Coronary Artery Bypass Grafting (CABG)

CABG (pronounced "cabbage") is open-heart surgery that creates new pathways for blood to flow around blocked coronary arteries. A healthy blood vessel from the chest, leg, or arm is grafted to reroute blood past the blockage. Approximately 200,000 CABG surgeries are performed in the US annually.

CABG is recommended for severe coronary artery disease when multiple arteries are blocked, the left main artery is significantly narrowed, or when angioplasty with stents is not suitable. It is often needed after a heart attack or when angina (chest pain) cannot be controlled with medication.

Pre-operative evaluation includes cardiac catheterization, echocardiogram, blood tests, and chest X-ray. Stop blood thinners, aspirin may continue. Do not eat or drink after midnight. Antiseptic body wash is used the night before.

Under general anesthesia, the surgeon opens the chest through the breastbone (sternotomy). The heart may be stopped using a heart-lung machine (on-pump), or the surgery may be done on a beating heart (off-pump). Vessel grafts are sewn in place. Surgery takes 3-6 hours.

ICU stay of 1-2 days, followed by 4-5 more days in the hospital. The sternum takes 6-8 weeks to heal — avoid pushing, pulling, and lifting over 10 pounds. Cardiac rehabilitation begins within weeks. Most patients return to work in 6-12 weeks.

Risks include bleeding, infection (including sternal wound infection), stroke (1-2%), atrial fibrillation (20-40%), kidney problems, memory/cognitive changes, and death (1-3% overall, higher in emergency cases).

Alternatives include percutaneous coronary intervention (PCI) with stents, intensive medical therapy (statins, blood thinners, blood pressure medications), and lifestyle changes. The choice depends on the number and location of blockages.

Covered by Medicare and most insurance plans as a medically necessary procedure. The high cost is due to the complexity of surgery, ICU care, and extended hospital stay.