CABG (Coronary Artery Bypass Graft)

Coronary artery bypass graft surgery, also known as CABG, is a surgical procedure that’s used to treat coronary artery disease. Coronary artery disease (CAD) is a condition in which the coronary arteries become narrow, restricting the functioning of blood vessels that supply oxygen and nutrients to the heart muscle. 

Overview

To effectively treat CAD, surgeons perform CABG on patients by using a healthy blood vessel (taken from another part of the body) to bypass the constricted part of the artery. Healthy blood vessels are usually taken from a vein located at the leg, an artery from the wrist, or an artery located in the chest. These blood vessels are also known as grafts. 

Commonly pronounced as ‘cabbage’, CABG is performed by first making an incision in the chest and opening up the sternum (the breastbone located at the chest cavity) to access the heart. This process of accessing the heart has seen many developments, both technically and clinically. 

Why is CABG surgery performed?

CABG is performed on patients suffering from CAD, and the symptoms associated with this condition are:

• Chest pain
• Fatigue (severe tiredness)
• Palpitations
• Abnormal heart rhythms
• Shortness of breath
• Swelling in the hands and feet

How is the surgery performed?

CABG procedure involves the use of a graft (blood vessel taken from another part of the body) to bypass an obstruction or a block in the artery. Depending on the severity of CAD, surgeons would recommend a specific type of coronary artery bypass graft procedure, but for all types of CABG procedure, the common steps involve identifying a graft and attaching it to the coronary artery around the blocked area of the artery to bypass the obstruction.

Usually administered by general anesthesia, the procedure can take anywhere between 3 and 6 hours, and the duration of the procedure depends on the number of grafts required to fully treat the artery block. 

 What are the risks associated with CABG?

The risk of CABG involves the following factors:

• Irregular heartbeat
• Wound infection
• Stroke
• Heart attack

What is the preparation involved for CABG? 

To prepare for a CABG procedure, patients are required to do the following activities:

• Check for any other medical issues that can cause complications during the procedure. An example of such a condition that patients are advised to check is dental problems. 
• Diabetic patients are required to get their nails trimmed.
• Plan for recovering after surgery, and this involves identifying a caretaker and a spokesperson (family) who can help the patient out at home. 
• Smokers are required to completely quit smoking
• Patients are required to eat a healthy, balanced diet and also avoid any stress triggers before the surgery
• To manage stress related to the surgical procedure, patients are also advised to practice stress relieving activities like meditation, deep breathing and listening to music

What to expect?

Before the surgery

To fully prepare themselves for the surgery, patients are also required to follow the below mentioned guidelines the day before the surgery:

• Follow any fasting related instructions provided by the surgical team
• Take a full-body shower the day before the surgery. If required, the surgical staff can also help, depending on the condition of the patient.
• Ensure a proper night’s sleep. In case patients experience trouble falling asleep, the surgeon can also prescribe medication for sleeping. 

During the procedure

Depending on the type of coronary artery bypass graft administered, patients can expect the following – 

• Minimally invasive heart bypass surgery

Minimally Invasive Coronary Artery Surgery, also known as MICAS, is a procedure in which the surgeon accesses the heart by making a small incision in the chest. A graft (usually taken from the leg of the patient) is taken using an endoscope (a thin surgical tube that has a tiny camera attached at the end). Once the graft is taken, the surgeon then uses it to bypass any block in the artery by placing it above and below the obstructed part. 

• Off-pump heart bypass surgery

Off-pump Heart Bypass Surgery, also known as the Beating Heart Bypass Surgery, is a CABG procedure in which the surgeon operates on the affected artery while the heart is beating. For this procedure, the surgeon will use certain surgical instruments to bypass the blocked artery. 

• Robotic heart surgery

As the name suggests, robotic heart surgery involves the usage of a robotic arm to make a surgical incision, and operate without opening up the chest cavity, and with the use of smaller incisions. The surgeon would control this robotic arm from a console located just outside the surgical room.

After the procedure

Once the CABG procedure is completed, the post-operative recovery depends on the type of CABG operation administered. Patients are taken to the recovery room after surgery. If a minimally invasive technique was administered, patients can be discharged within a day or two, and they can continue their recovery at home.

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.

Conclusion

Coronary Artery Bypass Graft Surgery is the most widely used surgical treatment to treat the onset of coronary artery disease. Once this procedure is administered, patients have reported to be symptom-free for over 10 years. However, patients may experience a recurrence of artery blockage if their lifestyle habits are unhealthy, which is why patients need to follow a healthy active lifestyle post-surgery. Some of the important lifestyle guidelines to follow here include:

• Follow a healthy balanced lifestyle
• Avoid smoking
• Exercise on a regular basis
• Avoid stress triggers 

Frequently Asked Questions (FAQs)

Is CABG open-heart surgery?

Yes, but only for certain types of CABG. Today, surgeons prefer minimally invasive techniques to reduce the overall risks associated with the procedure, and also reduce the time for post-operative recovery

Is CABG a stent?

Partially yes. Certain CABG procedures can used for inserting stents to clear blocked arteries, whereas other procedures would involve the use of grafts.

How long is CABG surgery?

CABG procedures usually last for 3 to 6 hours, and the duration depends on the severity and the number of artery blockages that are being treated.

Who is a candidate for CABG?

Patients who suffer from coronary artery diseases will require coronary artery bypass graft for effectively treating the condition.