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Coronary Artery Bypass Graft (CABG)
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22-07-2024 Team Medicover Cardiology

Coronary Artery Bypass Graft (CABG)

Coronary Artery Bypass Surgery (CABG) is a type of cardiac surgery that circumvents or bypasses blocked or restricted coronary (heart) arteries by using blood channels from another section of your body.

  • The surgery helps people whose coronary arteries have become narrowed or blocked by fatty material called plaque.
  • The bypass allows blood and oxygen to flow to the heart muscle, improving the blood supply to the heart and relieving the symptoms of angina.
  • Veins or arteries are used to bypass the blocked coronary arteries.
  • The Great Saphenous Vein (GSV) from the leg, the radial artery from the arm, or the internal mammary artery from inside the chest wall can be used for bypass grafts.
  • These are then sewn in place, providing an effective way of treating severe coronary artery narrowing.

Understanding Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) is a serious health problem where the arteries that carry blood to your heart become blocked. If left untreated, it can lead to a heart attack.

Coronary artery bypass surgery (also called CABG) is a treatment that can help you recover from this condition. This surgery uses a graft (a blood vessel from another part of your body) to create a new pathway (bypass) around the blockage.

Over time, fats, cholesterol, and other substances can build up on the walls of your arteries to form plaque. When plaque breaks open and a blood clot forms, it blocks blood flow to your heart. This can lead to chest discomfort called angina and potentially to a heart attack.

Read on to learn how bypass surgery will put you on the road to a healthier future. Understanding how your arteries become blocked can help you recognise the importance of treating CAD promptly to prevent severe complications.

Evaluation and Preparation Before CABG Surgery

Pre-Surgical Tests and Evaluation

  • Symptoms and Medical History: You'll discuss your symptoms and medical history to help doctors understand your condition and identify risk factors like high blood pressure, high cholesterol, or diabetes.
  • Physical Examination and Blood Tests: A physical exam and blood tests are performed to detect signs of Coronary Artery Disease (CAD) and assess overall health.
  • Diagnostic Tests: Based on initial findings, further tests may be conducted to assess the need for bypass surgery:

In some cases, procedures like angioplasty and stenting may be performed during cardiac catheterization to treat blockages. Based on the size, number, and location of blockages, doctors may recommend coronary artery bypass surgery as the most effective treatment.

Scheduling and Preparation

  • Scheduling Surgery: Depending on the urgency and evaluation results, surgery may be scheduled promptly after catheterization or at a later date.
  • Preparation: Before surgery, you'll meet with your doctor to discuss physical and emotional preparation for the procedure.
  • Anesthesia Discussion: Discuss anesthesia options and disclose all medications with an Anesthesiologist. Some medicines may need to be adjusted or stopped before surgery as directed by your surgeon.

During Bypass Surgery Procedure

On the day of your surgery, you'll be taken to a Cardiothoracic Operation Theater. During bypass surgery, the goal is to create a new pathway around blocked parts of coronary arteries rather than removing the blockages themselves. Here's how it typically proceeds:

Basic Proceedings

  • Preparation: Hair may be shaved from the chest or other incision sites to ensure cleanliness and facilitate surgery.
  • IV Medication: You will receive medication through an intravenous (IV) line. This helps administer necessary fluids and medications directly into your bloodstream.
  • Monitoring: Various lines will be connected to monitor your vital signs closely. These typically include sensors on your finger, wrist, arm, and neck, which are connected to machines to track oxygen levels, heart rate, blood pressure, and vein pressure.
  • Anesthesia Administration: Just before surgery begins, anesthesia will be administered to induce sleep and prevent pain throughout the procedure. This ensures you remain comfortable and unaware of the surgery as it progresses.

Preparing for the Bypass Graft

The bypass graft is taken from another part of your body. This usually doesn't affect blood flow in that body part. If you have more than one blockage, more than one graft may be needed. One or more of these blood vessels will be used:

  • The saphenous vein is located in the leg.
  • The radial artery is located in the arm.
  • The internal thoracic (mammary) artery is located in the chest wall.

