What do you need to know about coronary arteries bypass grafting?

Coronary artery bypass grafting (CABG) is a type of surgery that is performed to improve the flow of blood to the heart. The surgery is used by surgeons for the treatment of Coronary Heart Disease (CHD). This is a disease in which plaque or a waxy substance gets built up within the coronary arteries.

These arteries are responsible for supplying oxygen-rich blood to the heart. With the passage of time, the built-up plaque has the tendency to either harden up or break open (rupture). This narrows down the coronary arteries, and cuts down on the flow of blood to the heart itself which can cause chest discomfort or chest pain known as angina.

 

In CABG surgery, a leg vein of the patient, or a healthy artery from the chest or forearm, or a graft, is used to replace a portion of the coronary artery system, affected with partial or complete blockage. The blocked portion of the coronary artery is therefore ‘bypassed’ by the grafted vein or artery, paving way for oxygen-rich blood to once again supply the heart.

Multiple coronary arteries can be bypassed in a single surgery.

Procedure – Private Heart Specialist

There are two different approaches to the procedure. First off, there’s the traditional surgery, or on-pump  surgery, in which an incision of about 6 – 8 inches is made by the surgeon down the centre of the patient’s breastbone or sternum. This offers complete access to the heart where the procedure is to be performed.  The patient needs to be connected to heart-lung bypass machines, which makes it possible for the heart to continually acquire proper blood circulation throughout surgery. Once the surgery mentioned above is performed, the breastbone is closed using sternal wires, whereas the chest is closed with the help of internal or external stitches.

On the other hand, there is also off-pump surgery or beating heart bypass surgery. This option allows for the surgeon to perform the surgery while the heart continues to beat. This means that the heart-lung machine is not used in this procedure. However, this option requires for the surgeon to make use of advanced surgery equipment so that portions of the heart can be held or stabilised while the blocked artery is bypassed.

General protocol

Before the procedure, the surgeon is going to explain the procedure to you, and a complete medical examination will be performed too. Blood and other diagnostic tests are also going to be performed. The surgery is to be carried out after an eight hours fast. All jewellery items will need to be removed, and an intravenous IV line is going to be started on the patient. Catheters are also going to be inserted in the wrist and neck for the monitoring of the patients heart and blood pressure.

Risks

As with any surgery, there is always the risk of an infection developing at wound sites. Research shows that one in every 25 patients suffer from this problem. During procedure, the patient might suffer irregular heartbeats as well. Most importantly, there is the fact that the coronary arteries that supply blood the heart, and the heart itself are in a rather sensitive state once the surgery has been performed, which may lead to a heart attack.

The video below from the British Heart Foundation gives a very good overview, however to discuss coronary bypass surgery in greater detail contact Private Heart Specialist Dr Gill: