Your doctor might order a number of tests before your CABG procedure. These may include blood tests, EKG, echocardiogram, chest x-ray, cardiac catheterization and angiography.

You will receive detailed instructions from your doctor on how to prepare for CABG surgery. Instructions will include information on what you can eat or drink, what medicines you can take, and what activities to stop (ex: smoking). Most patients are admitted to the hospital on the same day as the surgery.

A diverse team of experts is involved in the performance of coronary artery bypass grafting procedure. A cardiothoracic surgeon performs the surgery with support from an anesthesiologist, physician assistant, perfusionist (heart-lung machine specialist), as well as other surgeons, and nurses.

CABG procedures require general anesthesia and last typically 3 to 5 hours, depending on the number of arteries being bypassed. Before surgery, anesthesia is administered to put you to sleep. During the length of the procedure, the anesthesiologist monitors your heartbeat, blood pressure, oxygen levels and breathing. A breathing tube - placed in your lungs through your throat and connected to a ventilator - helps you breathe.

There are several distinct types of CABG. Coronary artery bypass grafting procedures range from traditional methods to less invasive surgeries to a robot-assisted technique that allows the surgeon to perform the operation with remotely controlled surgical instruments.

In deciding on the best match between the patient and the type of coronary bypass procedure, the surgeon considers a number of factors. Factors include patient's age, build, weight, as well as the location and magnitude of plaque buildup. Presence of other illnesses, such as lung disease or hardened arteries, is also considered.

Interestingly, for many patients with more acute conditions, traditional heart surgery may be the safest option.

Traditional coronary bypass surgery involves an incision through the breastbone and the use of a heart-lung machine. The chest bone is cut and ribcage opened so that the surgeon can get to the heart. During this time, the heart is temporarily stopped while a heart-lung machine circulates oxygen-rich blood throughout your body.

Once grafting is completed, your heart is restarted with mild electric shocks. You are disconnected from the heart-lung machine, and the fluid drainage tubes are inserted into your chest. The surgeon then uses wires to enclose your chest bone and stitches or staples to close the skin incision. Once you are able to breathe on your own, the breathing tube is removed.

Off-pump coronary artery bypass grafting can be used to bypass any of the coronary arteries. During this procedure the heart isn’t stopped, nor is a heart-lung machine utilized. Instead, the part of the heart where grafting is taking place is steadied with a mechanical device. As a result, off-pump coronary artery bypass grafting is also called beating heart bypass grafting.

Because a heart-lung machine is not used during off-pump CABG, fewer complications tend to occur. This is especially true in people who had suffered a stroke or "mini-strokes" in the past, who are over 70 years of age, or patients afflicted with diabetes, lung disease, or kidney disease. Other advantages of off-pump CABG include decreased bleeding during surgery, smaller likelihood of infection and other complications and faster recovery.

After your coronary artery bypass grafting procedure, you will generally spend 1 to 2 days in an intensive care unit. Your heart rate and blood pressure will be closely monitored and you might be given intravenous medicines to regulate your blood circulation and blood pressure. When your condition has stabilized, you will be moved to a less intensive care area of the hospital for 3 to 5 days of monitoring.

For your recovery time at home, your doctor will provide you with detailed instructions. These will include guidance on caring for your healing incisions, recognizing signs of infection or other complications and knowing when to call the doctor immediately.

Instructions will also be provided on how to manage common surgery after-effects which generally disappear within 4 to 6 weeks after the operation. After-effects may involve one or more of the following symptoms:

• Irritation or itching from healing incisions
• Swelling of the area where an artery or vein was taken for grafting
• Muscle ache or tightness in the shoulders and upper back
• Fatigue, mood swings, or depression
• Difficulty sleeping
• Loss of appetite
• Constipation
• Chest pain around the site of the chest bone incision (this is more frequent with the traditional surgery)

Complete recovery from traditional CABG may take 6 to 12 weeks or longer. Nontraditional CABG patients usually have a shorter recovery time.

You will receive instructions from your doctor on when to resume regular physical activities. Although time-frames vary between patients, most people can resume sexual activity within 4 weeks and driving after 3 to 8 weeks. Most patients return to work after 6 weeks, unless their job involves strenuous physical labor. Some people may be advised to consider changing to less physically demanding type of work, permanently; others, to work a reduced schedule at first.

Ongoing care after CABG will include intermittent checkups with doctors. Tests (EKG, stress testing, and echocardiogram) may be performed during these visits, to see how your heart is functioning.

CABG is not a cure for coronary artery disease so you and your doctor may look at other options for staying healthy and reducing the chances of CAD worsening. Options may include developing a long term care plan that involves lifestyle changes like quitting smoking, following a healthy diet rich in fruits and vegetables, getting regular exercise, and managing stress.

Some patients might be referred by their doctor to a cardiac rehabilitation (rehab) program. After surgery, rehab programs can bolster you strength and energy through exercise training, and help you return faster to your daily routine. Also, through supervised physical activity and education, rehabilitation will guide you in pursuing healthier lifestyle choices that considerably reduce the risks of future heart problems.

Taking medicines as prescribed by your doctor is another essential component of post-surgery care. Medicines may be prescribed to manage pain through recovery; to lower cholesterol or blood pressure; to reduce the chance of developing blood clots; to treat diabetes; to alleviate depression.

Even though complications from coronary artery bypass grafting are uncommon, risk is a part of every surgical procedure. Potential risks include wound infection and bleeding, adverse reactions to anesthesia, fever, pain, stroke, heart attack or even death.

Some patients may develop a fever 1 to 6 weeks after surgery. This can be due to inflammation of the lung and heart sac, after surgeries that involve cutting through the pericardium (the outer covering of the heart). Symptoms range from chest pain to irritability and decreased appetite. This is usually a mild, self-limited illness, but a small number of patients may develop fluid buildup around the heart that necessitates further treatment.

Use of the heart-lung machine can also lead to complications. Some patients have experienced side effects like memory loss, difficulty concentrating or thinking clearly. These developments are more likely to occur in older people, patients with high blood pressure or lung disease, or those who consume excessive amounts of alcohol. These reactions mostly disappear several months after surgery.

The heart-lung machine can also raise the risk of blood clots. Clots can form in your blood vessels, then travel to the brain, lungs or other parts of the body, blocking blood flow and causing a stroke or other problems. Latest technical enhancements in heart-lung machines are lowering the risks of blood clots.

In most cases, the risk of complications are higher when CABG is done in an emergency situation (ex: if performed during a heart attack), if you are over 70 years old, or if you have a history of smoking. Your risks also rise if you have other diseases or conditions such as diabetes, kidney disease, lung disease, or peripheral vascular disease.