Coronary artery bypass grafts, or CABG, are among the most common heart surgeries.
What can you expect as a patient during one of these procedures?
Learn from Dr. John Kern, a UVA expert in heart surgery.
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What to Expect During a Coronary Artery Bypass Graft
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Learn more about Dr. John Kern
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John A Kern, MD
Dr. John Kern is a board-certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts.Learn more about Dr. John Kern
Learn more about UVA Heart & Vascular Center
Transcription:
What to Expect During a Coronary Artery Bypass Graft
Melanie Cole (Host): Coronary artery bypass grafts are among the most common heart surgeries but what should you consider if you're somebody that has coronary artery disease? My guest today is Dr. John Kern. He's a board certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts at UVA Health System. Welcome to the show, Dr. Kern. Tell us, who might be somebody that would be a candidate? Who might need coronary artery bypass surgery?
Dr. John Kern (Guest): Well, many patients with coronary artery disease might, in fact, need coronary bypass surgery. Coronary artery disease is when the arteries that supply blood flow and oxygen to the heart become blocked and that's the main cause of heart attacks. So, there, fortunately, are many different ways to treat coronary disease. Some patients might just need medications or changes in their lifestyle. Some patients, fortunately, can have their blocked arteries treated with stents but for a significant proportion of patients, depending on the number of blocked arteries and their other medical problems, it turns out that the best treatment, the best long-term treatment, would be coronary artery bypass surgery.
Melanie: How would somebody know if they have coronary artery disease?
Dr. Kern: Well, for a lot of patients, the first symptoms can be quite dramatic, meaning they're fine one day and the next day, they start developing chest pain and may be so unfortunate as to actually have a heart attack. Of course, those patients go to the hospital get evaluated, and treated, and probably get a cardiac catheterization, and then, depending on those findings, we decide, should those patients be treated with stents or should they undergo surgery? A lot of patients, the symptoms can be much more subtle. They aren't so dramatic. So, patients may be fine, but ,over the course of time, they develop some chest pain that they've never had before and if they're good about going to their doctor, they'll have it evaluated further. They may undergo a stress test, and then, ultimately, their coronary artery disease may be diagnosed.
Melanie: So then, you spoke that some people might start with medication. What would those be? What would be the first line of defense if you determine somebody has these blockages and coronary artery disease?
Dr. Kern: Well, a lot of the medications are designed as what we call "risk factor modification." So, certainly, aspirin or some form of anti-platelet therapy, medications to control blood pressure, medications to keep the heart rate under control, and then, other forms of medications to treat any kind of cholesterol or lipid imbalances which may also contribute to the development of blocked arteries.
Melanie: So, if medicational intervention does not work and you've determined that somebody might need bypass surgery, what's involved? What can they expect as a pre-surgical intervention and then, what's it like?
Dr. Kern: The pre-surgical interventions are mostly all diagnostic and are tests that are done to ensure as safe an operation as possible. In this day and age, coronary artery bypass surgery is remarkably safe. Nearly 99% of the patients who undergo coronary artery bypass surgery recover just fine with no complications. The time in the hospital is roughly five days. Most people are able to go home after surgery and all we do is ask them to take it easy for three to four weeks. The incisions we use in this day and age are much smaller than they used to be. A lot of people have friends or family who had coronary artery bypass surgery 10 or 20 years ago and they have very long incisions, either on their chest or they have long incisions on the leg from where we take some of the vein to use for the bypasses. These incisions are much smaller now, and, in fact, the incision on the leg is sometimes only an inch long because we use scopes to take the vein out, and so, the postoperative recovery is a lot quicker now than it used to be.
Melanie: So, speaking of taking that vein, the saphenous vein, whatever vein you choose, how does that work? You take a piece? Can they deal without a piece of their vein? What do you do with that?
Dr. Kern: Absolutely. Fortunately, the body is a remarkable machine and it's made with a lot of backup systems in place. When you talk about veins, even anyone can look at the back of their hand and see all of the blue veins on their hand and you might imagine that you can do without one of those and all the other veins take over its job.
Melanie: That's absolutely fascinating. So, once you do that and you've grafted this piece of vein in there, does the body create a collateral circulation or does it all run through what you've just grafted?
Dr. Kern: Exactly. The whole purpose of coronary artery bypass surgery is to provide a conduit for the blood flow to flow through around the area of blockage in the artery on the heart. So, we don't remove the blockage, we just provide another pathway for the blood to flow. Sometimes we use vein from the leg for that. Most of the time, for the main artery on the front of the heart, we use an artery on the inside of the chest wall called the "internal thoracic artery". That's very important because, that particular artery, when used as a bypass, stays open for the entire lifetime of the patient. In addition, we sometimes use an artery from the arm. The forearm has two arteries and we sometimes use one of the arteries from the arm. So, we have lots of options for alternative blood vessels to use for bypasses.
