Bypass Surgery / Coronary Artery Bypass Grafting (CABG) Surgery

Introduction:

The muscles of heart require continuous flow of blood and oxygen for its functioning. The heart gets this blood and oxygen from blood vessels called “Coronary Arteries”. There are 2 main coronary arteries, “Left Main Coronary Artery” LCMA & “Right Coronay Artery”. Both these coronary arteries arise from the Aorta. The Left Main Coronary Artery (LMCA) divides into 2 branches, namely Left Anterior Descending Artery (LAD) & Left Circumflex Artery (LCx). Two-thirds of the blood supply to the heart is via the LAD.

Pathology:

The Coronary Arteries can develop blockages. These blockages are called Atherosclerotic Plaques as they develop by a process called Atherosclerosis. Atherosclerosis is the process through which Cholesterol & Calcium is deposited inside the arteries.

Complications:

Over a period of time, the blockages increase in size reducing blood flow to the heart muscles.

During physical activity or emotional stress, the heart has to pump more blood into the body. The reduced blood flow due to blockages causes a demand supply mismatch to the heart muscles. This leads to Chest Pain (Angina on Exertion).
The plaque may crack or rupture forming a blood clot which can get trapped in blockages completely stopping flow of blood through the artery leading to injury or death of part of heart muscle causing a Heart Attack (Myocardial Infraction).

Treatment:

The usual investigations needed to diagnose and plan treatment for Coronary Artery Disease are ECG, Stress Test, 2D Echo & Coronary Angiography. The options available to manage significant blockages in Coronary Arteries are Angioplasty (PTCA/PCI) and Coronary Artery Bypass Graft (CABG) Surgery.

Coronary Artery Bypass Graft (CABG) Surgery is a procedure in which a healthy blood vessel (artery or vein) is harvested from other location of the patient & used to form a detour (bypass) around a blockage in a coronary artery. The original blockage in the Coronary Artery is left untouched. The Graft now provides adequate blood supply to the heart muscle while bypassing the blockage and corrects the demand supply mismatch. Hence CABG eliminates the risk of a Heart Attack. Globally, Coronary Artery Bypass Grafting (CABG) is by far the most frequently performed surgical procedure. There are 2 approaches to performing Coronary Artery Bypass Graft (CABG) Surgery.

Conventional CABG: The chest bone (Sternum) is split vertically to access the heart.

Minimally Invasive CABG: A small incision is made through the rib cage to access the heart. The procedure requires special instruments and techniques. This approach has its own limitations and is not applicable in all cases.

The blood vessel harvested to be used as a “Graft” determines the type of Coronary Artery Bypass Graft (CABG) Surgery performed. These include:

Internal Thoracic Artery (Internal Mammary Artery) Grafting: The artery is harvested from within the rib cage. When both right and left sided Internal Mammary Arteries are used, no additional incision is required on forearm or legs.

Saphenous Veins Grafting: The Saphenous Veins are harvested from one or both legs. These veins are grafted between the Aorta and Coronary Artery beyond the area of blockage.

Radial Artery Grafting: The Radial Artery is harvested from the non dominant forearm.

When both Internal Thoracic Arteries or a combination of one Internal Thoracic Artery and One Radial Artery is used, the procedure is called Total Arterial Bypass Grafting.

Beating Heart / Off-Pump Surgery

In the past, CABG was performed by cardiac surgeons using a heart-lung machine. This machine allowed temporary stoppage of the heart while connecting the graft to the Coronary Artery. Latest advances in Cardiac Surgery have allowed some trained Cardiac Surgeons to perform CABG without using the heart-lung machine. This revolutionary technique is called “Beating Heart” or “Off-Pump Surgery”.

Though technically more demanding on the Cardiac Surgeon, the benefits to the patient are significant. Almost all our CABG procedures are performed with “Beating Heart” technique. As a result, the patients spends less time in the ICU; requires less blood transfusions; avoiding complications; & significantly shorter hospital stay.

Salient Features of Coronary Artery Bypass Grafting (CABG) Surgery:

The Grafts used to bypass the blocked Coronary Arteries are harvested from the patients own body. The patients body responds very differently to the metallic stent used in Angioplasty, which it treats as a foreign body. Hence, Grafts are fully compatible as compared to a metallic stent. As a result, the Graft survives much longer than a Stent. In most CABG’s, the Graft is observed performing very well even after 15 years of surgery.
In CABG, all the blockages in Multi Vessel Coronary Artery Disease can be corrected at the same instance. Hence, repeated interventions are not required.
The short term as well as long term quality of life improves significantly after CABG. Feedback from patients indicates their life being restored to what it was before the start of symptoms of heart disease.
In Diabetic Patients, a study titled “Bypass Angioplasty Revascularization Investigation (BARI)” concluded that the risk of death (mortality) in cases with “Multi Vessel Coronary Artery Disease” was significantly greater in the first 5 years after Angioplasty as compared to CABG. Hence, Bypass Surgery is better suited for treatment of Coronary Artery Disease in Diabetic Patients.

Emergency State?

Required Login

Please Login for Submit Form.

Success

Thank you for scheduling an appointment with us! We’ve successfully received your request.

This field is required

Please enter a valid email

This field is required

Pre Surgery
Post Surgery

This field is required

Bypass Surgery / Coronary Artery Bypass Grafting (CABG) Surgery

Introduction:

Pathology:

Complications:

Treatment:

Beating Heart / Off-Pump Surgery

Salient Features of Coronary Artery Bypass Grafting (CABG) Surgery:

Emergency State?

Contact Us

Required Login

Success