Coronary Artery Bypass Graft

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Tahreem Tarique, Kim Jackson and Rucha Gadgil  

Introduction[edit | edit source]

CABG All.png

Coronary artery bypass grafting (CABG) is a common surgical procedure for the treatment of myocardial ischemia. The surgeon uses an artery or vein of the patient to anastomose from the aorta to the distal end of the stenosis, so that blood flow can directly supply the distal myocardium through the graft, thereby achieving the purpose of treating myocardial ischemia[1].

Image 1: 4 types of CABGs

  • Coronary artery bypass grafting remains one of the most commonly performed major surgeries, with well-established symptomatic and prognostic benefits in patients with multivessel and left main coronary artery disease.
  • Despite an increasingly higher-risk profile of patients, outcomes have significantly improved over time, with significant reductions in operative mortality and perioperative complications. Five- and 10-year survival rates are ≈85% to 95% and 75%, respectively.
  • A number of technical advances could further improve short- and long-term outcomes after coronary artery bypass grafting[2].

Indications[edit | edit source]

CABG is generally recommended when there are high-grade blockages in any of the major coronary arteries and/or percutaneous coronary intervention (PCI) has failed to clear the blockages[3]

Procedure[edit | edit source]

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During bypass surgery, the sternum is divided, the heart is stopped for a while and the blood is sent via a heart-lung machine, when the surgery is being performed, to the rest of the body. In contrast with other types of open heart surgery, the heart chambers are not opened while doing a bypass surgery. Depending on the number of arteries that are bypassed it is called as single, double, triple or quadruple bypass[4].

Image 2: Patient underwent CABG for three vessel disease. Bypass grafts were assessed for graft patency (3 bypass grafts can be seen which are patent).

Long term outcome of coronary artery bypass grafting depends on graft patency. Angiography was done for routine assessment of CABG, especially when the patient presented with recurrent angina. However, in the era of cardiac multidetector CT imaging, screening of grafts for patency is quite useful in the early (<1 month) as well as late (>1 month) postoperative period. [5]

Complications[edit | edit source]

  1. Non-graft related surgical complications: pleural or pericardial effusion; sternal, mediastinal or donor-site infection; sternal non-union; pulmonary embolism; mediastinal haematoma
  2. Surgery related: Thrombosis - most common in the early postoperative period, due to improper anticoagulation or endothelial damage during surgery; graft malposition or kinking; graft spasm; iatrogenic complications; graft damage during surgery.[5]

Physiotherapy[edit | edit source]

Pre Surgery Physiotherapy[edit | edit source]

Patients who did not engage in preoperative physical therapy have a higher chance of having postoperative pulmonary complications following CABG surgery. A number of elements, such as general anesthesia, the length of mechanical ventilation, cardiopulmonary bypass, and the sternotomy incision, may contribute to the impairment of postoperative pulmonary function.[6]

Preoperative exercise training  improve physical fitness, which increases a patient's capacity for withstanding surgical stress. Numerous physiotherapy techniques have been demonstrated to be successful in enhancing physical endurance and causing physiological changes in the diaphragm to enhance the patient's overall clinical condition.[6]

Different preoperative exercises help patients manage the stress of the procedure and the recovery period as well as enhance their physical condition and fitness such as

Preoperative therapies' primary objective is to reduce potential complications after cardiac surgery. Furthermore, by using these methods, patients' mortality rates might be decreased. Preoperative training reduces the length of postoperative hospital stay for patients. A short hospital stay also has the advantage of allowing patients to continue their recovery in their comfortable surroundings at home, freeing up hospital resources for other patients in need of medical attention.[7]

Post Surgery Physiotherapy[edit | edit source]

Surgery-1822458 1920.jpg

See phases of Cardiac Rehabilitation

Example of Typical Protocol

  1. Post Surgery Phase 1.
  • Phase I of rehabilitation occurring in the hospital is designed to mobilize the patient as soon as possible and to help the patient regain independence in daily life activities.
  • It takes 6-8 weeks for the sternum to heal, physiotherapists show the patient the safest ways to lift and move their body, including rolling and sitting in bed. You can learn more about this at Sternal Precautions


Phase 2 and 3 may be part of Cardiac Rehabilitation Program.

2. Phase 2.

Approximately applied for 3 weeks. Should include aggressive education and secondary prevention of cardiovascular events, and provide exercise monitoring.

  • Patients qualified for inpatient physiotherapy (InPhysio) train on cycloergometers and had collective gym exercises in the rehabilitation room. Cycloergometer workouts can be held twice a day under the supervision of physiotherapists. The load and type of training (with intervals or continuous) are adapted individually to the patient’s condition. Sessions on cycloergometers take about 20–30 min depending on the capability and strength of the patient. General gymnastics lasts 20 min each day, and breathing exercises with the use of TriFlo should be performed 10 times every hour.
  • In addition to pre-scheduled stationary exercises, patients should go for walks outside in good weather conditions.

3. Phase III is a continuation of exercises learned at earlier stages and further reduction of cardiovascular risk factors[8].

References[edit | edit source]

  1. Li B, Mao B, Feng Y, Liu J, Zhao Z, Duan M, Liu Y. The Hemodynamic Mechanism of FFR-Guided Coronary Artery Bypass Grafting. Frontiers in Physiology. 2021;12.Available from: https://www.frontiersin.org/articles/10.3389/fphys.2021.503687/full (accessed 20.5.2021)
  2. Head SJ, Milojevic M, Taggart DP, Puskas JD. Current practice of state-of-the-art surgical coronary revascularization. Circulation. 2017 Oct 3;136(14):1331-45.Available from:https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.116.022572 (accessed 20.5.2021)
  3. Bachar BJ, Manna B. Coronary artery bypass graft. StatPearls [Internet]. 2020 Aug 11.Available from: https://www.ncbi.nlm.nih.gov/books/NBK507836/(accessed 20.5.2021)
  4. Pain assist Precautions after CABG Available from:https://www.epainassist.com/chest-pain/heart/precautions-after-bypass-surgery (accessed 20.5.2021)
  5. 5.0 5.1 Radiopedia CABGs Available from: https://radiopaedia.org/articles/coronary-artery-bypass-graft(accessed 20.5.2021)
  6. 6.0 6.1 1. Shahood H, Pakai A, Rudolf K, Bory E, Szilagyi N, Sandor A, et al. The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: a randomized controlled study. Annals of Saudi Medicine. 2022 Jan;42(1):8–16. ‌
  7. 1. Shahood H, Pakai A, Kiss R, Eva B, Szilagyi N, Sandor A, et al. Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania) [Internet]. 2022 Jul 8 [cited 2022 Oct 21];58(7):911. Available from: https://pubmed.ncbi.nlm.nih.gov/35888629/ ‌
  8. Szylińska A, Listewnik M, Rotter I, Rył A, Kotfis K, Mokrzycki K, Kuligowska E, Walerowicz P, Brykczyński M. The efficacy of inpatient vs. home-based physiotherapy following coronary artery bypass grafting. International journal of environmental research and public health. 2018 Nov;15(11):2572.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266912/(accessed 20.5.2021)