The heart is a very complex organ, and special procedures are needed to treat specific heart problems. In coronary artery disease (CAD) the arteries that supply your heart muscle with blood and oxygen harden and narrow. You can try treatments such as lifestyle changes, medication, and angioplasty, procedures for opening your arteries. If this treatment doesn’t help, you may need coronary artery bypass surgery.
This operation creates a new pathway for blood travel to the heart. The surgeon removes a small piece of leg or artery from the chest or wrist and then attaches it to the coronary arteries, just above and below the area that is narrowed or blocked. It allows the blood to bypass the blockage. Sometimes people need more than one bypass.
The results of surgery are usually excellent. Many people remain symptom-free for years. A blockage in the artery or vein transplanted or blockage in an artery that was not previously blocked may warrant further surgery may be needed. Lifestyle changes and medication can help prevent clogged arteries.
This article provided by Dr Rajasekhar gives information about the Coronary Artery Bypass Grafting (CABG) Surgery.
Let’s see about CABG.
What Is Coronary Artery Bypass Graft Surgery?
Coronary artery bypass surgery is a surgical procedure that bypasses a blocked coronary artery to restore blood flow to the heart. During the process, healthy blood vessels are removed surgically from other parts of the body, such as leg veins or internal thoracic arteries. They get stitched around the blocked part of the affected artery. It creates an alternative route for oxygenated blood to bypass the blocked portion of the coronary arteries and restore blood flow to the heart.
Surgeons usually perform this procedure to treat severe cases of coronary artery disease. Coronary bypass grafting procedure used to treat severe blockages that significantly reduce the heart’s ability to pump blood throughout the body. This treatment returns normal blood flow to the heart and reduces symptoms associated with coronary heart disease, including angina (chest pain).
Who Needs Coronary Artery Bypass Grafting?
Coronary bypass surgery (CABG) is used to treat people with severe coronary artery disease (CHD) that can cause heart attacks. CABG can also be used to treat people who have heart damage after a heart attack but still have clogged arteries.
A doctor can recommend CABG if other treatments, such as lifestyle changes or medications don’t work. It can also recommend CABG if you have a severe blockage in a large coronary artery that supplies blood to the most heart muscle, especially if your pumping action has weakened. CABG can also be a treatment option if you have heart failure that cannot get treated with angioplasty.
A doctor will decide whether you need CABG following on several factors, including:
- The presence and severity of CHD symptoms
- The severity and location of the blockage in a coronary arteries
- A response to other treatments
- The quality of life
- Other medical problems that you might have
- CABG can perform in an emergency, such as during a heart attack.
How does CABG work?
The surgeon removes a blood vessel called a graft from other parts of the body, such as the chest, legs, or arms. Stick one end to the aorta, a large artery that comes from your heart. Then attach the other end to the artery under the blockage.
Graft creates a new way for blood to flow to your heart. If you have a lot of blockages, your surgeon can do one or more bypass procedures during the same operation.
How you prepare For CABG:
- A doctor will give specific instructions about limiting activities and changes in diet or medications that you need to take before surgery.
- Make arrangements that are needed after your operation. It will require about four to six weeks to recover.
- Follow all the preoperative care provided by the doctor before the surgery.
What can you expect during surgery?
Types of CABG Procedures:
During the procedure Traditional CABG process:
Coronary bypass surgery usually lasts between three and six hours and requires general anaesthesia. The number of bypasses you need depends on where a blockage is in heart and how severe blockage is.
A breathing tube is inserted into the mouth for general anaesthesia. This tube is connected to a ventilator that breathes for you during and immediately after surgery.
Most coronary bypass operations are done through a long incision in the chest, called traditional CABG procedure. At the same time, the cardiovascular device maintains the flow of blood and oxygen throughout your body. It is called coronary bypass on-pump surgery.
The surgeon cuts the centre of the chest along the sternum. It then opens the rib cage that opens to expose the heart. After opening the chest, the heart gets temporarily stopped with medication, and the heart-lung machine takes over blood circulation to the body.
The surgeon removes parts from healthy blood vessels, often from the inside of the chest wall or lower leg, and ties the edges above and below the blocked arteries, so that blood flow is directed around the narrowed part of the diseased artery.
After the transplant is complete, the surgeon restores your heartbeat, separates you from your heart lungs machine, and covers your sternum with wire. The wire remains in your body after the bones heal.
Although traditional open-heart surgery is still often preferred in the majority of the cases, more sophisticated and less invasive techniques for bypassing blocked coronary arteries have been developed.
Alternative CABG procedure:
Newer techniques aim to limit the complications of traditional coronary artery bypass
- Avoiding cardiopulmonary bypass (off-pump CABG)
- Avoiding median sternotomy (minimally invasive CABG)
Pulmonary heart bypass can be avoided in certain patients using techniques that allow the surgeon to revascularize the beating heart. Various tools and methods stabilize the myocardial region and keep the surgical site relatively fixed.
This type of CABG is similar to traditional CABG because the sternum is open to access the heart. However, the heart does not stop, and the heart-lung bypass machine is not used for cardiopulmonary therapy.
CABG procedures off pumps are more often done using small parasternal or intercostal incisions (minimally invasive CABG), sometimes with endoscopy or even with robot support. However, they can be done using traditional middle sternotomy, which offers better surgical exposure.
Minimally invasive CABG:
This process is similar to an off-pump CABG. Instead of a large incision to open the sternum, several small incisions are made on the left side of the sternum between the ribs.
The less invasive CABG technique is considered more challenging to perform when multiple bypass grafts are needed, especially those involving vessels behind the heart. Transfusion requirements, length of stay, and costs are usually lower for off-pump CABGs.
After the procedure:
Expect one or two days in the intensive care unit. The breathing tube remains in your throat until you wake up and can no longer breathe on your own.
Heart rehabilitation often starts while you are still in the hospital. You will receive a program with exercises and training to help you recover. You will continue to monitor the outpatient program until you can safely follow the home-based maintenance program.
To avoid complications, you will likely be discharged from the hospital within a week. You may still have problems with daily tasks or short distances or any of the following signs or symptoms after you return, contact your doctor:
- Rapid heart rate
- New or worsened pain around your chest wound
- Redness, bleeding, or other discharge around the chest wound.
The recovery period depends on patient to patient but expected of around six to 12 weeks. In most cases, you can return to work after four to six weeks, start exercising. However, make sure you are with your doctor before doing this.
After a successful bypass operation, symptoms such as shortness of breath, chest tightness, and high blood pressure tend to improve. A bypass can increase blood flow to the heart, but mandates change in habits to prevent future heart disease. However, coronary artery bypass is not a cure for coronary artery disease.
If you don’t change your lifestyle, e.g. For example, if you won’t eat healthy foods and exercise regularly, the arteries that grafted will harden. In some cases, coronary artery resurfacing would be suggested to dilate the arteries using small balloons and tubes called stents (coronary angioplasty).
One can witness the results of surgery in people with healthy lifestyle/habits. Talk to a doctor about diet and other lifestyle changes that you need to make after surgery. If you need more information about CABG surgery, contact Dr Rajashekar and book your appointment now!