CABG Procedure: Everything You Need to Know

The coronary artery bypass graft (CABG) procedure is a longstanding and effective surgical approach to improve blood circulation in the heart. This surgery is necessary when the coronary arteries become blocked or narrowed (a condition called atherosclerosis), leading to coronary artery disease (CAD). It is also be indicated to take on heart attack (myocardial infarction or MI)—and heart failure.

In this procedure, surgeons essentially reroute blood supply around these blockages, using an artery harvested from another part of the body. As many as five affected cardiac arteries can be corrected in one surgery.

A significant, potentially life-saving procedure, it’s important to have a sense of how CABG procedure works, as well as what preparation and recovery look like.

What Is CABG Procedure?

CABG nowadays is performed either as an open-heart procedure, which relies on opening up the chest, or using minimally-invasive techniques that require several smaller incisions. Regardless of the specific
technique, it’s always an in-patient procedure, meaning you’ll need to spend some time recovering in the hospital.

The aim of these techniques is to take on restrictions or blockages of cardiac arteries by creating new pathways for the blood to flow. This ensures that heart muscles are getting enough nutrients and oxygen.

Surgeons harvest healthy arteries or veins from other parts of the body, typically the leg, arm, or chest, and connect (or “graft”) these to the problem artery (or arteries) to re-route circulation. Up to five blocked or constricted cardiac arteries can be treated during one surgery.

CABG is used in emergency heart attack or cardiac arrest cases, in more severe cases of CAD, as well as when CAD persists despite other treatments.

Nowadays, several approaches to CABG procedure are employed:

• Traditional CABG procedure: The traditional approach involves accessing the heart through a large incision in the chest. The heart is temporarily stopped while surgeons graft new arterial pathways onto the heart, so patients will be connected to a cardiopulmonary bypass machine (CBM) that breathes and circulates blood for you. This will typically be the approach during emergencies.
• Off-pump CABG: A newer technique, applicable in some but not all CAD cases, off-pump CABG doesn’t require the heart to be stopped. This open-heart procedure employs a stabilizing device on the still-beating heart as new arteries are grafted to the problem areas.
• Minimally-invasive direct coronary artery bypass (MIDCAB) grafting: Developments in technology and robotics have also lead to the development of minimally-invasive techniques, called MIDCAB. These rely on accessing the heart via multiple smaller incisions, and healthcare providers use laparoscopic cameras to visualize the problematic area and guide the work. In some cases, robotic assistance is used to ensure accuracy. Depending on the case, stopping the heart may or may not be necessary for these procedures.

Contraindications

As with all heart procedures, there are some patients that may not be a good fit for CABG. There are two outright contraindications for this surgery:

• Arteries incompatible with graft: In some cases, your cardiac arteries may be too damaged, making grafting a riskier and less successful procedure. In these cases, alternatives will be explored.
• Absence of viable heart muscle: If the myocardium, or coronary muscles, have been excessively weakened, they may also not be able to accept a graft safely.
• Patient refusal: Obviously, patients unwilling to undergo CABG will require surgeons to explore an alternative.

In addition, there are a couple of other factors considered relative contraindications, meaning healthcare providers will carefully weigh the risks before deciding whether to go ahead:

• Asymptomatic patients: Some CAD patients don’t display symptoms, and if practitioners determine there’s no increased risk of heart attack or cardiac arrest, CABG may not be needed.
• Age: Older patients, especially those above the age of 85, have a higher rate of complications and may not be good candidates for this surgery.
• Obesity: This excessive weight status, defined as a body mass index (BMI) of 30 or above, can also increase the risk of complications.
• Hemodynamic instability: This is defined as unstable and fluctuating blood pressure, making CABG much more dangerous.
• Severe lung problems: Patients with advanced pulmonary diseases, such as asthma, pneumonia,
  chronic obstructive pulmonary disease (COPD), lung cancer, and others may also be poor candidates.
• Abdominal surgeries: A history of abdominal surgery, or the need for this to be done after CAD is treated, may also preclude this option. 
• Short life-expectancy: Those with chronic conditions who are only expected to live six or fewer months may also be excluded from this treatment.

Essentially, your healthcare provider needs to know that your body can handle the impact of this work, and that other conditions aren’t going to make it more dangerous.