Melanie: And, what is the outcome? What is their life after surgery like this take place? Back in the day, Dr. Kern, as you say, you asked them to take it easy, but there was no exercise, no nothing. Are you getting them up pretty quickly? Asking them to move around and get some exercise pretty quickly after that or, what is their life like?
Dr. Kern: Oh, absolutely. It starts right after surgery. Some of the things I hear from patients, again, is they had friends or family who had this operation 10 years ago and they remember they were on the breathing machine for three days and long times in the hospital. Now, this operation is like many other operations we do where the breathing tube is taken out and they're off the breathing machine within an hour of surgery. A lot of folks are sitting up that night of surgery and we're getting them out of bed and walking around, really, within 12-24 hours. And then, once the initial recovery is over, we really encourage everyone to engage in some form of cardiac rehab. There's really nothing too fancy about that, but what it is, is it's a dedicated exercise program done a few times a week which is done under some medical guidance. It reassures the patient that their heart is fine and they can gradually work up to pursuing their active life and maybe being even more active than they were before because they're no longer being limited by their chest pain.
Melanie: How long can these grafts last in somebody?
Dr. Kern: So, that's what I was referring to earlier. The artery that we use from the inside of the chest, literally has a 99% patency rate over the course of the lifetime. So, it's very unlikely for that bypass would ever block back up. The veins that we use to do bypasses don't have quite that high of a long-term patency rate, but, in this day and age, with the new medicines that patients are able to take after surgery; the statins to help keep the cholesterol and lipids under control and better blood pressure medications and staying on aspirin. The long-term patency of even these vein grafts can be very, very good.
Melanie: Dr. Kern, as a cardiothoracic surgeon, give your best advice to the listeners so that maybe they don't have to come see you.
Dr. Kern: Well, the best advice is you can never start too early when it comes to living a heart-healthy lifestyle. Many of us, we come, we grow up, we're in our teens, our 20s, our 30s, and we're invincible, but you really have to start all the way back in your teens living a good, healthy lifestyle. So, proper diet, and don't smoke; good exercise; don't get overweight. All those things contribute to the development of coronary artery disease.
Melanie: And, in just the last minute, Dr. Kern, it's such great information and you're so well-spoken, why should patients come to UVA Heart and Vascular Center for their heart surgery and for their heart care?
Dr. Kern: The unique thing about UVA is we have is what we call a true multi-disciplinary, collaborative heart team. When you come to UVA with a heart problem, you will not see just one individual, you will see a group of individuals with their own expertise in the area of heart disease. You will see the cardiologist, the interventional cardiologist, the cardiac surgeon, the specialized nurses, the exercise folks, the rehab folks, the physical therapists--the entire team that an individual would need to regain their heart health.
Melanie: Thank you so much for being with us. Really, really great information. You're listening to UVA Health Systems Radio and for more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
What to Expect During a Coronary Artery Bypass Graft
Melanie Cole (Host): Coronary artery bypass grafts are among the most common heart surgeries but what should you consider if you're somebody that has coronary artery disease? My guest today is Dr. John Kern. He's a board certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts at UVA Health System. Welcome to the show, Dr. Kern. Tell us, who might be somebody that would be a candidate? Who might need coronary artery bypass surgery?
Dr. John Kern (Guest): Well, many patients with coronary artery disease might, in fact, need coronary bypass surgery. Coronary artery disease is when the arteries that supply blood flow and oxygen to the heart become blocked and that's the main cause of heart attacks. So, there, fortunately, are many different ways to treat coronary disease. Some patients might just need medications or changes in their lifestyle. Some patients, fortunately, can have their blocked arteries treated with stents but for a significant proportion of patients, depending on the number of blocked arteries and their other medical problems, it turns out that the best treatment, the best long-term treatment, would be coronary artery bypass surgery.
Melanie: How would somebody know if they have coronary artery disease?
Dr. Kern: Well, for a lot of patients, the first symptoms can be quite dramatic, meaning they're fine one day and the next day, they start developing chest pain and may be so unfortunate as to actually have a heart attack. Of course, those patients go to the hospital get evaluated, and treated, and probably get a cardiac catheterization, and then, depending on those findings, we decide, should those patients be treated with stents or should they undergo surgery? A lot of patients, the symptoms can be much more subtle. They aren't so dramatic. So, patients may be fine, but ,over the course of time, they develop some chest pain that they've never had before and if they're good about going to their doctor, they'll have it evaluated further. They may undergo a stress test, and then, ultimately, their coronary artery disease may be diagnosed.
Melanie: So then, you spoke that some people might start with medication. What would those be? What would be the first line of defense if you determine somebody has these blockages and coronary artery disease?
Dr. Kern: Well, a lot of the medications are designed as what we call "risk factor modification." So, certainly, aspirin or some form of anti-platelet therapy, medications to control blood pressure, medications to keep the heart rate under control, and then, other forms of medications to treat any kind of cholesterol or lipid imbalances which may also contribute to the development of blocked arteries.
Melanie: So, if medicational intervention does not work and you've determined that somebody might need bypass surgery, what's involved? What can they expect as a pre-surgical intervention and then, what's it like?
