Coronary Artery Bypass Graft(CABG)
Coronary Artery Bypass Surgery (CABG) is a type of cardiac surgery. It circumvents or "bypasses" blocked or restricted coronary (heart) arteries by using blood channels from another section of your body. The surgery helps people whose coronary arteries have become narrowed or blocked by fatty material called plaque. The bypass allows blood and oxygen to flow to the heart muscle. CABG surgery is an effective way of treating the severe narrowing of the coronary arteries. It improves the blood supply to the heart and relieves the symptoms of angina. Veins or arteries are used to bypass the blocked coronary arteries. Great Saphenous Vein (GSV) can also be used from the leg, the radial artery from your arm, or the internal mammary artery from inside your chest wall for bypass grafts. These are then sewn in place.
Understanding CAD
Coronary Artery Disease (CAD) is a serious health problem. The arteries that carry blood to your heart become blocked. It can lead to a heart attack if left untreated. Coronary artery bypass surgery (also called CABG) is a treatment that can help to recover from this. This surgery uses a graft (blood vessel from another part of your body) to make a new pathway (bypass) around a blockage. Read on to learn how bypass surgery will put you on the road to a healthier future. How do the arteries of your heart become blocked? Over time, fats, cholesterol, and other substances can build up on the walls of your arteries to form plaque. When the plaque breaks open and a blood clot forms, blood flow to your heart is blocked. This can lead to chest discomfort called angina and to a heart attack.
Evaluation Before CABG
Doctors may take you through the examination of the heart for knowing the severity of CAD. To start with you will be asked about your symptoms and medical history. Then you will have a physical examination and blood tests. These will be helpful to identify other health problems that may be contributing to your CAD, such as high blood pressure, high cholesterol, or diabetes. Based on what is found during this part of the evaluation, some of the following tests are done. This will be helpful to the need for coronary artery bypass surgery.
- ECG
- 2D ECHO
- Treadmill Test (TMT) or Stress Test
- CT coronary angiogram
- Cath Angiogram
In some cases, blockages can be treated during cardiac catheterization with procedures such as angioplasty and stenting treatment. But based on the size, number, and location of the blockages, your doctors may decide that bypass surgery is the best treatment. You may need surgery just after your catheterization. Or surgery may be scheduled for a later date. Surgery may take place very soon after your evaluation. If time permits, you will meet with your doctor a few days before. At this visit, you will be told how to prepare for the surgery. Don’t be afraid to share your feelings with your doctor, family, and friends. Doing so can help you get ready emotionally.
Before Surgery
Just before the surgery your blood and urine may be tested for problems that could affect the surgery. You may also have a chest x-ray. You may meet with a doctor to discuss anesthesia (the medications that will keep you pain-free and asleep during surgery). Tell the doctor about all prescription and over-the-counter medications you take. This includes herbs and supplements. You may be asked to stop taking some of these; the surgeon will prescribe what medication has to be continued and what to be stopped.
On the Day of Surgery
Hair may be removed from the chest or other incision sites. You will receive medication through an IV (Intravenous). Lines will be connected to your finger, wrist, arm, and neck. These are attached to machines that monitor your oxygen levels, heart rate, blood pressure, and pressures in your veins. Just before surgery starts, anesthesia will be given to prevent pain and keep you asleep.
Bypass Surgery Procedure
On the day of your surgery, you will be guided to a Cardiothoracic Operation Theater at Medicover Hospitals. During bypass surgery, blockages are not removed. Rather, a new pathway is created around the blocked part of a coronary artery. First, a healthy blood vessel is taken from another part of the body. This is the bypass graft. The graft is attached to the coronary artery beyond the blockage. This way, blood flows through the graft and bypasses the blocked part of the artery.
Preparing the Bypass Graft
The bypass graft is taken from another part of your body. This usually doesn’t affect blood flow in that body part. If you have more than one blockage, more than one graft may be needed. One or more of these blood vessels will be used:
- The saphenous vein, which is located in the leg.
- The radial artery, which is located in the arm.
- The internal thoracic (mammary) artery, which is located in the chest wall.
Reaching the Heart
While one member of the bypass team is getting the graft, another member works to reach your heart. First, an incision is made in the chest. Then the breastbone (sternum) is divided. The breastbone is held open throughout the surgery. This puts pressure on the nerves of the chest. You may have soreness and muscle spasms in your chest, shoulders, and back during recovery.
Using the Heart-Lung Machine
In some cases, a machine does the work of your heart and lungs during surgery. Blood is circulated through this heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. This is known as an “on-pump” procedure. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs take over after the bypass is completed. In other cases, the heart-lung machine is not used and the heart is not stopped. This is known as an “off-pump” or “beating heart” procedure.
Attaching the Graft
A small opening is made in the coronary artery, below the blockage
- If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end is sewn onto the aorta.
- If the internal thoracic (mammary) artery is used, one end of the graft is sewn onto this opening. The other end is already attached to a branch of the aorta.
Finishing Up
Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage. If you have multiple blockages, more than one bypass may be done. Then your breastbone is rejoined with wires. These wires will stay on your chest permanently. The incision is closed, and you are taken to the intensive care unit to begin your recovery.