Potential Risks

While every effort is made to ensure that the CABG procedure goes smoothly and succeeds, there’s always a chance of complications. These include:

• Stroke: This “brain attack” occurs when blood flow to the brain becomes disrupted and can lead to brain damage, paralysis, and other symptoms.  
• Infection: The incision site or sites can become infected, leading to fever, redness, swelling, heat, and pain in and around the wound(s).
• Graft failure: Failure of the graft to successfully attach the new artery to the heart can also occur. This emergency condition most often occurs when the saphenous vein of the leg is used.  
• Kidney (renal) failure: About 1% to 3% of post-operative patients experience kidney failure. Risk factors for this complication are the presence of kidney disease, advanced age, diabetes, and shock, among others.
• Postoperative atrial fibrillation (AFib): AFib is a common form of arrhythmia, or erratic and unstable heartbeat. 
• Death: While mortality due to this procedure is rare, it does occur in 1% to 2% of cases. It’s more likely to occur when multiple artery bypasses are necessary, in emergency cases, and when the patient is suffering from other health conditions.

Purpose of CABG Procedure

The CABG procedure is called for in cases where atherosclerosis (a narrowing or blockage) of the cardiac arteries has progressed due to a build-up of “plaque,” a waxy substance made up of fat, cholesterol, calcium, and other substances. This can lead to several heart conditions:

• Coronary artery disease (CAD): CAD is a condition in which blockages in the arteries are leading to reduced blood flow to the heart’s muscles. This causes angina (chest pains), shortness of breath, and other symptoms and can lead to heart attack and heart failure. CABG is particularly recommended when there are blockages in multiple arteries, or when blockage in one is very severe and likely to lead to dangerous conditions. 
• Heart failure: Heart failure can accompany CAD. Interruptions of blood circulation lead to a weakening of the heart muscles so the heart can't properly pump blood throughout the body. Though it can be fatal, heart failure doesn’t mean that the heart has stopped beating. Symptoms range from angina to shortness of breath, an irregular and rapid heartbeat (AFib), and swelling in the legs, ankles, or feet.
• Heart attack: Clinically referred to as myocardial infarction (MI), this is when the blockages have caused part of the heart to die due to insufficient oxygen. Those experiencing a heart attack feel chest pain (angina), shortness of breath, numbness or pain in the arms, nausea and/or vomiting, and fatigue. This is a medical emergency and can lead to lifelong symptoms, as well as death.

Knowing the conditions that can arise due to CAD, it’s also important to understand how these are diagnosed. Here’s a breakdown of tests and assessments you typically undergo before CABG is indicated:

• Physical assessment: Healthcare providers assess important baseline signs, such as blood pressure, heart rate, and breathing. In addition—and, of course, in non-emergency cases—you’ll talk about your symptoms, lifestyle, medical history, and medications.
• Electrocardiogram (ECG): This is a test that records the electrical activity of the heart, which allows practitioners to assess the location(s) of atherosclerosis in the arteries. These devices measure heart rate and rhythm, so it’s able to catch AFib or other conditions that accompany CAD.  
• Echocardiography: In this assessment, sometimes called the “cardiac echo” test, ultrasound soundwaves are used to create real-time video of your heart. Transducers are placed on your chest,
  transmitting information and imagery to a computer and monitor. Healthcare providers use this to assess the size and shape of the organ, as well as areas where circulation is poor or disrupted.  
• Stress tests: These tests measure heart activity while you’re active and performing exercise. It can be done using several different kinds of imaging and evaluation, including echocardiography, magnetic resonance imaging (MRI), or others.
• Coronary angiography: A form of X-ray that relies on injecting patients with a contrast dye that allows practitioners to closely assess the inside of the cardiac
  arteries, isolating problematic areas.

How to Prepare

While this surgery is often an emergency procedure, some conditions warrant it being scheduled ahead of time. Preparation for CABG means getting ready for both a significant surgery and a significant period of recovery.

Important changes need to be made beforehand, and you have to plan for a hospital stay of four to seven days. As a patient, it’s essential to understand how to get ready for your surgery as well as what happens in the period of in-hospital recovery.

