Coronary artery bypass grafting (CABG)
CABG is a surgical operation in which blocked coronary arteries are bypassed. Another vessel, such as a vein from the leg (saphenous vein) or an artery (internal mammary, radial) is used to bypass the blocked section, so as to provide the heart muscle with blood.
What is involved ?
The operation, which usually takes from 3 to 5 hours, is undertaken under general anesthesia. The surgeon harvests the veins from the leg and/or prepares the arteries from the thoracic wall (internal mammary artery) or arm (radial artery) for grafting. The surgeon makes the choice as to the number and type of grafts. An incision is them made in the mid-chest and a specialised saw is used to go through the breastbone (sternum). The heart is then put on bypass, which consists of an external pump and a circuit that takes of the blood from the body and pumps it back. Whilst the circulation is on bypass, the heart is cooled and stopped. The surgeon makes an incision beyond the blockage of the coronary artery, connects one end of the graft to this site and the other to the aorta.
Once the grafts are secured, the heart is re-started and the patient's circulation is switched from the external pump and circuit to his/her own. Temporary pacing wires and a chest drain are inserted, the breastbone is closed and finally the skin. The patient is routinely admitted to the intensive care unit and then to the cardiac ward for another 3 to 5 days.
Using this techqniue, the heart is not bypassed, cooled and stopped.The surgeon operates on the heart whilst it is beating. This technique is appropriate for some patients.
Minimally Invasive CABG
Minimally invasive coronary artery bypass (MIDCAB) surgery is possible in patients who require only one graft - a left internal mammary artery (LIMA) bypass graft to the left anterior descending (LAD) artery.
As with any other operation, CABG involves risks. These are related to the severity of the disease and well as other conditions (co-morbidities), such as :
- Poor heart muscle function
- Disease obstructing the left main coronary artery
- Chronic lung disease
- Kidney failure.
- Bleeding or infection
- Stroke, which is more likely to age and history of a stroke
- Kidney failure
- Heart attack
- Heart failure - depends on the heart muscle function prior to surgery
Each patient is different. Your cardiologist and surgeon will be able to give you an estimate of risks.
Immediate follow-up by the surgeon or cardiologist will be required. In the weeks following CABG, you may require ECGs and echocardiograms to assess the effects of surgery.
Recovery from CABG takes about one months. Most patients can resume driving after 3 to 6 weeks.
Life after a CABG
A CABG bypasses areas of coronary heart disease, but it does not remove it or stop it. Here is how you can help reduce the risks of further problems:
- Stop smoking
• Take all the prescribed drugs
- Keep blood pressure in target: less than 130/80 mmHg.
- Keep total cholesterol to less than 4 mmol/L and LDL cholesterol to less than 2 mmol/L
- Complete rehabilitation programme and exercise regularly
- Attend revision every 6 months, to check blood pressure, lipid levels and need to change medications.
Video of a CABG operation