Heart is the functional soul of our body. The main function of the heart is to maintain the adequate blood supply to the tissues and organs to preserve their vitality. The heart is a muscular structure which receives its blood supply via the coronary arteries. Occasionally these coronary arteries are blocked and hence they are unable to supply blood in appropriate amounts for the smooth functioning of the heart. This condition in turn affects the normal functioning of the heart.
The Coronary Artery Bypass Grafting (CABG) is a surgical procedure where the blocked coronary arteries are bypassed by the surgical grafting of a blood vessel removed from any part of the body to restore the blood flow to the muscles of the heart. The substitute for coronary artery is obtained from the chest, legs or arms as other blood vessels can control the blood supply to these areas. A cardiothoracic surgeon decides which type and kind of graft is best suited depending upon the size of the coronary artery and the amount of blockage.
The heart acts as a pump. The heart is a muscular structure made up of specialized muscle called as the myocardium. The heart’s primary function is to pump blood throughout the body, so that the body’s tissues can receive oxygen and nutrients for maintaining their vitality.
The myocardium requires oxygen and nutrients, just like any other tissue in the body. However, the blood that passes through the heart’s chambers is only passing through on its trip through the body. The myocardium receives its oxygen and nutrients from the coronary arteries. The coronary arteries lie on the outside of the heart and supply oxygenated blood to the heart tissue.
The coronary artery supply the muscles of the heart as depicted in the picture.
What happens when the coronary arteries are blocked ?
When the tissues of heart do not receive adequate blood supply it can lead to ischaemia of the heart tissue which in turn can decrease the pumping ability of the heart. In coronary artery disease these coronary arteries are blocked hence affecting the flow of blood via them. This condition is also referred to as narrowing of the artery or hardening of the arteries. Medication to control the lipid deposition and blood thinners to improve the blood flow and prevent its clotting within the arteries is used as first line of treatment but usually a bypass surgery is performed to treat blocked or narrowing arteries, to restore the normal supply of blood to heart.
What are the symptoms of a coronary artery disease ?
The patients with coronary artery may present with symptoms of chest pain, shortness of breath, palpitations, abnormal heart beats and fatigue. In certain individuals the symptoms are not apparent initially and may appear later when major portion of the arteries are blocked. If the blood supply to heart keeps decreasing it can lead to ischaemia of the heart tissue leading to myocardial infarction or heart attack.
Who is a suitable candidate for coronary artery bypass grafting (CABG) surgery ?
If you are experiencing the above mentioned symptoms it is advised to seek consultation with your physician / cardiologist or a cardiothoracic surgeon. The consulting surgeon will conduct a complete evaluation of the signs and symptoms to identify a coronary artery disease and suggest the appropriate treatment. The evaluation may also require use of aids like an echocardiogram, electrocardiogram, treadmill test and routine blood evaluation. If the consulting doctor suggests the need for a CABG procedure, he will explain the procedure details along with its risks and benefits.
It is essential to inform your consulting doctor if you are pregnant ( in case of a female patient), if you have any previous history of bleeding disorders or if you are on any anticoagulant therapy. It is also advised to inform your surgeon about any previous surgeries or if you have a pacemaker. Smoking tobacco is one of the main etiologies of coronary artery disease hence it is suggested to mandatorily stop smoking as soon as possible as it may affect the outcome of the surgical procedure.
What happens during a coronary artery bypass grafting (CABG) surgery ?
A pre-operative evaluation will be done a night before the procedure. The patients are usually restricted from eating or drinking atleast 8 hours before the proecedure. The patient is shifted to the operating table and is made to lie on his/her back. The anesthesiologist will administer anesthesia and monitor the heart rate, breathing and blood oxygen level. After sedatives are administered to put you to sleep a trachea tube is inserted to help provide oxygen to your lungs during the procedure. A catheter is inserted into your urinary bladder for urine drainage. The skin over the surgical site is cleaned with antiseptic solutions. The surgeon will make an incision in the center of the chest to just above the navel. A special instrument (retractor )is used to divide the breastbone into two and spread them apart to expose the heart.
