CABG (Heart Bypass)

Coronary artery bypass graft (CABG) surgery is usually done to restore the normal flow of blood to heart. This is performed to clear the blockage in one or more than one coronary arteries, reducing risk of angina and death. During surgery, blood vessel graft is used to bypass blocked arteries. The blood vessels are taken from the patient’s own veins and arteries from the arm, leg or chest.

Why did it need?

CABG is prescribed for conditions such as

  • The disease of the coronary artery with blockages in 2-3 major coronary arteries
  • Chest pain or severe angina is caused by mild exertion
  • The function of the left ventricle is poor
  • The patient does not respond to any conservative treatment

Symptoms

  • Shortness of breath
  • Chest pain
  • Tiredness, weakness or reduced exertion capacity
  • Palpitations, dizziness
  • Weight gain, swelling in the leg

Facts and figures

  • Patients of heart failure have been described in Ebers Papyrus, the oldest, a well-preserved medical document written in approx 1600 BC
  • Coronary artery atherosclerosis is the major cause of coronary artery disease. It is the main cause of death in the US
  • First CABG was done by surgeons guided by Dr. Robert Goetz
  • According to data from AHA, 448, 000 CABG procedures were done in 2006 in the US
  • Though the risk is equivalent for all races and genders, the risk increases at age 40 and more
  • The mortality rate is more among women, as they develop heart disease 10 years later/after men do

Advantages

  • Marked improvement in ischemia and chest pain
  • Surgery helps patients to carry on normal life, apart from improving quality of life
  • Prolongs patient life and reduces heart attack risk
  • High success rate – 90% of patients are satisfied with CABG

Disadvantages

  • CABG cannot prevent coronary artery blockage from recurring
  • The overall mortality rate is 4-5%
  • Increased lung complication and chest infection risk
  • Confusion, short term memory loss is possible, but these subside after about 6 post-surgery

Risk and complication associated with CABG include

  • Damage possible to adjacent veins and arteries
  • Closing or blockage of graft
  • Low or high blood pressure
  • Arrhythmia – Abnormal heart rates
  • Blood clots may increase heart attack risk
  • Mood swings or depression
  • Kidney failure
  • Anesthesia reaction
  • Pulmonary embolism
  • Bleeding
  • Infection

Preoperative preparation

  • Surgery is ideally performed when the patient is stable after a heart attack
  • Avoid antibiotics and dental treatment before CABG
  • Complete physical examination
  • Urine and blood analysis
  • Diagnostic tests like stress tests, ECG, X-Rays and cardiac catheterization
  • The patient has to consult a doctor or surgeon one week prior to CABG, to obtain list of medicines to be stopped or taken
  • Inform surgeon regarding alcohol or smoking habits and quit smoking
  • Notify the surgeon if suffering from sore throat, fever or cold before surgery
  • Arrange for caregivers after surgery
  • Prepare the home as required post-surgery
  • The patient should not drink/eat anything prior to surgery

Post operative care

  • Patients usually have to stay in the hospital for about 10 days post-surgery, including ICU stay. His/her vital statistics are monitored continuously
  • The drainage tube is removed between 1-3 days post-surgery
  • The patient will feel discomfort in the chest during any activity for approx 2 months
  • Rehabilitation starts after the patient is stable

Dos, Don’ts, and Precautions

  •     Do keep incision hole dry and clean
  •     If saphenous vein is used for the graft, the patient should not cross or elevate legs
  •    Walk daily
  •   Follow prescribed lifestyle change for maximum benefit
  •    Quit smoking
  •    Maintain a healthy weight
  •    Participate in rehabilitation programs (post-cardiac)
  •     Do be meticulous in taking medicines
  • Do be regular in following up visits to physician and  surgeon