Alternative Coronary Artery Bypass Graft Techniques

A number of alternative CABG techniques have been developed that may have fewer complications for
some groups of patients. Off-pump CABG (OPCAB) surgery has been used successfully in many patients
since the 1990s. OPCAB involves a standard median sternotomy incision, but the surgery is performed
without CPB. A beta-adrenergic blocker may be used to slow the heart rate. The surgeon also uses a
myocardial stabilization device to hold the site still for the anastomosis of the bypass graft into the
coronary artery while the heart continues to beat (Fig. 28-12). The potential benefits of OPCAB include a
decrease in the incidence of stroke and other neurologic complications, renal failure, and other
postoperative complications (Lattouf, Puskas, Thourani, et al., 2007). Comparison of this technique with
traditional CABG has been found to be favorable in some patient groups.
Minimally invasive surgical techniques that eliminate median sternotomy have also been developed.
These endoscopic techniques use smaller incisions and a robotic system to place bypass grafts (Katz
&
Bonatti, 2007). The patient is placed on CPB via the femoral vessels. Patients who require multiple
bypass grafts or grafts to arteries on the dorsum of the heart may not be candidates for this technique.
Complications of Coronary Artery Bypass Graft
CABG may result in complications such as hemorrhage, dysrhythmias, and MI (Table 28-5). The patient
may require interventions for more than one complication at a time. Collaboration among nurses,
physicians, pharmacists, respiratory therapists, and dietitians is necessary to achieve the desired patient
outcomes. Although most patients improve symptomatically following surgery, CABG is not a cure for
CAD, and angina, exercise intolerance, or other symptoms experienced before CABG may recur.
Medications required before surgery may need to be continued. Lifestyle modifications recommended
before surgery remain important to treat the underlying CAD and for the continued viability of the newly
implanted grafts.
Nursing Management
Cardiac surgery patients have many of the same needs and require the same perioperative care as other
surgical patients (see Chapters 18 through 20), plus some special needs.
Preoperative Management
Preoperative teaching is important; patients and their families may be very anxious as the association of
the heart with life and death intensifies their emotions. Before surgery, physical and psychological
assessments establish a baseline for future reference. In addition, it is necessary to evaluate the patient’s
understanding of the surgical procedure, informed consent, and adherence to treatment protocols.