You’re driving on the highway and see a sign warning that the road is closed a mile ahead due to construction. Another sign directs you to a detour around the blocked roadway. So you take the detour and continue on your way.
That’s a simple way to explain Coronary Artery Bypass Grafting (CABG), also known as coronary bypass surgery or simply a “bypass.” CABG is an open-heart operation that creates a detour around blocked coronary arteries, which supply blood to your heart. When an artery becomes blocked, it can lead to a heart attack, and can cause the heart muscle to be damaged from a lack of blood supply.
Dr. Walter McGregor, cardiac and thoracic surgeon at Allegheny Health Network’s (AHN’s) Allegheny General Hospital (AGH) in Pittsburgh, explains how the procedure works, how it came about, when you may need CABG, and what makes AHN unique in the field of heart surgery and cardiovascular care.
To perform CABG, heart surgeons use healthy artery or vein grafts from other parts of the patient’s body. The open ends of the artery or vein graft are sewn into the clogged artery above and below the blockage, bypassing the obstruction. Once in place, the grafted artery or vein increases blood flow by keeping blood moving smoothly to the heart, Dr. McGregor says.
“During the operation, we may use a heart-lung machine to circulate your blood and add oxygen to it while we’re working on you,” says Dr. McGregor. “After the operation, you may spend three to eight days in the hospital, possibly in the intensive care unit. It can take about four to six weeks to recover.”
Cardiac rehabilitation is part of recovery for CABG patients. Cardiac rehabilitation focuses on regaining strength and getting back to normal activities after surgery, while making lifestyle improvements to reduce the risk of future problems. This includes exercise programs, as well as programs to help patients eat a healthier diet and cope with stress.
CABG was invented in the 1960s by Dr. Rene Favoloro, an Argentinian heart surgeon working at the Cleveland Clinic. He was the first surgeon to use a portion of the saphenous vein to bypass a blocked section of coronary artery.
Over the last 50 years, several newer, less-invasive techniques for CABG have been developed.
During off-pump bypass surgery, a surgeon uses innovative robotic technology to perform single or multiple vessel revascularization through just a few small incisions rather than with traditional open-heart surgery. The procedure is performed without the use of a heart-lung machine. The surgeon takes one of the patient’s healthy blood vessels — often from inside the chest wall — and attaches the ends above and below the blocked artery so that the blood flow is diverted around the narrowed part of the diseased artery.
For endoscopic radial artery and saphenous vein harvesting the surgeon uses an artery or vein in the patient’s arm or leg to create a bypass graft. This graft is then used to replace the narrowed blood vessel that is reducing blood flow. This procedure is performed through just a few small incisions rather than long, open incisions, which can mean a shorter recovery time and reduced risk of complications.
“If all three of the main coronary arteries to your heart are blocked, or if you have severe coronary artery disease, those are two situations when you may need CABG,” Dr. McGregor says. “We’ve come up with a lot of new technologies to deal with blocked coronary arteries in the area of interventional cardiology. That means that a lot of blockages that we used to treat with CABG can be treated with cardiac catheterization and stents. These new, minimally invasive approaches have made a big impact on things like recovery time and risk of complications and have reduced pain for patients. Although we use these technologies more and more often, there are still situations where CABG is the right treatment.”
Dr. McGregor also emphasizes that, “Whether you need CABG or another treatment for blocked or narrowed coronary arteries depends on a lot of different factors, and every case is unique. That decision is best left to your doctor. And of course, it’s always a good idea to get a second opinion.”
“What makes AGH and AHN’s Cardiovascular Institute unique when it comes to caring for your heart and circulatory system is our team approach,” Dr. McGregor says. “It’s not just involving the cardiologists and heart surgeons who operate on you. We bring many different professionals together so that we can make the most informed decisions possible based on your unique needs.”
Dr. McGregor is a key part of this team. He meets with several other doctors, nurses and other professionals, including cardiac imaging experts and rehabilitation experts, across all of the sub-specialties of cardiology to discuss patients’ cases and approaches to treatment.
“We conduct, on average, more than 1,000 open heart surgeries every year, which includes CABG, as well as other operations such as repairing or replacing bad heart valves. What’s more, we see many of the most complex cases in the region, such as ‘redo’ procedures where patients who’ve had CABG in the past need repeat surgery, either because they have blockages in other arteries or because we need to ‘bypass a bypass’ because it, too, became blocked. In these cases, patients have scar tissue that can make these operations more complex.”
Dr. McGregor’s work builds upon a long, proud heritage of innovation and leadership in cardiovascular care at Allegheny Health Network hospitals. The first sutureless artificial heart valve was invented in the early 1960s at AGH by famed cardiologist Dr. George Magovern, Sr. One of the first heart transplants in Pennsylvania was performed at AGH, as well.
“That heritage is one we have to live up to every day we go to work,” Dr. McGregor says. “What this means is that we not only think about how we care for patients today, but also — based on what we’ve learned — where we’re going in the future.”
He also describes cardiovascular care as “one of the most exciting, fastest changing and growing specialties out there. Advances that help make care better, faster and more cost-effective are being made almost every day. At AHN, we’re leading the way in research and clinical trials to develop new ways of treating cardiovascular problems. Our work is not only adding years to patients’ lives, but life to those years.”
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