Using the Heart-Lung Machine
In some cases, a machine does the work of your heart and lungs during surgery. Blood is circulated through this heart-lung machine. The machine supplies the blood with oxygen and pumps it back through the body. This is known as an “on-pump” procedure. In these cases, the heart may be stopped temporarily before the graft is attached. Your own heart and lungs take over after the bypass is completed. In other cases, the heart-lung machine is not used and the heart is not stopped. This is known as an “off-pump” or “beating heart” procedure.
After Surgery
Post-surgery you will be taken to the ICU (intensive care unit). When you wake up, you may be thirsty, groggy, and feel cold. These sensations are common and won’t last long. Dedicated nurses will make sure you have everything you need. When your condition is stable, you will be moved to another room of the hospital. This may happen on the same day of the surgery, or a day or more later. You will be connected to tubes and machines that allow your nurses to monitor your health and recovery. The connections will be removed as you become stable. You may have:
- A line on your wrist or neck to monitor blood pressure or other pressures in your heart.
- An IV to provide medications and fluids.
- Drainage tubes to drain fluid from your chest.
- A catheter to drain urine.
- An intra-aortic balloon pump to take over some of the heart’s pumping function (if needed). This lets the heart relax and recover. You will likely be sedated until this is removed.
Preventing Lung Problems
At first, a tube will help you breathe. It is inserted through your mouth and into your throat. This is normal. You won’t be able to talk with the breathing tube in. Nurses will ask simple questions so you can respond by nodding or shaking your head. The tube may make your throat sore. There may also be a tube in your nose or mouth, which keeps your stomach empty. As soon as you can breathe on your own, these tubes will be removed. Then you’ll likely receive oxygen through a mask or small prongs in your nose. After the breathing tube has been removed, a respiratory therapist or nurse will help you with deep breathing and coughing exercises. These will help you to prevent pneumonia. Your healing breastbone incision may make deep breathing and cough painful. But still, it is very important to do the exercises. You will be taught how to do them in a way that reduces the pain.
Reducing Swelling
Your legs may be swollen post-surgery, especially if grafts were taken from your legs. Raising the foot off your bed can help reduce swelling. You may also be taught to do exercises in bed, such as the ankle exercise described below.
Ankle Exercise
- Start with your toes pointed. Flex your foot at the ankle and count to 5. Then relax.
- Repeat 10 times with each foot.
Protecting Your Breastbone
Your breastbone was divided to reach the heart during bypass surgery. This will take 6 to 8 weeks to heal. While in the hospital and later at home, you need to take special care. This will reduce pain and aid healing. Avoid motions that strain your arms or chest, this means avoid pushing, pulling, or lifting heavy objects. Also, avoid reaching behind you or high above your head. You will be shown ways to move that protect the breastbone, such as the method below for standing.
Standing Up
When you get out of a chair, it’s okay to use your arms for balance. But don’t push them against the arms of the chair. To stand:
- Scoot to the very front edge of the chair.
- Rock yourself onto the balls of your feet. Slowly rise to a standing position
- Use the same method to get out of bed. Don’t push your arms against the mattress.
Caring for Your Incisions
Your incisions may be bruised, itchy, numb, and sore. After a shower, pat them dry (do not rub). Do not use lotion or powder. Be sure to check the incisions every day. This way you will see any signs of problems early.
Risks & Complications
There are a few risks involved in bypass surgery, some risks are:
| S.No | Risks of bypass surgery |
|---|---|
| 1 | Breathing problems |
| 2 | Fast or irregular heartbeat |
| 3 | Nerve injury or muscle spasms |
| 4 | Infection of the incision sites |
| 5 | Pneumonia (lung infection) |
| 6 | Excessive bleeding |
| 7 | Memory problems or confusion |
| 8 | Heart attack, stroke, or death |
Dos and Don’ts after Bypass Surgery
| Dos after Bypass Surgery | Don’ts after Bypass Surgery |
|---|---|
| Wear loose clothes that don’t stick to your body as the surgical incision of the bypass surgery needs air | Increase your fiber intake; indulge in more leafy vegetables, sprouts, and more fresh fruits rather than processed intake. |
| Clean your bypass surgery incision with medically approved lotions and solutions but avoid harsh detergents or antiseptics as it may cause discomfort and may lead to infection. | Try low carb diets in case you feel bloated and treat yourself to protein-based diets including egg whites, chicken, oats, etc. |
| Sleep straight and avoid sleeping on your stomach at least for the first month as you don’t want your fat or muscles to add pressure to the bypass surgery wound. | Choose cooking oils that are high in Omega 3 and 6 fatty acids. |
| Take a shower with warm water instead of hot water. Avoid shower which will let the water pressure hit the incision to rupture | Avoid all junk food as it may just cause unwanted blockage in your arteries |
| In case of rashes or swelling or even if you witness blood stains near the incision immediately consult the doctor. | Give up on sweets and rather indulge in natural or organic sweeteners in case you have cravings like honey that will ensure you curb those sinful cravings without building upon any kind of calories |
| Patients who have undergone bypass surgery should indulge in cardiovascular exercises like walking or slow jogging and avoid straining them too much. | Besides all of these factors, there are basic don’ts for the bypass surgery patient: Avoid alcoholAvoid smokingAvoid any kind of sexual activity at least for the initial 1-month StressNo work, this will land up increasing your pulse. Avoid Junk and Fatty FoodsAvoid Exertion |
All you need to do is be happy and smile as that is what is good for your immune system and most importantly your heart.