In a traditional on-pump bypass surgery a heart lung machine is used to maintain the circulation of blood and the heart is stopped by injection of a solution to maintain its vitality. The surgeon then performs the bypass procedure by suturing one end of the section of the graft vein over a tiny opening made in the aorta and the other one of the coronary artery. The number of bypasses depends on the number of blockages. After all the grafts are successfully placed the surgeon will check if they are working appropriately. Once the grafting procedure is over the bypass machine is allowed to return the blood to the heart and the heart will be restarted.
A modified procedure is an off-pump procedure of CABG where the heart functions normally while the surgeon performs the bypass procedure. A heart-lung machine is not used. Though it is kept on standby so that it can be used if required during the procedure.
Catheter or tubes are inserted to help in drainage of blood and other fluids from the adjacent tissues. A stomach tube is also inserted to drain any stomach fluids. Post-grafting the sternum is pushed back and the retractors are removed and suture material is used to sew them together. The skin over the sternum is also sutured. A sterile bandage is applied over the surgical site.
What is the post- surgical care for coronary artery bypass grafting (CABG) surgery in the hospital ?
After the procedure the you will be shifted to an ICU (intensive care unit) to be closely monitored. Breathing is artificially maintained till you are fit to breathe on your own. The breathing tube is removed when the patient is able to breathe comfortably and cough. The surgical incision is usually painful and hence the consulting surgeon will advise pain medication to relieve pain. Once the breathing tube and stomach catheters are removed the doctor and nurse may start you on liquid diet. Diet is then modified to solids depending on your recovery. The doctor suggests when you can be transferred to a normal ward once your condition is stable.
What is the post-surgical care for coronary artery bypass grafting (CABG) surgery at home ?
Recovery from a CABG takes time and everyone recovers at slightly different speed. The length of the hospital stay depends on the recovery after the procedure. It is advised to keep the surgical area clean. Specific bathing instructions need to be followed. The doctor will advise you to take appropriate rest and avoid any kind of strenuous exercises. The consulting surgeon may also advise you to start moderate exercise in consultation with a physiotherapist. The surgeon might also put you on medication for pain, blood thinners and statins ( to lower blood cholesterol ). Regular follow ups are essential to monitor the healing of the surgical site and post surgical evaluation.
What are the risks associated with coronary artery bypass grafting (CABG) surgery ?
The risks are similar to the risks associated with any other surgical procedure like bleeding during or after surgery, blood clots, infection at the surgical site, lung infection, difficulty in breathing, abnormal heart rythms, stroke or a heart attack.
Are there any alternatives for coronary artery bypass grafting (CABG) surgery ?
The main alternative to a CABG procedure is a coronary angioplasty procedure where a long, flexible hollow tube is inserted into a blood vessel of the arm or groin area which is then inflated to widen the artery and a small stent is used to maintain its patency. Recovery from a coronary angioplasty is faster but the chances of getting a angioplasty done again are more as it is not indicated in cases of multiple blockages. Your doctor would decide whether you are an ideal candidate for a CABG or an Angioplasty procedure after doing a thorough evaluation.
What is the outcome of a coronary artery bypass grafting (CABG) surgery ?
After a CABG, you will experience a significant improvement in symptoms such as breathlessness and chest pain. The risk of getting a heart attack is greatly lowered. Though CABG is mainstream treatment for coronary artery disease it is not a cure for the same. Lifestyle modification includes healthy eating habits, exercising and cessation of smoking as they affect the success of a CABG procedure. With the advancement in surgical procedure a minimally invasive bypass technique is also devised where the post operative recovery is much faster. The main success of treating a coronary artery disease depend on its appropriate identification, correct treatment planning and lifestyle modification.
How to find cardiac surgeons for coronary artery bypass grafting (CABG) surgery ?
Now you can find and reach cardiac surgeons for CABG surgery from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple cardiac surgeons, get cost estimates for CABG surgery from different heart hospitals, compare things and then choose a cardiac surgeon for CABG surgery.
Find and choose a cardiac surgeon for CABG surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
