What is a Coronary Artery Bypass Graft Surgery (CABG)?
Imagine travelling by road and getting stuck in a traffic jam. To 'bypass' the jam, you take another route and join the same road back again after the road block. That's exactly what takes place in a CABG (Coronary Artery Bypass Graft) surgery, or commonly known as bypass surgery.
A Coronary Artery Bypass Grafting (CABG) is a surgical procedure done to create a 'bypass' around the blocked part of a coronary artery (blood vessels that supply blood to the heart) to restore blood supply to the heart muscle. The bypass is made with the help of blood vessels (known as grafts) taken from other parts of the body (leg, hand, chest wall, etc.)
Why and when is a CABG done?
When one or more coronary arteries become partially or totally blocked, the heart does not get adequate blood supply. This is called an ischemic heart disease or Coronary Artery Disease (CAD). It can lead to heart pain (angina) or a heart attack (myocardial infarction).
CABG is one of the treatment options for ischemic heart disease, advised for
Disease of the left main coronary artery
Significant, multiple blockages in all three main vessels of the heart
Failure of angioplasty
How is the surgery done?
As CABG is a major cardiac surgery, the whole body system needs to be closely monitored. If you are prescribed to undergo a CABG, you will be administered general anesthesia and all your vital parameters (B.P., oxygen level, urine output etc.) will be closely monitored. During the surgery your breast bone will be divided in the middle to gain access to your heart. For grafting, vessels are used from your own body. These vessels are called conduits.
One end of the graft is stitched to an opening beyond the blockage in the coronary artery. If the grafted vein is from the leg or the radial artery, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.
The Internal Mammary Artery (IMA) situated on both sides of the breast bone is most commonly used for the graft. It has the advantage of staying open for many more years than vein grafts, but there are some rare situations in which it cannot be used. It is the best conduit to use for bypass surgery & Asian Heart Institute is the pioneer in using it in India.
The other most commonly used artery is the radial artery, which supplies blood to the hand and can usually be removed from the arm without any impairment of blood supply. The saphenous vein, which runs from the ankle to the groin, is also used for a bypass. It normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without adversely affecting the leg. While it is common for the leg from which the vein is taken, to swell slightly during the initial few weeks of recovery, this is only temporary. The entire surgery takes about 4 to 8 hours depending on the number of bypass grafts done, usage of one or both IMAs, etc.
Arteries give much longer lasting results as compared to veins. That is why at Asian Heart Institute, we most often use only arterial grafts. We are the only center in the world to use only arterial grafts in almost 90% of our patients.
In a traditional bypass surgery, the heart is stopped after connecting to the heart lung machine, which adds oxygen to the blood and circulates it to other parts of the body during surgery. The heart lung machine is necessary because the heart muscle is stopped before the grafting can be done.
However in a beating heart surgery, the heart lung machine is not used and the surgery is performed on a beating heart. This method is known as an Off-Pump Coronary Artery Bypass surgery (OPCAB) or beating heart surgery.
By using a device known as 'octopus', the bypass can be created while the heart is still beating. The advantage includes quicker recovery, fewer complications and better long term outcomes. This is especially so in the case of elderly patients, and in patients with problems like kidney failure, lung problems, previous brain strokes, etc. Asian Heart Institute is one of the few centers in the world that specializes in this type of surgery. We perform nearly 100% of our bypass surgeries on a beating heart with almost 90% patients getting total arterial grafting.
Redo bypass surgery
A second or redo bypass surgery is needed if blockages develop after the first surgery. It is complex and risky because after the first surgery, the heart and lungs stick to the breast bone. While opening the chest to do the surgery there is a risk of injuring the heart. That is why redo bypass surgery is very complex & very few surgeons or centers have the expertise to carry it out successfully. Asian Heart Institute is the best center in India, and one of the best in the world, for redo bypass surgery. For this reason, the Asian Heart Institute team was selected to do a complex redo bypass surgery on the then Prime Minister of India Dr. Manmohan Singh.
Re-redo bypass surgery
Re-redo or a 3rd bypass surgery for any patient is a very complex operation. However at Asian Heart Institute, we have some of the best experienced doctors in the world to do this complex surgery.