your doctor has recommended an on pump coronary artery bypass graft procedure also called cabbage before we talk about this procedure let's review some information about your body and your medical condition the heart is in the middle of the chest under the ribs it is protected by the sternum also called the breast bone the heart is a muscle that pumps blood to all parts of the body through blood vessels called arteries veins are vessels that carry blood back to the heart the aorta is the largest artery in the body two vessels that branch off from the aorta are the right and left coronary arteries they supply the heart muscle with the oxygen-rich blood that is necessary to keep it working coronary arteries can become blocked by plaque fat and calcium deposits that build up over years the result is coronary artery disease also called heart disease severe blockages cause chest pain heart attacks and sometimes death during a cabbage procedure new pathways called bypasses are put in place to carry blood past and around blockages healthier blood vessels from other sites in the body are used to create each bypass a section of leg vein or piece of an artery from an arm may be removed and used to create the bypass these transplanted vessels are called grafts the right and left internal thoracic arteries are also commonly used as grafts these arteries naturally pass close to the heart when creating a bypass with one of these vessels often only one end of the vessel is moved to the coronary artery past the blockage when arteries or veins are moved or removed from one body part to another this is possible only when there will still be enough blood supplied from other nearby vessels there are different surgical techniques for coronary artery bypass on pump and off pump during the several hours it takes to do an on pump cabbage surgery the heart is stopped for about 30 to 90 minutes this keeps the heart muscle still while the surgeon sews vessels into place to create the necessary bypasses the heart is stopped a special pump called a heart lung machine keeps blood oxygenated and flowing through the body blood is carried from the body through tubing to a machine where it is mixed with oxygen then pumped back to the body after all of the grafts have been placed the heart is restarted and the pump is disconnected in some situations a less invasive cabbage procedure may be offered this can include an off pump technique where the heart is not stopped in some cases smaller incisions may be used during these procedures converting to an on-pump procedure is still possible individual surgical treatment decisions depend on many factors including the experience of the surgeon how many arteries are involved the location of the blockages and their severity now let's look closer at the on pump coronary artery bypass surgery you will be given medication to be pain-free and asleep during this procedure the necessary grafts are created by surgically removing sections of blood vessel from the leg and or arm as needed these incisions are sutured and bandaged to reach the heart the surgeon makes an incision down the center of the chest the sternum bone is carefully cut a retractor is then placed to hold the edges apart creating a working area the protective sack that surrounds the heart called the pericardium is opened the surgeon inspects the heart and identifies the vessels to be bypassed the heart lung machine is prepared by connecting tubing to the heart and vessels as appropriate for each situation when the pump is primed and the grafts are ready for placement the heart lung machine is turned on the heart is cooled and the aorta is able to be clamped blood flow through the heart and motion of the heart stops the surgeon then stitches the intended grafts into place depending on the number of blockages connections to one or both internal thoracic arteries may be used to complete the necessary bypasses the clamp is removed from the aorta once the heart is beating normally the heart lung machine is disconnected and the tubing sites are repaired the pericardium is positioned back over the heart flexible drains are placed and the sternum is closed and supported with wire or small plates and screws the remaining tissue layers are brought together the skin is closed and a dressing is placed after a cardiac bypass graft surgery you will stay in an intensive care unit i see you you may have a breathing mask or tube in your throat until you are awake and strong enough to breathe on your own when you first wake up you will have some confusion this typically improves in a few hours but may take longer especially for elderly patients you can expect to have some pain muscle aches bruising and swelling pain medication will help other approaches to providing comfort and pain relief will also be used you will be transferred out of icu when you are breathing without assistance and your heart rate and other vital signs are stable as your hospital recovery continues the focus will change to assisting you with increasing your activity even walking early return to activity and eating tends to lower the risk of complication you will learn how to keep your incisions clean and dry to lower your risk of infection this includes instructions about when to shower and how often drains are commonly removed before you leave the hospital your hospital stay will last several days although you will be carefully monitored you can help your care team to recognize problems early by speaking up if you have dizziness difficulty breathing unexpected pain or other concerns serious potential problems related to this surgery include internal bleeding stroke heart attack and irregular heart rhythm other risks of this surgery include lasting or permanent memory problems infection and blood clots the overall risk of death arising from these complications is about three percent or three of 100 patients your personal risk of complication from this surgery is most related to your age and health before surgery the severity of your heart disease existing heart damage and the experience of your surgeon be patient as you heal communicate your concerns with your surgeon if you do have long-term side effects from your procedure you will likely see improvements slowly over months as you continue to recover for the best results follow your care instructions and call your doctor if you have a fever worsening pain swelling or redness in your legs or at your incision site call 9-1-1 if you have chest pain shortness of breath dizziness bleeding that doesn't stop and any other sign that you may be having a complication from the procedure hospital admission medication or surgery may be needed to correct some problems coronary artery bypass surgery is not a cure for heart disease keeping your heart healthy depends on lifestyle changes that can include simple dietary changes like cutting back or eliminating sugary and fried foods soda and junk food you may need to start an exercise routine and find ways to manage your stress get enough sleep do not smoke follow treatment recommendations to manage your medical conditions especially diabetes high cholesterol high blood pressure and sleep apnea you may need to take aspirin and other medications for months or years to prevent a blood clot depending on your situation this can be critical to prevent a bypass from becoming blocked if you are being admitted the day of surgery you can help to avoid cancellation or complications from anesthesia and your procedure do not eat drink or chew gum after midnight the night before the procedure unless you are given different instructions take only medications you were told to on the morning of the procedure with a sip of water follow instructions regarding aspirin and blood thinners before surgery as you may be asked to stop or continue taking them depending on your situation and arrive on time be ready to confirm your list of medical problems and surgeries all of your medications including vitamins and supplements your current smoking alcohol and drug use and all allergies especially to medications latex and tape all surgery and anesthesia have a small but possible risk of serious injury even some problems very rarely leading to death it is your job to speak up and ask your surgeon if you still have questions about why this surgery is being recommended for you the risks and alternatives this video is intended as a tool to help you better understand the procedure that you are scheduled to have or are considering it is not intended to replace any discussion decision making or advice of your physician you