CABG, pronounced as 'cabbage'

Information source from Wikipedia

Coronary artery bypass grafting

A type of surgery called revascularisation, used to improve blood flow to the heart in people with severe coronary artery disease (CAD).

CAD occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become blocked due to the buildup of a material called plaque on the inside of the blood vessels.

CABG is one treatment for CAD. During CABG, a healthy artery (from arm or other places of the body) or vein (from leg known as saphenous vein – a long vein running along the inner side of the leg) is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked portion of the coronary artery. This new passage routes oxygen-rich blood around the blockage to the heart muscle. Artery grafts are much less likely than vein grafts to become blocked over time.

Number of bypasses - less or more?
The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure.

A greater number of bypasses does not imply a person is "sicker," nor does a lesser number imply a person is "healthier." A person with a large amount of CAD may receive fewer bypass grafts owing to the lack of suitable "target" vessels. A coronary artery may be unsuitable for bypass grafting if it is small (less than 1 mm or less than 1.5 mm depending on surgeon preference), heavily calcified (meaning the artery does not have a section free of CAD) or intramyocardial (the coronary artery is located within the heart muscle rather than on the surface of the heart). The surgeon will estimate the number of bypass grafts prior to surgery, but the final decision is made in the operating room upon examination of the heart.

Procedure (Simplified)
This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed.

1. Area that will be operated will be shaved. Patient will be asked to fast at least 6 hours prior to operation. Sedative given the night before to 'calm' the patient.
   
2. Patient changes to operating night gown, brought to the operating room and moved on to the operating table.
   
3. An anaesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the patient unconscious. During the surgery, the anesthesiologist monitors your heartbeat, blood pressure, oxygen levels, and breathing.
   
4. An endotracheal (breathing) tube is inserted through your throat and secured by the anaesthetist and mechanical ventilation is started.
   
5. An incision is made down the center of your chest (about 8 inches). The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart.
   
6. The bypass grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins.
   
7. In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
   If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart.
   
8. One end of each graft is sewn on to the coronary arteries beyond the blockages and the other end is attached to the aorta.
   
9. The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the Aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
   
10. Protamine is given to reverse the effects of heparin.
    
11. The sternum is wired together. Stitches or staples to close the skin incision.
    
12. The patient is moved to the cardiac intensive care unit (ICU) to recover and monitored 24 hours. The breathing tube is removed when you’re able to breathe without it. Patient is able to eat some light food. A small pillow is recommended to be placed on the chest to counter any coughs or sneezes.
    
13. After stabilizing in the ICU (approximately 3 days), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days thereafter).

The progress.....

My dad is stable, heavily sedated with morphin. Lots of tubes everywhere at the moment. He had a quadruple bypass - we were surprised with the additional graft as we had been told earlier it will be triple bypass.

Will update more later - thanks to all for your prayers and well wishes.