Coronary artery
bypass graft
(CABG)
Prepared by
Muntadher abulrahman
Anatomy of coronary artery
Coronary artery bypass graft (CABG)
Coronary artery bypass graft is a surgical
procedure in which a blood vessel is grafted to
an occluded coronary artery so that blood can
flow beyond the occlusion
Purposes
 Restore blood flow to the heart
 Relieves chest pain and ischemia
 Improves the patient's quality of life
 Enable the patient to resume a normal lifestyle
 Lower the risk of a heart attack
The major indications for CABG are:
 Alleviation of angina that cannot be controlled with
medication or PCI.
 Treatment for left main coronary artery stenosis or multi
vessel CAD.
 Prevention of and treatment for MI, dysrhythmias, or
heart failure.
 Treatment for complications from an unsuccessful PCI.
The recommendation for CABG is determined by a
number of factors, including
 the number of diseased coronary vessels
 the degree of left ventricular dysfunction
 the presence of other health problems
 The patient’s symptoms
 previous treatment.
Procedure
 For a patient to be considered for CABG, the coronary
arteries to be bypassed must have at least a 70%
occlusion, or at least a 50% occlusion if in the left main
coronary artery.
 Current
guidelines
recommend
that
the
internal
mammary artery should be used for CABG, if possible.
 A vein commonly used for CABG is the saphenous vein
Traditional Coronary Artery Bypass Graft
 CABG
procedures are performed with the patient
under general anesthesia.
 the surgeon performs a median sternotomy and
connects the patient to the cardiopulmonary bypass
(CPB) machine.
 Next, a blood vessel from another part of the patient’s
body (e.g., saphenous vein, left internal mammary
artery) is grafted distal to the coronary artery lesion,
bypassing the obstruction.
Alternative Coronary Artery Bypass Graft
 Off-pump coronary artery bypass (OPCAB) involves a
standard median sternotomy incision, but the surgery is
performed without CPB.
 A beta-adrenergic blocker may be used to slow the
heart rate.
 The surgeon also uses a myocardial stabilization device
to hold the site still for the anastomosis of the bypass
graft into the coronary artery while the heart continues
to beat
Off-pump coronary
artery bypass
Complications of Coronary Artery Bypass
Graft
hemorrhage
dysrhythmias
MI
thromboembolic events
Preoperative nursing management
 Nurse perform a history and physical examination.
 Preoperative
testing consists of a chest x-ray; ECG;
laboratory tests, including coagulation studies; and
blood typing and cross matching.
 Obtain consent form
 Reducing Fear and Anxiety.
 Providing Patient Education
Postoperative Nursing Management
 achieving or maintaining hemodynamic stability and recovery
from general anesthesia.
 Care focuses on monitoring of cardiopulmonary status, pain
management, wound care, progressive activity, and nutrition.
 Check vital signs every hours
 Education about medications and risk factor modification is
emphasized.
 Monitor input and out put
 Measure postoperative chest drainage
 Monitor fluid and electrolyte balance
 Assess renal function
 Patient education
Thank you