Location

In the hospital operating room you’ll find a great deal of specialized equipment. This includes:

• Standard equipment: You’ll be placed on an adjustable operating table, and you’ll see trays with surgical instruments, such as scalpels, clamps, and scissors. The surgical theater needs to be well-lit, so there will be several very bright, adjustable lights.
• Anesthesia apparatus: You’ll be connected to a machine that delivers anesthesia medicine to you via an intravenous (IV) catheter. You’ll also be connected to a ventilator to help you breathe while asleep. 
• Monitors: As this surgery is performed while you’re on general anesthesia, you will be connected to monitors of important vital signs, including heart activity and oxygen levels.
• Cardiopulmonary bypass machine: If necessary for CABG, you’ll need to be connected to a cardiopulmonary bypass machine (commonly called a “heart-lung bypass” machine) that circulates blood and oxygen for you as the heart is temporarily stopped during surgery.
• Transesophageal echocardiogram: The outline of your heart will be monitored in real-time using
  ultrasound, with live video transmitted from a transducer in the throat to a monitor.  
• Endoscope/laparoscope: These adjustable tubes, outfitted with cameras, provide live video of the affected area to guide the work. These are guided into place via the throat (in the case of endoscopy) or small incisions in the abdomen, chest, or leg (for laparoscopy).
• Heater-cooler device: One way to reduce complications or risks associated with this surgery is by cooling the blood, which helps prevent brain toxicity. A special device is used to first cool, and then later reheat blood as necessary.
• Imaging: Additional X-ray machines may be needed throughout the course of the procedure.

What to Wear

The key to dressing for your hospital stay is to think practicality and comfort. You’ll wear a hospital gown during the procedure and throughout recovery. Here’s a quick list:

• Sweatpants or loose shorts
• Loose-fitting shirt and sweater
• Slippers or slip-on shoes
• Post-surgery bra (with front/shoulder hooks/velcro)
• A robe
• Comfortable clothes for the ride home

Food and Drink

Aside from broader lifestyle changes your healthcare provider may recommend to boost heart health, there aren’t too many dietary restrictions prior to CABG procedure.

That said, because the presence of material in the stomach can complicate general anesthesia, you’ll be asked to refrain from eating or drinking anything starting at midnight the night before your surgery. This means no coffee, alcohol, juices, sodas, or other drinks; however, you may take small sips of water to take medications.

Medications

Another important aspect to consider prior to CABG is your medication intake. Before surgery, you may need several drugs, including:

• Antiplatelet medications: A type of antithrombotic drug, these include Plavix (clopidogrel), Brilinta (ticagrelor), and Effient (prasugrel), among others. Dosages may need to be modified or stopped the week of surgery.
• Aspirin: Daily doses of 81 milligrams (mg) aspirin are frequently recommended as it is associated with better post-surgical outcomes.
• Antibiotics: On the day of surgery, you’ll be given antibiotics before surgery; this helps reduce the risk of infection in the heart or in the incision(s).

It’s also essential to understand what medications, drugs, and supplements you should avoid prior to CABG. Some of these may be drugs you’re already taking for CAD:

• Blood-thinning medications: While antiplatelet medications may be indicated as an initial treatment, having these in your system during surgery increases the risk of excessive bleeding. Depending on the case, your practitioner will ask you to stop taking these for at least five days before surgery; make sure you’re clear about what’s safe to take.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Healthcare providers will ask you to stop taking NSAIDs like Aleve (naproxen), Motrin, or Advil (ibuprofen) for at least one week prior to your surgery date. These are available over-the-counter or may be prescribed in higher doses to manage conditions like arthritis.  
• Herbs and supplements: A number of herbal supplements may also increase the risk of excess bleeding, including chondroitin, feverfew, ginger tablets, fish oil, and garlic pills, among others.

What to Bring

To be ready for your hospital stay, here’s a list of what you should have with you:

• Insurance card
• Government-issued ID card
• Books, magazines, iPad, tablet, or e-reader
• Basic toiletries (toothbrush, toothpaste, etc.)
• Health proxy information (which authorizes a loved one to make medical decisions)
• Pillow
• CPAP machine or breathing assistance device if you use one
• List of allergies you have and medications and/or supplements you’re taking
• A notebook or journal (to take notes about aftercare)

Make sure to for transportation back home from the procedure, as you won’t be clear to take the wheel for some time following surgery.

Pre-Op Lifestyle Changes

To get your body ready for the CABG procedure, you may be counseled to make some changes to lifestyle:

• Quitting smoking yields many health benefits and greatly reduces the risk of post-operative complications. If you smoke tobacco or use nicotine products, talk to your practitioner about medications or strategies to help you stop the habit.
• Exercise will be essential for life afterwards, but it’s also helpful before surgery. In non-emergency cases of CAD, healthcare providers may ask you to emphasize physical activity to help with circulation and heart health. In particular, obesity has been linked with higher rates of mortality after surgery, so losing weight can also help.
• Diet: Adjusting diet can also help you lose weight, while also taking on related conditions, such as high blood pressure, high cholesterol, and others. A heart-healthy diet should emphasize lean proteins and fresh fruits and vegetables, while working to reduce salt and saturated or trans-fat intake, among other features.

