Coronary Artery Bypass Grafting (CABG): Complete Pre-Surgery Guide

Preparing for Coronary Artery Bypass Surgery

CABG restores blood flow to the heart by grafting vessels (saphenous vein, internal mammary artery, radial artery) around blocked coronary arteries. Thorough preparation improves outcomes and reduces anxiety.

10 Essential Pre-Surgery Steps

1. Understand Your Indication: Review coronary angiography results with your cardiologist. Know which vessels are blocked, the severity, and why CABG is preferred over PCI (stenting) in your case (e.g., left main disease, multi-vessel disease, diabetes, reduced ejection fraction).
2. Complete Preoperative Testing: Blood work (CBC, BMP, coagulation, type/screen), ECG, chest X-ray, echocardiogram, carotid ultrasound (if indicated), pulmonary function tests (if COPD), dental clearance (to prevent endocarditis).
3. Medication Optimization: Discuss antiplatelets (aspirin, clopidogrel, ticagrelor), anticoagulants, beta-blockers, statins, ACEi/ARB, diabetes meds. Stop antiplatelets per surgeon protocol (typically 5–7 days for clopidogrel/ticagrelor).
4. Smoking Cessation: Mandatory. Smoking increases pulmonary complications, wound infection, and graft failure. Quit ≥4 weeks pre-op; nicotine replacement supported.
5. Risk Discussion: Bleeding, stroke (1–2%), MI, AKI, atrial fibrillation (20–40%), infection, cognitive changes, mortality (1–3% elective). Ask for your STS/ACT risk score.
6. Recovery Planning: Hospital stay 4–7 days. Home help needed 1–2 weeks. No driving 4–6 weeks. Sternal precautions (no lifting >10 lbs, no pushing/pulling) for 8–12 weeks. Cardiac rehab referral (Phase II).
7. Pain Management Plan: Multimodal: scheduled acetaminophen, gabapentin, limited opioids, regional techniques (paravertebral block). Set expectations.
8. Lifestyle Commitment: Mediterranean diet, gradual exercise progression, stress management, lifelong smoking abstinence, medication adherence.
9. Follow-Up Schedule: Surgeon (2 wks), cardiologist (1 mo), cardiac rehab (3×/wk × 12 wks), labs, imaging as needed.
10. Financial Counseling: Verify insurance coverage, estimated out-of-pocket, disability/FMLA paperwork, cardiac rehab copays.

Questions for Your Surgical Team

• What conduits will be used? (LIMA to LAD is gold standard)
• On-pump vs. off-pump? Why?
• What is my personalized risk profile?
• How will my diabetes/COPD/kidney disease be managed perioperatively?
• Who do I call with concerns after discharge?

Active participation in your care leads to better recovery. Bring a support person to all preoperative visits.