Coronary Artery Bypass Surgery


DESCRIPTION
Coronary Artery Bypass Grafting also known as Coronary Artery Bypass Surgery or plainly bypass surgery is one of the most popular and common type of surgery procedure in cardiology. This procedure helps to improve the flow of blood to the heart. This surgery is mostly helpful for patients suffering from severe Coronary Heart Disease which is also known as Coronary Artery Disease. This condition arises when a substance called plaque builds up inside the coronary arteries. Coronary arteries are those which supply oxygen rich blood to the heart. Plaque is the substance made up of fat, cholesterol, calcium and other substances found in the blood. It narrows or blocks the coronary arteries and reduces blood flow to the heart muscle.  This may result in severe chest pain also know as Angina, shortness of breath, and, in some cases, heart attack. During a CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked artery. This grafted artery bypasses or goes around the blocked portion of the coronary artery and creates a new passage, and oxygen rich blood is routed around the blockage to the heart muscle.


TYPES OF CABG

Traditional Coronary Bypass Grafting

One of the most common forms of CABG.  In this procedure, the chest bone is opened to access the heart. Medicines are given to stop the heart functions temporarily and a heart-lung bypass machine is used to maintain the blood and oxygen circulation throughout the body. This allows the surgeon to operate on a still heart.

Off-Pump Coronary Artery Bypass Grafting
This type of surgery is somewhat similar to traditional CABG, with an exception that the heart isn’t stopped and a heart-lung bypass machine isn’t used. Off-pump CABG is also called Beating Heart Bypass Grafting.

Minimally Invasive Direct Coronary Artery Bypass Grafting
In minimally invasive CABG, instead of a large incision or cut to open the chest bone, several small incisions are made on the left side of the chest between the ribs. This type of surgery is used for bypassing the blood vessels in front of the heart, It is a comparatively new procedure and is done less often than other types of CABG.


THE PROCESS
Some tests are performed on the patient to prepare him/her for CABG. The patient may have to undergo several blood tests, an EKG (electrocardiogram), echocardiography, a chest x-ray, cardiac catheterization, and cardiac angiography. Specific instructions will be given to the patient on the preparation for the surgery.  The patient will be advised on his diet, his medication, and what all activities to restrict or stop like smoking, drinking etc.  During the surgery, general anesthesia will be performed on the patient. An incision is made down the center of the chest of the patient. The chest bone is then cut and the ribcage is opened to gain access to the heart. Medicines are used to stop the heart which allows the surgeon to operate on it while it’s not beating. A heart-lung bypass machine is used to keep the oxygen rich blood moving throughout the patient’s body during the surgery. An artery or vein is taken from any part of the patient’s body for example, the chest or the leg and is prepared to be used as a graft for the bypass. In surgeries with several bypasses, both artery and vein grafts are commonly used. After the grafting is done, blood flow to the heart is restored. Usually the heart starts beating again on its own but in some cases, mild electric shocks are used to restart the heart. The patient is then disconnected from the heart-lung bypass machine. The surgeon completes the procedure by closing all the incisions and cuts made during the surgery with stitches and staples.


DURATION OF THE PROCESS
CABG surgery may last 3 to 5 hrs.


HOSPITALIZATION PERIOD
After CABG surgery, a patient will be hospitalized for 6 to 7 days.


TIME SPAN FOR RECOVERY
In the case of medical tourists/patients, they can schedule their return to their home country after 10 to 12 days from the CABG surgery.


AFTERCARE GUIDELINES
After a CABG surgery, patients are advised to be extremely careful and vigilant about their health. They have to strictly follow the doctor’s instructions on the areas given below.
  • To care for the healing incisions.
  • Immediately call the doctor if any complications occur.
  • To make regular follow up appointments.
  • Strictly refrain from strenuous physical activities like lifting heavy objects or performing heavy exertion during the healing period.
  • Patients are also advised not to drive or indulge in sexual activities for at least 4 weeks.
  • Patient can return to work after 6 weeks unless his/her job involves specific and demanding physical activity.
  • To make essential changes in the present lifestyle like changes in diet, quitting smoking, and bringing down the stress level to the minimum.
  • Doctor can suggest cardiac rehabilitation for patients. This is a medically supervised program that helps improve the health and well-being of people who have heart problems.
  • Strictly follow the prescribed medications and exercises for effective recovery.


THE RISKS

  • Wound infection and bleeding
  • Reactions to Anesthesia
  • Fever
  • Chronic pain at incision sites
  • Memory loss
  • Fatigue (tiredness), mood swings, or depression
  • Problems sleeping or loss of appetite
  • Stroke
  • Heart Attack

The risks are higher with the following category of patients,

     - Older people (70 yrs and more)
     - Diabetic patients
     - Patients suffering from kidney failure
     - Patients with high blood pressure
     - Patients with poor heart muscle function


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