Coronary Artery Bypass Grafting (CABG)
Coronary artery bypass grafting (CABG) is a surgical procedure designed to address severe blockages or narrowing in coronary arteries. CABG’s procedure involves creating a grafted artery bypass to the heart muscle across severe blockages or narrowing in coronary arteries by taking healthy blood vessels from another part of the body and grafting them between the top and bottom of the heart to allow better blood flow to the heart muscle, reduce and relieve chest pain, and treat angina pectoris in those with severe coronary artery disease or blockage, myocardial ischemia, or a heart attack, a major cause of sudden death. Coronary artery bypass grafting saves lives and allows those with heart disease to return to normalcy.
Why coronary artery bypass grafting?
Coronary artery bypass grafting, or heart bypass surgery, is a procedure used to treat coronary artery disease (CAD) or severe blockage of multivessel coronary arteries caused by fat deposits, tartar, or blood clots accumulating on the coronary artery walls. As a result, the coronary arteries become narrow, blocked, and hardened to the point of inadequate blood supply to the heart muscle, resulting in myocardial ischemia, angina pectoris, a heart attack, and potentially death.
Cardiologists will consider coronary artery bypass grafting for those who cannot undergo other treatments due to severe coronary artery blockage. Using a saphenous vein from the thigh, a radial artery from the forearm, or an internal mammary artery below the left breastbone to create a new coronary artery, connecting between the above aorta and the below coronary artery bypasses the blocked coronary artery to allow blood flow to the heart muscle more conveniently, helps alleviate chest pain, and improves heart function.
Indications for coronary artery bypass grafting
- Those experiencing severe chest pain, tightness in the chest, epigastrium, or the sensation of heavy objects pressing on the center of the chest.
- Those who are easily tired, have difficulty breathing, experience heart palpitations, sweat profusely, feel dizzy, faint, lose consciousness, or sustain a cardiac arrest.
- Those experiencing severe chest pain that radiates to the left shoulder, arm, back, neck, under the chin, and jaw.
- Those who have stable angina or chronic stable angina.
- Those experiencing severe chest pain who have not responded to medication.
- Those who have been diagnosed with severe coronary artery disease or a coronary artery blockage.
- Those diagnosed with poor left ventricular contraction due to severe stenosis of the coronary arteries to the left ventricular muscle.
- Those who have had an acute myocardial infarction or chronic myocardial ischemia.
- Those who have been diagnosed by a doctor with multivessel coronary artery disease or multiple blocked coronary arteries, particularly those with diabetes and chronic kidney failure.
- Those who have been diagnosed by a doctor with other heart diseases that necessitate heart surgery, such as heart valve stenosis or regurgitation.
- Those who have had a heart attack that doctors are unable to treat coronary angiograms using balloon angioplasty and stents due to the risk of coronary artery rupture, complicated stenosis, or severely calcified walls.
What diseases can a coronary artery bypass grafting treat?
- Myocardial ischemia:
- Acute coronary syndrome (ACS)
- Chronic coronary syndrome (CCS)
- Silent myocardial ischemia
- Coronary artery disease (CAD):
- Severe coronary artery disease
- Multivessel coronary artery disease
- Atherosclerosis
- Coronary artery blood clots
- Sudden cardiac arrest
- Heart disease or Heart failure
What is the diagnosis before determining coronary artery bypass grafting?
If it is not a medical emergency requiring immediate resuscitation, the cardiologist will make a diagnosis of coronary artery disease, myocardial ischemia, heart attack, or other cardiovascular diseases by performing a physical examination focusing on the heart, lungs, and pulse and taking a detailed history if the patient exhibits the following symptoms:
Medical history
- Experience severe chest pain, angina pectoris, heart palpitations, fatigue, shortness of breath, dizziness, or loss of consciousness.
- Have a history of heart disease or a family history of a heart attack or an acute myocardial infarction.
- Have an underlying disease that puts you at risk for heart disease, such as high blood lipids, hypertension, diabetes, or chronic kidney failure.
- Have been diagnosed with various heart abnormalities by a doctor using heart screening tests such as Electrocardiograms (ECG), Exercise ECG Stress Tests, Coronary CT scans, or Echocardiograms.
