CORONARY ARTERY BYPASS GRAFT SURGERY

Definition: - coronary artery bypass graft surgery comprises of direct anastamosis of reversed segments
of saphenous vein to the ascending aorta and to a patent segment of one or more or major coronary
arteries and their main branches. CABG surgery is a palliative, not a curative intervention and is less than
continuing with medical therapy.

Purposes:-

To restore coronary arterial blood flow to the myocardium distal to the occluded coronary vessels.

Preoperative preparation:-

1. Establish rapport with patient and his family

2. Explain procedure and its benefits cost and show him other similar cases.
3. Assess and stabilize any other disease conditions and optimize cardiac functions (E.g. Diabetes,
Hypertension, & COPD etc.
4. Assess and treat any sources of possible infection. E.g. Peridontal disease, skin lesion, stasis ulcer
etc.
5. Decrease the anxiety associated with waiting for hospitalization.
6. Provide information regarding pre operative routine, length of surgery, visiting routines in CCU,
recovery phase etc.
7. Stop anticoagulant therapy before 5 to 7 days prior to surgery
8. Assess learning needs and teach breathing exercises, to ensure optimum lung expansion and
oxygenation post operatively, together with teaching about coughing and leg exercises
9. Check for the following:-
Chest-X-ray
Echocardiography
ECG
Angiography
All blood investigations
Arrange blood
Clearance
Consent
Physical preparation(whole body saving & bowel preparation)
Betadine scrub bath
NPO status
Pre-operative medications

Procedure:-

A median sternotomy incision is made through the skin & soft tissue from the supraclavicular
notch to the xyphoid process. The sternum is divided longitudinally using a special saw or scissors. If
surgery doing with “on pump” (cardio pulmonary bypass machine) before cannulating the graft kept
ready. Usually single cannulation is used in CABG. From aorta cannulated to cardiac pulmonary bypass
machine. This machine is doing heart’s pumping work & lungs purification work. In this time heart is in
the resting period. During grafting they are using cardioplegic solutions to arrest the heart & also fibrillate
the heart.
While the person is on cardiopulmonary bypass and the heart is not beating, surgeon sews the
distal end of the vein to the aorta and the proximal end to the coronary vessels distal to the blockage. In
some cases internal mammary artery (IMA) can be grafted to a coronary artery. The disadvantage of the
IMA is that more time is required to remove it & it is shorter. It is used to revascularize the portion of
myocardium supplied by the left anterior descending artery. IMA grafts have a greater chance to remain
patent. The veins are reversed so that their valves do not interfere with blood flow.
If they are taking radial artery means they are doing “Y” graft, because the radial artery is short. First
connect the radial artery to LIMA and then anastamosis with the diseased area. The “sequential graft”
means both one graft anastamosing more than one block. After grafting clamp the cannulation, put chest
tubes & closes the chest with sterna wires.
Off pump means they are doing grafting in beating heart. There is an instrument called “octopus”,
with the help of this they will arrest the part of the occluded area only & doing grafting and the other
areas of the heart is functioning properly.

Post operative assessment:- the primary focus of nursing care initially is acute assessment and prompt
intervention to stabilize the patient. Emotional support of the patient (and family) and comfort are equally
important. Assess the following…..
Monitor intracardiac pressures for the first 24 hours.
Monitor arterial blood pressure
Check pulses
Venous & left heart filling pressures
Body temperature
Heart
ECG monitoring
Chest Drainage
Fluid & electrolyte balance
Renal function
Electrolyte Balance
Neurological responds
Monitoring level of consciousness
Monitoring pupil size and reaction
Monitoring orientation
Monitoring ability to move extremities
Check chest & graft sites regularly
Administer all post operative medication as per order
 Before transferring the patient from unit, his ET tube, arterial catheters, and probably the chest
tubes and urinary catheter are removed. Cardiac monitoring may be continued (usually 72 hours).
Increase ADL, ambulation, sitting and vigorous respiratory care to reduce atelectasis.pain management
care offered frequently. Patient should be monitored for supraventricular arrhythmias, hypertention,
congestive heart failure and emotional distress.