Reaching the Heart

While one member of the bypass team is getting the graft, another member works to reach your heart. First, an incision is made in the chest. Then, the breastbone (sternum) is divided. The breastbone is held open throughout the surgery, putting pressure on the chest's nerves. During recovery, you may have soreness and muscle spasms in your chest, shoulders, and back.

Using the Heart-Lung Machine

  • While one part of the surgical team prepares the graft, another team member accesses your heart.
  • An incision is made in the chest, and the breastbone (sternum) is divided to provide access. The sternum remains open throughout the surgery, which may cause soreness and muscle spasms in your chest, shoulders, and back during recovery.

Attaching the Graft

A small opening is made in the coronary artery below the blockage

  • If a saphenous vein or radial artery is used, one end of the graft is sewn onto this opening. The other end is sewn onto the aorta.
  • If the internal thoracic (mammary) artery is used, one end of the graft is sewn onto this opening. The other end is already attached to a branch of the aorta.

Finishing Up

Once the graft has been attached, blood will start flowing through this new pathway to bypass the blockage. If you have multiple blockages, more than one bypass may be done. Then, your breastbone is rejoined with wires. These wires will stay on your chest permanently. The incision is closed, and you are taken to the intensive care unit to begin your recovery.

Using the Heart-Lung Machine

  • Once the graft is securely attached, blood begins flowing through the new pathway, bypassing the blockage.
  • If multiple blockages exist, multiple bypasses may be performed.
  • The breastbone is then rejoined using wires, which remain in place permanently.
  • The incision is closed, and you are transferred to the intensive care unit to begin your recovery process.

After Surgery

After your surgery, you'll be taken to the ICU (intensive care unit). When you wake up, you may feel thirsty, groggy, and cold. These sensations are typical and short-lived. Nurses will ensure you have everything you need.

Once stable, you'll move to another hospital room, either the same day or later. You'll be connected to tubes and machines for monitoring, which will be removed as you recover.

You may have:

  • A line on your wrist or neck to monitor blood pressure or other pressures in your heart.
  • An IV to provide medications and fluids.
  • Drainage tubes to drain fluid from your chest.
  • A catheter is used to drain urine.
  • An intra-aortic balloon pump to take over some of the heart's pumping function (if needed). This lets the heart relax and recover. You will likely be sedated until this is removed.

Preventing Lung Problems Caused by CABS

After surgery, you'll be assisted with breathing using a tube inserted through your mouth into your throat. Here's what to expect during this phase:

  • Breathing Assistance: The breathing tube prevents speaking, so you communicate with nurses through simple yes or no gestures. It may initially cause throat soreness.
  • Stomach Emptying: Another tube in your nose or mouth keeps your stomach empty until you can breathe independently.
  • Transition to Oxygen: Once you can breathe on your own, these tubes will be removed. You may then receive oxygen through a mask or small prongs in your nose.

After the breathing tube is removed:

  • Breathing Exercises: A respiratory therapist or nurse will guide you through deep breathing and coughing exercises. These help prevent pneumonia despite potential discomfort from your healing breastbone incision.
  • Pain Management: Techniques will be taught to perform these exercises with minimal pain, ensuring you recover effectively.

After CABG Surgery Care?

How to Reducing Swelling

Your legs may be swollen post-surgery, especially if grafts were removed. Raising the foot off your Coronary Artery Bypass Graft (CABG) can help reduce swelling. You may also be taught to do exercises in Coronary Artery Bypass Graft (CABG), such as the ankle exercise descriCoronary Artery Bypass Graft (CABG) below.

Ankle Exercise

  • Start with your toes pointed. Flex your foot at the ankle and count to 5. Then relax.
  • Repeat ten times with each foot.

Protecting Your Breastbone

Protecting your breastbone post-bypass surgery is crucial for healing. Here are some tips to follow while in the hospital and at home:

  • Avoid straining movements: Avoid activities that strain your arms or chest, such as pushing, pulling, or lifting heavy objects.
  • Limit arm movements: Avoid reaching behind you or high above your head to prevent stressing your breastbone.
  • Learn proper movements: Nurses will teach you safe ways to move that protect your breastbone, such as standing techniques that minimise strain.