What to Expect on the Day of the Procedure

All told, CABG procedure can take anywhere from four to six hours, after which you spend one to two days in the intensive care unit (ICU) before additional recovery in the hospital. Since this a major, complex surgery, you’ll need to undergo extensive evaluation beforehand and an intense period of initial rehabilitation afterwards. It’s therefore important to gain a sense of what happens on the day of the procedure.          

Before the Procedure

The first order of business on the day of CABG is a final medical evaluation. This may include:

• Initial assessment of vital signs includes checking heart rate, blood pressure, and other important measures.
• Blood tests provide a sense of overall health, as well as that of the heart.
• ECG may be needed for a final assessment of electrical activity.
• Imaging techniques like echocardiogram, coronary angioplasty, and chest X-ray are also needed.
• Cardiac catheterization involves running a thin tube (called a catheter) into a large artery and running it to the heart to measure blood flow and pressure and assess muscular health. 
• Anesthesiology consultation also occurs, in which the anesthesiologist determines a proper dosage of medicine that will put you to sleep during the procedure.
• Antibiotics and other preoperative medications will be given to you, and you will be connected to an IV.
• An IV will be placed into your arm to provide you with necessary providing necessary fluids.

During the Procedure

Once the medical team is sure you can safely undergo CABG procedure, you’ll be taken to the OR for the surgery, itself. Surgery is always a carefully coordinated, collaborative effort. Who makes up a cardiac surgery team? Here’s a quick breakdown:

• Cardiac surgeon: If the operating room is a ship, then the cardiac surgeon is the captain. These healthcare providers are specialists in this work, having undergone five years of surgery residency, and two to three years of a specialized cardio fellowship, on top of medical school.
• Anesthesiologist: The anesthesiologist will ensure you’re getting the correct amounts of general anesthesia and track your progress.
• Perfusionist: In traditional CABG and some minimally-invasive approaches, this specialist operates the cardiopulmonary bypass machine. They ensure your body is getting oxygen and nutrients while your heart is temporarily stopped.
• OR nurses and technicians: The nursing team and other technicians in the OR are specially trained to work as part of the cardiac surgery team.

Traditional CABG procedure, which relies on the cardiopulmonary bypass machine, is the most commonly performed. How does it work? Here’s a quick rundown:

• Intubation: Once you’re on the operating table and asleep, a tube will be placed in your throat to help you breathe. A special catheter, called a Foley catheter, will be placed into your urethra. This will allow you urinate during the surgery and in early recovery.
• Echocardiograph and staging: Echocardiography is essential for the surgery team. After transducers are in place on the chest, the surgeon will mark out the incisions that they plan to make.
• Cardiac catheterization: A final evaluation and assessment may be done in the OR, something especially important in cases of emergency CABG. This involves running a thin tube (a catheter) through a large vein to the heart and the pulmonary artery to measure blood flow and pressure, while assessing muscular health.
• Chest incision and opening: You’ll lie down on the operating table, and, once asleep and on anesthesia, the surgeon will make an incision down the middle of your chest. They’ll then need to cut through and open the sternum, or chest bone, to access the heart.
• Connection to the cardiopulmonary bypass machine: The heart is medicated so that it stops beating, which will allow the surgeon to perform the work. You’ll be connected to the cardiopulmonary bypass machine, which will circulate blood for you.
• Harvesting: Once the heart is ready, the surgeon will carefully remove arteries or veins from other parts of the body—usually the chest or leg—and seal these off. If the former is used, the left internal thoracic artery, which supplies the front chest wall and breasts, is most commonly selected. In the latter case, the saphenous vein, which runs up the leg is the choice. Surgeons will carefully decide which veins or arteries are most likely to succeed in rerouting the blood.
• Bypass grafting: The surgeon then creates new arterial pathways around a blockage or multiple blockages using the harvested artery or vein. Depending on the scope of CAD and other heart conditions, up to five arteries can be treated this way (what’s called quintuple CABG). Once circulation is restored, the heart often starts beating on its own, though sometimes mild electrical shocks are needed to restart it.
• Coming off the cardiopulmonary bypass machine: Once the heart is beating, you’ll be taken off the cardiopulmonary bypass machine. In addition, a catheter is placed into your chest that will drain fluids.
• Closing up: Once the bypass is completed, the surgeon uses wires to close up the sternum. The wires will remain in the body after surgery. In addition, staples or sutures will be used to close up the chest. 

