The coronary arteries are the blood vessels which supply oxygen rich blood and nutrients to the muscles of the heart. These vessels arise directly from the aorta. Aging, diabetes, obesity and high cholesterol are all risk factors for the build up of plaque in the walls of these vessels which can cause significant obstruction to blood flow leading to coronary artery disease (CAD). This reduction in blood flow manifests with chest pain and can progress to a heart attack in the event of complete obstruction of the vessel.
Coronary Artery Bypass Grafting, often referred to as CABG (pronounced as cabbage), is a surgery of the heart where arteries or veins from other parts of the body are utilised to bypass the blocked coronary artery to restore blood supply to the heart. Every year around 1000 CABGs are performed per million individuals in the United States of America with excellent outcomes.
The other procedure used for treating CAD and heart attacks is Percutaneous Coronary Intervention (PCI) which is non invasive and involves inserting a stent into the obstructed vessel to reopen it. While PCI is being done more commonly across the world, CABG has the advantage of being able to achieve complete restoration of blood flow and longer duration of symptom free survival. CABG is performed by a Cardiac Surgeon and PCI is performed by a Cardiologist.
Often, a patient may undergo both PCI and CABG of different vessels depending on the pattern of CAD and the severity.
There are three major types of CABG all of which are performed under general anaesthesia. They generally take from 3 to 6 hours depending on the number of vessels to be operated on and their structural variations. The following are the different types of CABG
The vessel used to bypass the obstructed coronary artery is generally taken from the patient’ chest, arm or leg. Both arteries and veins can be used.
Arterial Grafts: These have the advantage of being less likely to get blocked over time. The most commonly used graft is the internal mammary artery (aka internal thoracic artery) which runs on either side of the sternum within the chest wall. Due to its close proximity to the heart, the left artery is frequently used for grafting. The radial artery in the fore arm is also used.
Venous Grafts: The most commonly used vein is the saphenous vein which runs superficially on the inner aspect of the leg is used. These are more prone for obstruction over time with need for a repeat CABG.
In the Hospital:As traditional CABG involves open heart surgery, complete recovery can take 6 to 12 weeks. The first few days following the procedure are spent in an Intensive Care Unit (ICU) with provision for continuous cardiac monitoring and frequent measurement of vital signs. Chest drains would be left in place to allow for draining of secretions. This is to facilitate patient recovery, prevent post CABG infection and monitor for complications. After the ICU, a few days are spent in a step down unit or the ward before being discharged home.
At Home:Instructions for caring for the operation wound are provided upon discharge along with instructions on medications and follow up visit. Generally, individuals can return to work after 6 weeks, begin driving after 3 to 8 weeks and resume sexual activity after 4 weeks. Regular follow up and compliance to medications is necessary for long term success of the graft
CABGs have had excellent outcomes. Most people remain free of symptoms for up to 10 to 15 years with proper care and are able to live longer with a good quality of life.
This post was last modified on July 14, 2023 1:00 pm
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