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Heart Bypass Surgery (CABG) Heart Bypass Surgery (CABG)

Heart Bypass Surgery (CABG)

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About “Heart Bypass Surgery (CABG)”

Heart Bypass Surgery (CABG)

Coronary artery bypass grafting (CABG) is a surgical procedure used to treat severe heart disease. To improve blood flow and oxygen supply to the heart, it diverts blood away from narrowed or blocked parts of the main arteries. A coronary artery bypass graft involves taking a blood vessel from another section of the body such as the chest, leg, or arm. It is joined to the coronary artery over and under the narrowed or blockage area. This newly formed blood vessel is known as a graft.

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Indications for CABG (When is CABG required?)

A coronary artery bypass graft is usually needed for patients who have the following medical conditions:

  • Acute coronary heart disease (CHD), is also called coronary artery disease.
  • Heart damage leads to heart attack due to blockage of arteries.
  • Acute blockage in the big coronary arteries leads to weak heart function.

Some of the signs and symptoms of coronary artery disease that require a CABG:

  • Fatigue
  • Chest pain
  • Shortness of breath.
  • Palpitations
  • Abnormal heart rhythms.
  • Indigestion
  • Swelling in the hands and feet.
  • Angina – When the reduction of the arteries becomes crucial, patients may experience symptoms such as chest pain and shortness of breath. This is known as angina.
  • Heart Attack – It can be a severe or minor heart attack. Sometimes the patient may suffer a heart attack or myocardial infarction.

Diagnosis for CABG

Your doctor will check if you are eligible for CABG. It depends on the following factors, which include:

  • Survival and severity of coronary heart disease.
  • Medical period and extent of blockage of coronary arteries.
  • Responding to other treatments.
  • The condition of your health.
  • Other basic medical conditions.

Medical Tests for Detecting Heart Bypass Graft (CABG) Treatment

A basic physical test is done. Tests are done to check which and how many arteries are blocked. If there is any kind of heat damage. Some of the tests your doctor may recommend include:

  • ECG (Electrocardiogram) – This test is performed to detect and record the heart’s electrical activity.
  • Stress test – Several tests are done at a time when the heart is working hard due to physical exercise.
  • Echocardiography – The test provides information about the size and shape of the heart and how well the heart’s chambers and valves are working using sound waves.
  • Coronary Angiography – Doctors use this test to check for blockages that might lead to heart attacks. It is performed using dyes to examine the flow of blood through the coronary arteries.

CABG Surgical Procedure

A coronary artery bypass graft involves taking a blood vessel from another part of the body such as the chest, legs or arm. It links it to the coronary artery over and under the narrowed or blockage area. The newly formed blood vessel is called a graft. The number of grafts required depends on the severity of the heart disease and the severity of blood vessel narrowing. A coronary artery bypass graft is performed under general anesthetic, which means you will be unconscious throughout the operation. It generally takes about 3 to 6 hours.

Types of CABG

There are several types of CABG procedures. One is an old-fashioned procedure and the other is a non-traditional procedure. The traditional procedure is open heart surgery and the non-traditional procedure is minimally invasive.

Traditional Method

This is an open heart surgery performed under anesthesia and it takes around 3 to 5 hours to operate. Staying in the hospital varies from 7 to 9 days. As part of the traditional procedure, some steps are taken before, during, and after surgery.

  • The patient is prescribed general anesthesia.
  • A cut is made in the center of the chest to reach the heart.
  • Medicines are prescribed to slow the heart and protect it.
  • By bypassing the heart and lungs, blood containing enough oxygen can flow throughout your body and serve as a replacement for the heart.
  • After the grafting is performed, blood flow to the heart is restored and the heart resumes its function.
  • The patient is detached from the heart-lung bypass machine.
  • Tubes are inserted into the chest to drain the fluid.
  • Use of wires to close the chest bone.
  • Use stitches or staples to close the skin incision.

Non-traditional Coronary Artery Bypass Grafting

In non-traditional coronary artery bypass grafting, there are two kinds of procedure:

  1. Off-Pump CABG

  2. Minimally invasive CABG

  • Off-Pump CARG – It is also known as beating heart bypass grafting. An off-pump coronary artery bypass graft is performed without a heart-lung bypass machine and while the heart is still beating. In this process, a mechanical device is used to stabilize the region of the heart where grafting is utilized.
  • Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Grafting – MIDCAB can be of various types and varies significantly from traditional bypass surgery. As the name implies, this is a less invasive method in which a small cut is made on the chest to reach the heart. MIDCA is generally performed when one or two coronary arteries need to be bypassed. A series of cuts generally 3 inches long are made between the left side of the ribs where the internal mammary artery is used for the graft. During the procedure, no heart-lung bypass machine is used.
  • Post-access Coronary Artery Bypass – In this procedure, artery or vein grafts are used and the procedure is done with small incisions in the chest. The surgeon uses a heart-lung bypass machine for the surgery.
  • Robot-assisted technique – In the advanced and modern CABG  technique, very small incisions are made in the heart that allow the surgeon to use a remote-controlled device to perform the surgery. Occasionally, a heart-lung bypass device is used.

Post-Surgery Complications

Following are the complications related to CABG. It includes:

  • Fever
  • Pain
  • Wound infection
  • Bleeding
  • Stroke
  • Heart attack

Factors Affecting Cost of Treatment

  • Some of the factors which will determine the average cost of treatment of your coronary artery bypass grafting surgery:
  • Choice of hospital and rooms.
  • Skill, experience, and reputation of the surgeon.
  • It includes the fees of doctors, surgeons, anesthesiologists, physiotherapists, special nurses, and dieticians.
  • The cost of traditional bypass or minimally invasive surgery is high.
  • Diagnostic procedure charges.
  • Cost of medications and doctor visits.
  • Length of stay in hospital.
  • Period of observation in the ICU (particularly relevant for open heart surgery).

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