Traditional CABG has a long history in medicine, and is still a standard approach. However, newer techniques to CABG have emerged, including off-pump CABG, in which the heart is not stopped.

In addition, in some cases—often those that are not as severe—minimally-invasive direct coronary artery bypass (MIDCAB) procedure can be used. This relies on multiple smaller incisions, rather than one large one, so relatively quicker recovery is expected.

After the Procedure

All told, in-hospital recovery after CABG can take anywhere from four days to one week, with some cases requiring a longer stay. You’ll wake up in the intensive care unit (ICU), where you’ll be under careful observation for one to two days. What happens in the ICU? Here’s a quick breakdown:

• Continued monitoring: In the ICU, you’ll be connected to IVs and monitors tracking important aspects of health. This includes an EKG tracking heart activity, as well as observation of blood pressure, breathing rate, and levels of oxygen.
• Medications: An IV will be attached that delivers medications to help with pain, as well as those to prevent infection, excess bleeding, or any other post-op issues.
• Extubation: In many cases, you’ll be attached to a machine to help you breathe via a tube running down the throat. This will be removed when the medical team is sure that your lungs are strong enough.
• Oxygen therapy: Some patients require increased oxygen during recovery, in which case you’ll wear a mask with nasal prongs attached to a ventilator.
• Pacemaker: In some cases, pacing wires, which use electrical signals to control heart activity, are placed through a vein or directly onto the heart when the chest is open, then connected to an external box for monitoring. Post-operative patients have an increased chance of heart palpitations or other irregular rhythms.  
• Nutrition: You will not be able to eat solid foods or drink while you’re still being fed and receiving fluids via IV. Once these are removed, solid foods are gradually worked in.

When the medical team is sure that your condition is stable and are able to remove the breathing tubes, you’ll be transferred to a traditional hospital room for recovery. Most patients require an additional three to five days, depending on the scope of the procedure. Here, the emphasis will be on:

• Working in activity: To prevent the formation of blood clots in the legs (deep venous thrombosis), you’ll be asked to get up and take occasional walks as you can. During your stay (and beyond), the idea will be to gradually and carefully scale up your level of activity.
• Breathing exercises: Nurses and/or healthcare providers will also encourage you to exercise your lungs to prevent mucus build up and restore pulmonary strength. You’ll be told to try coughing while hugging a pillow, and taught how to use an incentive spirometer. This is a device that helps encourage your lungs to expand.  
• Consultation: Before you go home, you’ll have a consultation with the cardiac surgeon, your practitioner (or a cardiologist), as well as other medical professionals to get guidance about what you can expect as you recover. This means discussion of medications, nutrition, and lifestyle changes that help as you recover and promote overall heart health.
• Recovery benchmarks: As you continue to recover, you’ll still undergo routine evaluation. Before you’re clear to go home, the medical team needs to see that you are recovering without complications, can manage pain with oral medication, and are able to get up and move with minimal assistance or on your own.

Recovery

The period after a CABG procedure is absolutely critical to the overall success. Complete recovery typically takes four to six weeks; however, surgeries that involve more extensive work may require more time.

The keys during rehabilitation will be to work with the medical team to ensure there are no post-operative issues or complications, being careful about what activities you can and can’t do, and making significant, heart-healthy lifestyle changes.

It’ll be particularly important for you to keep up with your follow-up appointments:

• First follow-up occurs within three days after you leave the hospital. The cardiac care team ensures that CABG has succeeded in improving circulation problems, and that there are no signs of infection or complications. EKG, stress testing, imaging, and other evaluations may all be used.
• Follow-up with cardiologist or your primary care physician should also be scheduled within the first month after surgery. This is to check in on progress, assess medications, and ensure that heart issues have resolved.
• Second follow-up with the surgery team will occur at four to six weeks after surgery, roughly around the time when recovery is expected to be completed. Again, EKG, echocardiogram, stress testing, or other imaging methods are employed to fully assess heart activity.
• Subsequent care, at minimum, involves annual check-ups; however, in some cases, you’ll need to do more frequent EKGs or other assessments. Talk to your healthcare provider about what you’ll need to maintain the positive results of CABG procedure.

