Having Off-Pump Coronary Artery Bypass Graft (CABG) Surgery

Coronary artery bypass graft (CABG) surgery is a type of heart surgery. A cardiopulmonary bypass machine isn't needed during off-pump CABG surgery (also called beating heart surgery). The surgery is done to bypass a blocked area in a coronary artery. This is known as coronary artery disease (CAD). The coronary arteries are blood vessels that supply blood to the heart muscle. They keep the heart muscle healthy so it can pump blood around the body.

What to tell your healthcare provider

Tell your provider about all the medicines you take. This includes prescription and over-the-counter medicines, such as ibuprofen. It also includes vitamins, herbs and other supplements, as well as illegal drug use. Tell your provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)

• Are pregnant or think you may be pregnant

Tests before your surgery

Before your surgery, you may need tests such as:

• Chest X-ray

• Electrocardiogram (ECG) to check the heart’s rhythm

• Blood tests to look at your general health

• Echocardiogram to view heart anatomy and blood flow through the heart

• Cardiac stress testing to check your heart’s activity during exercise

Getting ready for your surgery

Talk with your healthcare provider how to get ready for your surgery. You may need to stop taking some medicines, such as blood thinners and aspirin, before the surgery. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your provider if you need help to stop smoking.

Also, make sure to:

• Ask a family member or friend to take you home from the hospital. Don't drive yourself.

• Plan some changes at home to help you recover. Arrange for help at home.

• Follow any directions you're given for taking medicines and for not eating or drinking before surgery.

• Follow all other instructions from your provider.

You'll be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions if something isn't clear.

On the day of surgery

Your procedure will be done by a cardiac surgeon. This is a doctor who treats diseases of the heart. They'll work with a team of specialized nurses and operating room staff. The surgery can be done in more than one way. Some surgeons use robot-controlled arms to do the surgery. Talk with your surgeon about the risks and benefits of this kind of surgery. The surgery will take several hours. In general, you can expect the following:

• You'll have general anesthesia, medicine that allows you to sleep through the surgery. You won’t feel any pain during the surgery.

• Hair in the area of the surgery may be removed.

• Your heart will keep beating during the surgery. 

• A healthcare team will watch your vital signs, like your heart rate and blood pressure, during the surgery.

• Your surgeon will make an incision to remove a blood vessel from another part of your body. This is the graft. The graft vessel is most often taken from your chest wall, leg, arm, or abdomen.

• The surgeon will make an incision down the middle of your chest. They'll then separate your breastbone to reach your heart.

• If you're having a minimally invasive off-pump CABG, the surgeon will instead make a small incision down the middle of your chest. They'll then separate a small part of your breastbone. They may use special tools and a tiny camera to do the surgery. The surgeon may make several small incisions in your chest between the ribs.

• The surgeon will attach the graft vessel to the aorta. The aorta is the main blood vessel leading from the heart out to the body. The surgeon will attach the other end of the graft vessel to the blocked coronary artery, to bypass the blockage.

• The healthcare team wires your breastbone back together, if needed.

• The team closes all incisions with stitches or staples. They put dressings on the incisions.

After your surgery

After surgery, you'll be taken to a recovery room or directly to the intensive care unit (ICU). Nurses will check your breathing, heart rate, and blood pressure. You may have a tube draining fluid from your chest. You may have a tube in your throat to help you breathe. This may be uncomfortable, and you won’t be able to talk. The tube is usually removed within 24 hours. You may stay in the hospital for up to 5 days.

You may have some pain at the incision site after surgery. You can take pain medicines to help relieve it. Only take pain medicine approved by your healthcare provider.

In a day or two, you should be able to sit in a chair and walk with help. You may need to do breathing therapy to help prevent or remove fluid building up in your lungs. You can go back to your normal food as soon as you feel able.

Make sure you have someone to help at home for a while. When you go home, it may take a little while for you to go back to your normal activities. Avoid vigorous exercise until your provider says you're ready. Don’t lift anything heavy until your provider says it’s OK. Ask your provider when it's safe for you to drive.

Follow-up care

You'll likely have your stitches or staples removed in 7 to 10 days. Make sure you keep all of your follow-up appointments. Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Your provider may refer you to a cardiac rehab program. This is to help you regain your strength after heart surgery.

Call your healthcare provider right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Increase in pain, redness, bleeding, or fluid leaking from the incision

• Other symptoms as advised