Standing Up

When you get out of a chair, it's okay to use your arms for balance. But don't push them against the arms of the chair. To stand:

  • Scoot to the very front edge of the chair.
  • Rock yourself onto the balls of your feet. Slowly rise to a standing position.
  • Use the same method to get out of Coronary Artery Bypass Graft (CABG). Don't push your arms against the mattress.

Caring for Your Incisions

Your incisions may be bruised, itchy, numb, and sore. After a shower, pat them dry (do not rub). Do not use lotion or powder. Be sure to check the incisions every day. This way, you will see any signs of problems early.

Complications

There are a few risks involved in bypass surgery. Some risks are:

S.No

Risks of Bypass Surgery

1

Breathing problems

2

Fast or irregular heartbeat

3

Nerve injury or muscle spasms

4

Infection of the incision sites

5

Pneumonia (lung infection)

6

Excessive bleeding

7

Memory problems or confusion

8

Heart attack, stroke, or death

Dos and Don'ts After Bypass Surgery

Do's after bypass surgery

Don'ts after bypass surgery

Wear loose clothes that don't stick to your body as the surgical incision of the bypass surgery needs air

Increase your fibre intake; indulge in more leafy vegetables, sprouts, and fresh fruits rather than processed intake.

Clean your bypass surgery incision with medically approved lotions and solutions but avoid harsh detergents or antiseptics as they may cause discomfort and may lead to infection.

If you feel bloated, try low-carb diets and treat yourself to protein-based diets, including egg whites, chicken, oats, etc.

Sleep straight and avoid sleeping on your stomach, at least for the first month, as you don't want your fat or muscles to add pressure to the bypass surgery wound.

Choose cooking oils that are high in omega-3 and six fatty acids.

Take a shower with warm water instead of hot water. Avoid showering, which will let the water pressure hit the incision to rupture

Avoid all junk food as it may just cause unwanted blockage in your arteries

In case of rashes or swelling or even if you witness blood stains near the incision, immediately consult the doctor.

Give up on sweets and rather indulge in natural or organic sweeteners in case you have cravings like honey that will ensure you curb those sinful cravings without building upon any kind of calories

Patients who have undergone bypass surgery should indulge in cardiovascular exercises like walking or slow jogging and avoid straining them too much.

Besides all of these factors, there are basic don'ts for the bypass surgery patient: Avoid alcoholAvoid smokingAvoid any kind of sexual activity, at least for the initial 1-month stress work, this will end up increasing your pulse. Avoid Junk and Fatty FoodsAvoid Exertion

All you need to do is be happy and smile, as that is what is good for your immune system and, most importantly, your heart.

Frequently Asked Questions

CABG (coronary artery bypass graft) surgery is one of the most common surgical operations. CABG surgery is recommended for a restricted set of patients who have substantial cardiac artery narrowings and blockages (coronary artery disease).

The three types of coronary artery bypass grafting are:

  • Arterial Grafts
  • Internal Thoracic Arteries
  • Radial Artery

If you have a clogged artery in your heart, one therapy option is coronary bypass surgery. If you experience severe chest discomfort caused by constriction of numerous arteries that supply your heart muscle, leaving the muscle short of blood even during modest exercise or at rest, you and your doctor may want to consider it.

CABG can significantly reduce the risk of future heart problems by improving blood flow to the heart. Long-term prevention, however, requires modifying one's lifestyle and taking care of underlying illnesses including diabetes, high blood pressure, and high cholesterol.

CABG is often recommended for patients with multiple or complex blockages, while angioplasty is suitable for less severe blockages. CABG provides longer-lasting relief but is more invasive compared to angioplasty, which involves using a balloon to open the artery and placing a stent to keep it open.

Evaluation During Surgery After Surgery Care Risks & Complications Frequently Asked Questions
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