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Coronary Artery Bypass Graft surgery (CABG)


Coronary Artery Bypass Graft surgery (CABG) or bypass surgery, often pronounced as “cabbage” is one of the most common surgeries performed. From its infancy in the 1960s, till today, CABG has undergone many developments both technically and clinically.

What is CABG Surgery?

CABG is a surgery which is performed when the arteries supplying blood to the heart (coronary arteries) are blocked, which can be treated by giving the blood a new pathway to reach the heart muscle. In this procedure, a blood vessel (vein from the leg, or an artery from the arm or chest wall) is removed to bypass a coronary artery that is narrowed or blocked and restore blood flow to the heart muscle. This vessel is called a graft.

Where do the substitute blood vessels come from?

These substitute blood vessels can come from the chest, legs, or arms. They’re safe to use as there are other pathways that take blood to and from those tissues. Internal mammary arteries located in the chest have been shown to give the best long-term results, with over 90% of grafts working well even after 10 years. Saphenous veins from the leg or the Radial artery (an artery of the wrist), can also be used. All arterial grafts are used in some, while in others a mix of arterial and venous grafts are used. A patient may have to undergo one or more bypass grafts, depending on the number of coronary arteries blocked.

Why is the surgery performed?

  • Manage the blockage of blood flow to the heart muscle.
  • Improve the supply of oxygen and blood to the heart.
  • Relieve chest pain (angina).
  • Reduce the risk of a heart attack.
  • Improve the ability for physical activity.

How is the surgery performed?

During traditional heart bypass surgery, a surgeon makes an incision (about 6 to 8 inches) down the center of the breastbone to get direct access to the heart. The patient is connected to a heart-lung bypass machine which allows circulation of blood during surgery. The heart is stopped following which, the surgeon performs the bypass procedure.

What is Off-Pump Heart Bypass Surgery?

In the Off-pump Heart Bypass Surgery (or the Beating Heart Bypass Surgery), the surgeons perform the operation while the heart is still beating. The heart-lung machine is not used. The surgeon makes use of advanced operating equipment to hold certain portions of the heart and bypass the blocked artery. During the procedure, the rest of the heart continues to pump and circulate blood to the body.

What is Minimally Invasive Heart Bypass Surgery?

Minimally Invasive Coronary Artery Surgery or MICAS is a technique where the heart is approached through the side of the left chest via a small 4 cm incision. The chest is entered between the ribs without cutting any bones and by splitting the muscle. The vessel from the leg to be used for grafting in these operations is also removed through an endoscope (thin surgical tube with a light and camera at the end). This is called Endoscopic Vein Harvesting (EVH). MICS CABG has advantages such as earlier discharge from hospital, lesser pain, a positive effect on breathing, minimal blood loss and low infection risk.

What is Robotic Heart Surgery?

Some patients are also fit for surgery using robotic-assisted techniques, letting surgeons perform bypass surgery in a closed chest, beating-heart environment using even smaller incisions.

Can CABG be combined with stents?

The development of ‘hybrid suites’ that allows for simultaneous or staged CABG and stenting procedures are also currently done. In a little over a century, heart surgery has gone from rare to commonplace. Major advances have made the CABG a safer and more accepted procedure. Continued research into different approaches, methods and medical interventions may make cardiac surgery less invasive and even lower risk in the future.

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