In some cases, you’ll have to undergo a hospital-directed cardiac care program following surgery. The duration and frequency of this treatment vary based on the case. Typically taking place in outpatient centers or clinics, this entails:

• Working on exercises with physical therapists and trainers designed to be both accessible and promote fitness.
• Nutrition education will help you establish a diet that promotes good health. In particular, some may need to make adjustments aimed at lowering high blood pressure.
• Counseling about other aspects of life—including mental health—can also play a critical role.

As you recover, you’ll also have to be very careful about returning to your usual activities. Here’s what you need to keep in mind:

• Physical activity: As you recover, for four to six (or more) weeks, you won’t be able to engage in any kind of high-impact sport, such as football, martial arts, or basketball. Get your healthcare provider’s OK before starting again or taking up anything new. 
• Driving: Not only can you not operate a car while on painkillers, the twisting and turning motions of steering can impact incisions. You’ll be cleared to start driving again once everything has healed: usually at four to six weeks.
• Return to work: Typically, patients take six to eight weeks off of work after surgery. If you work a more physically demanding job, you may require more time.
• Travel: Take at least two weeks after surgery before traveling. Flying after surgery, for instance, raises the risk of blood clot formation.
• Sexual activity: Refrain from any kind of sexual activity for at least four weeks and wait to get clearance to do so from your practitioner.

Healing

Care for your incisions is another important aspect of recovery. It takes four to six weeks for them to heal completely, and the main task during this time will be to do what you can to prevent infection. This requires daily inspection. Call your healthcare provider if you experience any of the following signs:

• Excessive drainage from incision(s)
• Opening in wound growing
• Redness, swelling, and warmth around any incision
• Fever of 101 degrees Fahrenheit
• Severely fluctuating blood-sugar levels among people with diabetes

And what should you do to care for the incision(s)? Here’s a quick overview:

• Regular cleaning: As they heal, incisions should be kept clean and dry. Once there is no more discharge, bandages and dressing can fall off on their own and shouldn’t be reattached. Don’t use creams, lotions, or salves on the wounds until they fully heal.  
• Showering: So long as you’re not seeing signs of infection, and there is no discharge, you should take daily, quick showers (no more than 10 minutes) in warm water. If you have stitches in your chest, for the first two weeks at home, stand facing away from the showerhead.
• Bathing: Baths can be a little more problematic as incisions heal, but bathing in warm water is acceptable. If you do so, make sure to limit the time you soak in the tub to no more than 10 minutes.
• Soap and water: When cleaning incisions, rely on unscented bar soap, water, and a washcloth. Bath wash or shower gel should not be used. Employ a low-impact, up-and-down motion when cleaning, and gently pat the area to dry.
• Elevation of legs: If a vein or artery from your leg was used to perform CABG, then make sure to keep it elevated if you sit more than 15 minutes and as you sleep.
• Physical limitations: Avoid lifting objects heavier than 5 pounds, doing heavier housework, reaching backward, or raising your arms above your head.

Coping With Recovery

Since recovery from CABG procedure is extensive and can significantly impact your life, it’s not uncommon to feel sad or depressed following this treatment. As many as one in four patients experience “cardiac depression” following major heart surgery, and this can actually impact overall long-term outcomes.

So what can you do about post-surgical depression? The American Heart Association has some helpful strategies:

• Stick to a regular routine throughout the stages of your recovery. Creating an established schedule for your daily activities can add structure and shape during this challenging time. Being consistent about when you get up in the morning, go to bed, and have your meals has been shown to improve mental health. 
• Celebrate small milestones of recovery and keep in mind that each step is part of a longer journey towards recovery. Try to find rewards in the progress you’re making.
• Be aware of the challenges you’ll face as you adjust to life after surgery and be realistic about your expectations for recovery. Healing takes time. Try not to fixate on the challenges and struggles and learn to accept them as part of the process.    
• Get help from family or loved ones. During recovery, not only can those close to you help with daily tasks, but they can also be a source of emotional support. Recovery from CABG, like the procedure itself, is a team effort.
• Seek counseling or emotional support. Sessions with psychiatrists or mental health counsellors specialized in post-surgical therapy can certainly help, as can group therapy sessions. There also many online forums and social media groups for those who’ve been affected by heart problems. These can be great spaces to share experiences and talk about what you’re going through.

