Treatment Options

Coronary Artery Bypass Graft Surgery (CABG) for the Treatment of Coronary Artery Disease (CAD)

Significant Value

The coronary arteries are blood vessels that carry blood and oxygen to the heart muscle. Coronary artery disease occurs when these arteries become clogged with fatty deposits (plaque). Plaque forms in the arteries over many years in a process called atherosclerosis. As plaque builds up, the artery opening gradually narrows and becomes clogged. Coronary artery disease is the single leading cause of death in the U.S.

The goal of CABG is to improve symptoms (quality of life) or to improve prognosis (how long you will live after the procedure) or both. Not everyone with coronary artery disease needs CABG surgery. In general, CABG is done when non-surgical treatment (such as lifestyle changes, medications) hasn't worked, when there are constant symptoms such as chest pain (angina) and/or the individual is not a good candidate for balloon angioplasty. CABG is also done when there are multiple coronary blockages that are life threatening. CABG does not cure coronary artery disease. Therefore, continued attention to risk factor modification (such as diet, weight loss, smoking cessation, exercise) is still needed.

Coronary artery bypass grafting (CABG) is an invasive surgical procedure. CABG is done to increase the blood supply to the muscle of the heart that has been decreased due to coronary artery disease. CABG is carried out under general anesthesia with the patient asleep. The chest is opened, the heart is temporarily stopped and blood is rerouted to a heart-lung (bypass) machine. The graft (blood vessel) is removed (harvested) from a vein in the lower leg, arm or an internal chest wall (mammary) artery. More than one graft can be done during the surgery. The graft is attached above and below the narrowed part of the coronary artery. Blood is redirected from the heart-lung machine back to the heart, which is restarted with controlled electrical shocks.  The length of hospitalization is usually 5 to 6 days. Due to graft reblockage repeat surgery is sometimes necessary.

Things to Consider

  • This assessment will address coronary artery bypass graft surgery (CABG) using the heart-lung bypass machine only.
  • Not everyone with coronary artery disease needs CABG surgery.
  • You and your physician should discuss if CABG is the best treatment option for you.

See also:

Results

Significant Value

Will I live longer if I have CABG?

CABG may or may not lengthen your life.  However, CABG has been associated with better survival than percutaneous coronary intervention (PCI; mainly balloon angioplasty), after adjustments for risk profile (such as age, diabetes, lower heart function) in individuals with multivessel coronary artery disease and many high-risk characteristics (such as diabetes). 

Will a CABG improve my quality of life?

This procedure may improve the quality of your life by relieving chest pain and increasing your energy level.

Safety

Moderate Value

CABG is an invasive surgical procedure.  There is a risk of complications from the procedure.  The amount of risk can vary according to age, general health, smoking history, specific medical conditions and heart function.  CABG is recommended when it is considered to be the best option for you.  Attention to lifestyle changes (such as diet, weight loss, smoking cessation, exercise) is also needed after surgery.

Comparison

Significant Value

Alternatives to CABG surgery may include:

  • Non-surgical treatment (such as changes in lifestyle, medications)
  • Surgical procedures that open blocked arteries (such as balloon angioplasty, coronary artery stenting)

Not everyone with coronary artery disease needs CABG surgery.  You and your physician should discuss if CABG is the best treatment option for you. The treatment option recommendation will be based on factors such as the state of your health, the severity of your condition, an assessment of alternative treatments or procedures, and the risks associated with doing nothing at all.  CABG has been associated with better survival than percutaneous coronary intervention (PCI; mainly balloon angioplasty), after adjustments for risk profile (such as age, diabetes, lower heart function,) in individuals with multivessel coronary artery disease and many high-risk characteristics (such as diabetes).  You may also want to get a second opinion from a different physician for comparison of treatment options for your particular condition. 

Cost

Significant Value

CABG would be the most cost-effective treatment for an individual when it is the best treatment option.

The cost of a CABG procedure may range from $90,000 to over $150,000.. 

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

MayoClinic.com. (2012, October). Coronary bypass surgery. Retrieved January 8, 2014 from
http://www.mayoclinic.com/health/coronary-bypass-surgery/MY00087.

MedicineNet. (2007, May). Coronary bypass surgery (CABG). Retrieved January 8, 2014 from http://www.medicinenet.com/coronary_artery_bypass_graft/article.htm.
      
The Society of Thoracic Surgeons. CABG information.  Retrieved January 8, 2014 from http://www.sts.org/sections/patientinformation/adultcardiacsurgery/cabg/index.html?CFID=1153886&CFTOKEN=81704858.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  significant value

safety:  moderate value

comparison:  significant value

cost: significant value


total: significant value

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Page modified:January 31, 2014