles. The ventricles are
connected to the arteries that carry blood away from
the heart.

5. A form of bypass surgery that can create new routes
around narrowed and blocked coronary arteries,
permitting increased blood flow to deliver oxygen and
nutrients to the heart muscle. CABG surgery is one of
the most commonly performed major operations.

6.  1. Restore blood flow to the heart.
 2. Relieve chest pain & ischemia.
 3. Improves the patient’s quality of life.
 4. Enables the patient to resume a normal life cycle.
 5.Lower the risk of a heart attack.

7. Indications for Coronary Artery Bypass Grafting
(CABG) depend on various factors, mainly on the
individual's symptoms and severity of disease. Some of
these include:
 Left main artery disease or equivalent
 Triple vessel disease
 Abnormal Left Ventricular function.
 Failed PTCA.
 Immediately after Myocardial Infarction (to help
perfusion of the viable myocardium).
 Life threatening arrhythmias caused by a previous
myocardial infarction.
 Occlusion of grafts from previous CABG.

8. ●Left main artery disease or aortic valve insufficiency
●Abdominal aortic aneurysm
●Haemorrhage diseases
●Valve diseases, congenital heart diseases,
cardiomyopathy
●Lower extremities edema
●Severe hypertension, blood pressure higher than
70/110
●Uncontrolled arrhythmias
●Pregnancy

9.  Physical Exam and Diagnostic Tests-
 ECG (Electrocardiogram)
 MRI
 Echocardiography
 Coronary Angiography

10. Traditional Coronary Artery Bypass Grafting-
This is the most common type of coronary artery
bypass grafting (CABG). It's used when at least one
major artery needs to be bypassed.

12. This type of CABG is similar to traditional CABG
because the chest bone is opened to access the heart.
However, the heart isn't stopped, and a heart-lung bypass
machine isn't used. Off-pump CABG is sometimes called
beating heart bypass grafting.

14. Alternate methods of minimally invasive coronary artery
bypass surgery have been developed. Off-pump coronary
artery bypass (OPCAB) is a technique of performing
bypass surgery without the use of cardiopulmonary
bypass.

15.  The patient is brought to the operating room and moved
onto the operating table.
 An anaesthetist or anesthesiologist places intravenous and
arterial lines and injects an analgesic, usually fentanyl,
intravenously, followed within minutes by an induction
agent (usually propofol or etomidate) to render the patient
unconscious.
 An endotracheal tube is inserted and secured by the
anaesthetist and mechanical ventilation is started. General
anaesthesia is maintained with an inhaled volatile
anesthetic agent such as isoflurane.
 The chest is opened via a median sternotomy and the
heart is examined by the surgeon.

16.  The bypass grafts are harvested – frequent vessels are
the internal thoracic arteries, radial
arteries and saphenous veins. When harvesting is done,
the patient is given heparin to inhibit blood clotting.
 In the case of "off-pump" surgery, the surgeon places
devices to stabilize the heart.
 In the case of "on-pump" surgery, the surgeon
sutures cannulae into the heart and instructs
the perfusionist to start cardiopulmonary bypass (CPB).

17.  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 an intensive care unit (ICU)
or cardiac universal bed (CUB) to recover. After
awakening and stabilizing in the ICU for 18 to 24
hours, the person is transferred to the cardiac
surgery ward..

18. Although complications from coronary artery bypass
grafting (CABG) are uncommon, the risks include:
 Wound infection and bleeding
 Reactions to anesthesia
 Fever
 Pain
 Stroke, heart attack, or even death

21. CABG

22.  https://cardiacsurgery.ucsf.edu/conditions--
procedures/coronary-artery-bypass-grafting-(cabg).aspx
 https://www.medicinenet.com/script/main/art.asp?articlekey
=2841
 https://en.wikipedia.org/wiki/Coronary_artery_bypass_surg
ery
 https://www.hopkinsmedicine.org/healthlibrary/test_proced
ures/cardiovascular/coronary_artery_bypass_graft_surgery_
92,P07967
 https://my.clevelandclinic.org/health/treatments/16897-
coronary-artery-bypass-surgery
 Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, Thirteenth edition, 2013, Elsevier publications.