Possible Future Surgeries

While CABG is very effective, blockages or other issues may recur or other issues may arise post-operatively. Over the long term, for instance, it’s not uncommon for a person to require additional bypasses or for the grafted arteries to fail. In these cases, there are several additional surgeries that may be performed:

• Angioplasty: Among the alternatives to CABG and most often indicated in cases of graft
  failure afterward is angioplasty, which involves using stents to open up constricted arteries. This minimally-invasive procedure is performed using a catheter to access the blocked artery, rather than an open incision. A surgical balloon is inflated to open up the artery before the stent, which reinforces the walls, is put in position.
• CABG revision: Some graft-failure cases can be treated by performing an additional CABG procedure to correct the problem. In addition, this treatment may be required to take on any other blockages that develop in the heart. Notably, however, risks can increase if you have multiple CABG procedures.

Lifestyle Adjustments

As you recover from CABG and beyond, you’ll also want to make some lifestyle changes to promote heart health and a good, long-term outcome. These include:

• Quit smoking: Among the many reasons smoking cigarettes or using nicotine products is unhealthy is that it can impact heart rate and blood pressure, while raising the risk of cancer, among other health problems. Cessation of this habit will go a long way in promoting better outcomes.
• Exercise: Regular exercise not only helps build cardiac strength and help, it can also help manage stress and anxiety, which yields further benefit. At a minimum, aim for daily walks of 30 or so minutes, though other activities, such as swimming, cycling, or taking part in sports, are also easily managed.
• Eat a heart-healthy diet: As you’ll be counseled, dietary modifications can go a long way in preserving the outcomes of CABG. This means decreasing intake of saturated and trans fats, while emphasizing healthy types of fat (mono or polyunsaturated fats like olive oil, nuts, seeds, and avocadoes, among others). In addition, fresh fruits and vegetables, as well as healthier lean proteins, are preferred.
• Manage excess weight: Excessive weight can increase the chance of subsequent heart problems and increase the risk of complications. If you’re overweight or obese, your practitioner may talk to you about weight loss options.
• Take on high blood pressure: Also known as “hypertension,” high blood pressure is consistently a risk factor for heart problems. Managing this, either using medications or lifestyle changes, will be recommended to those with this condition. To help, healthcare providers may recommend you follow a Dietary Approaches to Stop Hypertension (DASH) diet.
• Treat type 2 diabetes: Diabetes, characterized by an inability to process and digest sugars, can also lead to heart issues, while being debilitating in its own right. Patients with this condition will need to be proactive about managing the condition through medications, lifestyle adjustments, or both.

Long-Term Care

When it comes to ensuring the long-term success of CABG, the focus is on ensuring you’re keeping up with the lifestyle changes and other considerations necessary after surgery. Here’s what to think about:

• Continued care: At a minimum, you’ll need annual follow-up appointments and testing after a CABG procedure. In some cases, however, more frequent testing and follow-up is called for. These regular assessments are crucial to ensure long-term success of the procedure and will catch any emerging problems.
• Medications: After surgery, you’ll also often be prescribed medications to take on high blood pressure, AFib, or any other issues that can arise afterwards. You also may require pills for type 2 diabetes or other issues you have. In some cases, you’ll need to continue taking these for years after surgery, so make sure you stay on top of your prescriptions and don’t lapse.
• Keeping up with diet and exercise: As you recover, you’ll adopt dietary and lifestyle changes to promote the health of your heart. The key to long term care is keeping up with these. It may make sense to work with a dietician, nutritionist, or trainer to ensure you remain on the right path.

A Word From Verywell

While the prospect of having heart surgery can be frightening and fraught, it’s important to remember two things: CABG procedure has a long history in medicine, and the way it’s performed today makes it safer and more effective than it’s ever been before.

Globally, over 500,000 of these procedures are performed every year, and 98% are successful. This is thanks to advances in technology and surgical techniques, as well as improvements in the understanding of long-term care afterwards.

There’s no denying that the CABG procedure has saved lives and helped countless people achieve positive health outcomes. However, if you’re undergoing this surgery, remember that the journey to a good outcome is one that you can’t take alone.

Alongside the medical staff, know that family and loved ones can and should play an instrumental, supportive role. With the right medical team and a community behind you, you’ll be well on your way toward brighter days and better health.