Dr. Kern: The pre-surgical interventions are mostly all diagnostic and are tests that are done to ensure as safe an operation as possible. In this day and age, coronary artery bypass surgery is remarkably safe. Nearly 99% of the patients who undergo coronary artery bypass surgery recover just fine with no complications. The time in the hospital is roughly five days. Most people are able to go home after surgery and all we do is ask them to take it easy for three to four weeks. The incisions we use in this day and age are much smaller than they used to be. A lot of people have friends or family who had coronary artery bypass surgery 10 or 20 years ago and they have very long incisions, either on their chest or they have long incisions on the leg from where we take some of the vein to use for the bypasses. These incisions are much smaller now, and, in fact, the incision on the leg is sometimes only an inch long because we use scopes to take the vein out, and so, the postoperative recovery is a lot quicker now than it used to be.
Melanie: So, speaking of taking that vein, the saphenous vein, whatever vein you choose, how does that work? You take a piece? Can they deal without a piece of their vein? What do you do with that?
Dr. Kern: Absolutely. Fortunately, the body is a remarkable machine and it's made with a lot of backup systems in place. When you talk about veins, even anyone can look at the back of their hand and see all of the blue veins on their hand and you might imagine that you can do without one of those and all the other veins take over its job.
Melanie: That's absolutely fascinating. So, once you do that and you've grafted this piece of vein in there, does the body create a collateral circulation or does it all run through what you've just grafted?
Dr. Kern: Exactly. The whole purpose of coronary artery bypass surgery is to provide a conduit for the blood flow to flow through around the area of blockage in the artery on the heart. So, we don't remove the blockage, we just provide another pathway for the blood to flow. Sometimes we use vein from the leg for that. Most of the time, for the main artery on the front of the heart, we use an artery on the inside of the chest wall called the "internal thoracic artery". That's very important because, that particular artery, when used as a bypass, stays open for the entire lifetime of the patient. In addition, we sometimes use an artery from the arm. The forearm has two arteries and we sometimes use one of the arteries from the arm. So, we have lots of options for alternative blood vessels to use for bypasses.
Melanie: And, what is the outcome? What is their life after surgery like this take place? Back in the day, Dr. Kern, as you say, you asked them to take it easy, but there was no exercise, no nothing. Are you getting them up pretty quickly? Asking them to move around and get some exercise pretty quickly after that or, what is their life like?
Dr. Kern: Oh, absolutely. It starts right after surgery. Some of the things I hear from patients, again, is they had friends or family who had this operation 10 years ago and they remember they were on the breathing machine for three days and long times in the hospital. Now, this operation is like many other operations we do where the breathing tube is taken out and they're off the breathing machine within an hour of surgery. A lot of folks are sitting up that night of surgery and we're getting them out of bed and walking around, really, within 12-24 hours. And then, once the initial recovery is over, we really encourage everyone to engage in some form of cardiac rehab. There's really nothing too fancy about that, but what it is, is it's a dedicated exercise program done a few times a week which is done under some medical guidance. It reassures the patient that their heart is fine and they can gradually work up to pursuing their active life and maybe being even more active than they were before because they're no longer being limited by their chest pain.
Melanie: How long can these grafts last in somebody?
Dr. Kern: So, that's what I was referring to earlier. The artery that we use from the inside of the chest, literally has a 99% patency rate over the course of the lifetime. So, it's very unlikely for that bypass would ever block back up. The veins that we use to do bypasses don't have quite that high of a long-term patency rate, but, in this day and age, with the new medicines that patients are able to take after surgery; the statins to help keep the cholesterol and lipids under control and better blood pressure medications and staying on aspirin. The long-term patency of even these vein grafts can be very, very good.
Melanie: Dr. Kern, as a cardiothoracic surgeon, give your best advice to the listeners so that maybe they don't have to come see you.
Dr. Kern: Well, the best advice is you can never start too early when it comes to living a heart-healthy lifestyle. Many of us, we come, we grow up, we're in our teens, our 20s, our 30s, and we're invincible, but you really have to start all the way back in your teens living a good, healthy lifestyle. So, proper diet, and don't smoke; good exercise; don't get overweight. All those things contribute to the development of coronary artery disease.
Melanie: And, in just the last minute, Dr. Kern, it's such great information and you're so well-spoken, why should patients come to UVA Heart and Vascular Center for their heart surgery and for their heart care?
Dr. Kern: The unique thing about UVA is we have is what we call a true multi-disciplinary, collaborative heart team. When you come to UVA with a heart problem, you will not see just one individual, you will see a group of individuals with their own expertise in the area of heart disease. You will see the cardiologist, the interventional cardiologist, the cardiac surgeon, the specialized nurses, the exercise folks, the rehab folks, the physical therapists--the entire team that an individual would need to regain their heart health.
Melanie: Thank you so much for being with us. Really, really great information. You're listening to UVA Health Systems Radio and for more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.