02/23/2024
Coronary artery bypass graft surgery (CABG) is a treatment for coronary artery disease (CAD), which occurs when the coronary arteries constrict, reducing the delivery of oxygen-rich blood to the heart muscle. The graft is replaced with a healthy blood vessel from another part of the body, such as a vein from the leg or an artery in the chest. The bypass procedure involves cutting the breastbone in half and spreading it apart, then inserting tubes into the heart to pump blood through the body. Less invasive approaches, such as "off-pump" operations, keyhole surgery, and robotic surgery, have also been developed.
Why Might I Need Coronary Artery Bypass Surgery?
Coronary artery bypass graft surgery (CABG) is used by your doctor to treat a blockage or narrowing of one or more coronary arteries, restoring blood flow to your heart muscle.
Symptoms of coronary artery disease may include:
- Chest pain
- Fatigue (severe tiredness)
- Palpitations
- Abnormal heart rhythms
- Shortness of breath
- Swelling in the hands and feet
- Indigestion
Unfortunately, you may not notice any signs of early coronary artery disease, but the condition will advance until there is enough arterial blockage to create symptoms and complications. If the blood flow to your heart muscle continues to deteriorate as a result of increased blockage in a coronary artery, you may suffer a stroke. If blood flow is not restored to the injured portion of the heart muscle, the tissue will die. There may be other reasons for your doctor to recommend CABG surgery.
Risks
Possible risks of coronary artery bypass graft surgery (CABG) include:
- Bleeding during or after the surgery
- Blood clots that can cause a heart attack, stroke, or lung problems
- Infection at the incision site
- Pneumonia
- Breathing problems
- Pancreatitis
- Kidney failure
- Abnormal heart rhythms
- Failure of the graft
- Death
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Procedure
Doctors often have several options for treating a blockage. Doctors may attempt to resolve the problem with drugs and less intrusive procedures, such as a stent, but this is not always the case. Heart bypass surgery is the primary treatment option for complex vascular disease, numerous bypasses, or underlying health issues such as diabetes.
An open bypass procedure consists of the following stages:
- General Anesthesia: After preparing for surgery, an anesthesiologist will administer a general anesthetic to put the patient to sleep and insert a breathing tube into their windpipe.
- Harvesting Of Graft Vessels: Graft vascular harvesting occurs when surgeons extract target vessels from a patient's leg, arm, or chest.
- Incision And Opening: To gain access to the heart, the surgeon will make an incision in the center of the chest and separate the sternum. They will briefly stop the heart's beating at this point.
- Cardiopulmonary Bypass: Doctors may place a patient on a cardiopulmonary bypass. This entails connecting the individual to a machine that takes over their heart and lung functions. The use of this bypass is not required for every surgery.
- Grafting: Surgeons will attach new graft vessels to either side of obstructions to redirect blood flow.
- Restoring Blood Flow: If necessary, doctors will remove the cardiopulmonary bypass and ensure that blood is properly flowing through the grafted conduit.
- Closure: After confirming blood flow through the graft, the surgeons will secure the sternum with metal wires and close the incision site. The individual will be transferred to an intensive care unit to recover.
The surgery usually takes 3–6 hours; however, this can vary depending on how many grafts are required.
Types Of Heart Bypass Surgery
There are several forms of bypass surgery.
Coronary Artery Bypass Grafting (CABG)
Multiple Bypass Surgeries
A single bypass operation occurs when a surgeon needs to bypass only one blocked artery. If more than one artery is blocked, several bypasses will be required.
Surgeons could also perform:
- Double Bypass Surgery: If both arteries are blocked, two grafts will be required.
- Triple Bypass Surgery: If there are three blockages, three bypass grafts are required.
- Quadruple Bypass Surgery: If four coronary arteries are blocked, four grafts are required to bypass them. Quintuple bypass surgery involves all five major arteries that supply the heart and requires five bypass grafts.
On and off-pump
Heart bypass surgery is usually an open-heart procedure. It means the surgeon opens the chest to reach the heart. The surgeon may then execute the surgery "on-pump" or "off-pump."
- On-pump surgery uses a heart-lung machine to circulate blood and perform the lungs' gas exchange function. The equipment allows doctors to halt the heart, making the procedure easier.
- Off-pump surgery, commonly known as "beating heart surgery," is performed while the heart is still beating but without the use of the heart-lung machine.
Minimally Invasive Bypass Procedure
Heart bypass surgery can be performed by surgeons without involving a full chest opening. They can make tiny incisions between ribs on a person's side. The bypass treatment is then carried out with the use of small cameras and surgical instruments. This can be performed by surgeons with or without robotic help. Recovery from minimally invasive cardiac surgery is typically shorter. The techniques can produce outcomes that are just as good as open surgery.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB): It enables a smaller incision (thoracotomy) on the left side of the chest to access the heart without exposing the sternum. This technique reduces surgical trauma and speeds up recovery by allowing the bypass for certain coronary arteries without the need for cardiopulmonary bypass.
Robot-Assisted Coronary Artery Bypass (RACAB): It performs precise, minimally invasive bypass grafting procedures with the help of robotic surgical instruments. Robotic arms fitted with surgical instruments are used by surgeons in a setup that enables more precise graft insertion and improved field-of-view visibility. Compared to standard CABG operations, RACAB may result in fewer incisions, reduced blood loss, and shorter hospital stays.
Conclusion
After recovering from coronary artery bypass surgery, most people feel better. Some people remain symptom-free for many years. However, the graft or other arteries may become clogged in the future. If this happens, you might need another surgery or procedure.
Your results and long-term outcome depend on how well you control blood pressure and cholesterol levels and chronic conditions such as diabetes. It's important to take your medicines as directed.