Skip to main content

Saturn Medic

Coronary Artery Bypass Grafting (CABG)

Clinical Subject Page

Coronary Artery Bypass Grafting (CABG)

Also called

Heart Bypass Surgery

ICD-10

02100Z9

Specialty

Cardiology

Onset

For Acute & Chronic Conditions

Reviewed

July 2026

On This Page

Overview

(CABG) is an open-heart surgical procedure that restores blood flow to ischemic myocardium by bypassing obstructed coronary arteries using arterial or venous grafts.

Indications

  • Left main coronary artery disease
  • Complex multivessel coronary artery disease
  • Triple-vessel disease
  • Diabetes mellitus with multivessel CAD
  • Failed or unsuitable PCI
  • Persistent angina despite optimal medical therapy
  • Mechanical complications of MI requiring surgery

Contraindications

    • Absolute

      • No absolute contraindication when CABG is lifesaving

      Relative

      • Severe frailty
      • End-stage non-cardiac illness
      • Diffuse coronary disease not amenable to grafting
      • Severe irreversible neurological injury
      • Very poor surgical candidate

Pre-Procedure Assessment

    1. General anesthesia
    2. Median sternotomy
    3. Harvest grafts (LIMA, radial artery, or saphenous vein)
    4. Cardiopulmonary bypass (or off-pump CABG)
    5. Distal coronary artery anastomosis
    6. Proximal graft anastomosis to the aorta (if required)
    7. Restore coronary blood flow
    8. Hemostasis and chest closure

CABG Procedure (Step-by-Step)

  • 1. Preoperative Preparation

    • Confirm coronary artery disease with coronary angiography.
    • Review blood tests, ECG, echocardiography, and other investigations.
    • Obtain informed consent.
    • Stop or adjust selected medications as directed.
    • Establish intravenous access and monitoring.

    2. General Anesthesia

    • The patient receives general anesthesia.
    • An endotracheal tube is inserted.
    • Mechanical ventilation and continuous cardiovascular monitoring begin.

    3. Surgical Access

    • The surgeon usually makes a midline chest incision.
    • The sternum is divided through a median sternotomy to expose the heart.

    Some selected procedures may use smaller minimally invasive incisions.

    4. Graft Vessel Harvesting

    A healthy blood vessel is taken or prepared to bypass the blocked coronary artery.

    Common grafts include:

    • Internal mammary artery, usually the left internal mammary artery
    • Great saphenous vein from the leg
    • Radial artery from the arm

    The internal mammary artery often remains attached to its original blood supply at one end.

    5. Anticoagulation

    • Heparin is administered to prevent blood clotting during surgery.

    6. Cardiopulmonary Bypass

    In conventional on-pump CABG:

    • Cannulas are inserted into the heart or major vessels.
    • The patient is connected to a heart–lung bypass machine.
    • The machine oxygenates and circulates the blood while the surgeon operates.

    CABG may also be performed off-pump, while the heart continues beating.

    7. Temporary Cardiac Arrest

    In on-pump CABG:

    • The aorta is cross-clamped.
    • Cardioplegia solution is administered.
    • The heart temporarily stops and is protected during graft placement.

    8. Graft Anastomosis

    The graft is connected so blood can flow around the coronary blockage.

    • The distal end is attached to the coronary artery beyond the obstruction.
    • For a free graft, the proximal end is commonly attached to the aorta.
    • An internal mammary artery graft usually remains attached proximally and is connected distally to the coronary artery.

    This creates a new route for oxygenated blood to reach the myocardium.

    9. Restore Heart Function

    • The aortic clamp is removed.
    • Blood flow returns to the heart.
    • The heart may restart spontaneously or require electrical stimulation.
    • The surgeon checks graft flow and cardiac function.

    10. Weaning From Bypass

    • The heart gradually resumes pumping the circulation.
    • The patient is separated from the heart–lung machine.
    • Heparin is reversed, usually with protamine.

Types of Stents & Devices

  • Arterial Grafts

    • Left Internal Mammary Artery (LIMA) (gold standard)
    • Right Internal Mammary Artery (RIMA)
    • Radial artery

    Venous Grafts

    • Great saphenous vein

    Surgical Techniques

    • On-pump CABG
    • Off-pump CABG (OPCAB)

Postoperative Care

    • ICU monitoring
    • Continuous ECG monitoring
    • Pain control
    • Early extubation
    • Early mobilization
    • Aspirin therapy
    • High-intensity statin
    • Cardiac rehabilitation
    • Wound care and infection prevention
    •  
Home / Home / Clinical Cases / Cardiovascular System Clinical Cases / Coronary Artery Bypass Grafting (CABG)
Related Topics

Complications

    • Bleeding
    • Surgical site infection
    • Atrial fibrillation (most common)
    • Stroke
    • Myocardial infarction
    • Graft occlusion
    • Acute kidney injury
    • Mediastinitis
    • Death

Prognosis

  • Excellent long-term symptom relief.
  • Improves survival in selected high-risk patients.
  • LIMA-to-LAD graft has excellent long-term patency.
  • Long-term success depends on secondary prevention and graft patency.

Key Points / Clinical Pearls

    • CABG is preferred for left main disease and complex multivessel CAD.
    • LIMA to the LAD is the gold-standard graft because of its excellent long-term patency.
    • CABG provides more durable revascularization than PCI in many complex coronary lesions.
    • Secondary prevention (aspirin, statins, BP control, smoking cessation, and cardiac rehabilitation) is essential after surgery.
    • Postoperative atrial fibrillation is the most common complication.