Blood Tests
- Measures blood cell platelets, kidney function, and plasma electrolytes, as well as checking for other abnormalities such as diabetes, kidney disease, and high blood lipids.
Heart screening Tests
- Electrocardiogram (EKG/ECG)
- Echocardiogram
- Exercise Stress Test (EST)
- CT Coronary Angiogram
- Coronary angiogram (CAG)
How many coronary arteries bypass grafting techniques are available?
There are 2 surgical techniques for coronary artery bypass grafting. The cardiac surgeon will determine the most suitable surgical technique for each patient, as follows:
- On-pump CABG is a surgical technique that involves temporarily stopping the heart and using a heart-lung bypass machine to pump blood to various parts of the body until the CABG procedure is completed. On-pump CABG is a conventional and widely recognized approach in the cardiothoracic surgeon community, known for producing positive treatment outcomes in both the short and long term.
- Off-pump CABG is a surgical technique that neither uses a heart-stopping technique nor a heart-lung bypass machine to temporarily pump blood during the surgery. Instead, the cardiac surgeons will perform the off-pump technique while the heart is still beating, using a local stabilizer device to hold the heart in place while the artery is grafted. The procedure allows the heart to continue functioning as usual. Off-pump CABG is a surgical technique designed to reduce complications in patients whose doctors have determined that they are unsuitable for on-pump CABG or other surgical techniques
What is a coronary artery bypass grafting procedure?
Coronary artery bypass grafting at MedPark Hospital is performed using gold standards in diagnosis and treatment, considering the utmost safety and treatment effectiveness. Throughout the treatment, the patient undergoing surgery will stay in the hospital for approximately 1 week before returning home to continue recuperating if the treatment results are good and no complications are discovered.
Pre Coronary Artery Bypass Grafting Procedures
- The cardiologist will ask the patient to stop taking certain medications, such as blood thinners, aspirin, ibuprofen, naproxen, or Plavix, a week before the surgery.
- Those undergoing surgery eat and take medications strictly as prescribed by the cardiologist.
- Refrain from eating and drinking for at least 6 hours before the surgery.
- Refrain from smoking and alcohol consumption.
- Before surgery, a team of heart surgeons and anesthesiologists evaluates your physical condition.
- The medical staff explains the coronary artery bypass grafting procedure and obtains consent forms prior to the surgery.
During Coronary Artery Bypass Grafting Procedures
- The nurse cleans the body from the neck to the toes and applies disinfectant to prevent infection.
- The anesthesiologist begins the procedure by starting an IV line for saline infusion, administering general anesthesia, connecting the breathing tube to the ventilator, and inserting catheters in various parts of the body.
- The cardiac surgeon performs a CABG procedure by making a vertical incision down the center of the chest over the breastbone (sternum).
- The surgeon searches for and selects a healthy blood vessel to create a new coronary artery (graft) for blood and oxygen supply to the heart. The harvested blood vessel was either selected from the internal mammary artery (LIMA) beneath the left breastbone, a radial artery from the forearm, or a reversed saphenous vein from the thigh.
- The cardiac surgeon removes the harvested blood vessel from its natural site of origin and harvests the upper end of the aorta at the heart's pole and the lower end of the coronary artery to create a new pathway of coronary artery bypassing the narrowed or blocked coronary arteries. This allows the blood to fully pump and circulate to the heart muscle.
- The cardiac surgeon assesses heart function and a new coronary artery before closing the sternal wound. The surgery typically takes approximately 3–6 hours.
Post Coronary Artery Bypass Grafting Procedures
- The patient will be transferred to the ICU for 1-2 days of close care and monitoring by the cardiac surgeon and a multidisciplinary team.
- If the recovery process goes well, the cardiologist will allow the patient to move and stay in a regular wardroom for an additional 5-7 days to recover.
- The cardiologist will use IVs to administer pain relievers and prevent complications such as blood clots.
- The cardiologist will monitor the symptoms, vital signs, heart rate, and blood pressure on a regular basis, as well as any complications that may occur.
- Following surgery, the patient will participate in a cardiac rehabilitation program, engaging in breathing exercises to strengthen their lungs and hearts.
- Engaging in a physical movement program to enhance overall body strength for a speedy recovery.
- Involving in a nutrition class for heart-healthy diets, efforts to quit smoking, abstaining from alcohol, adopting a positive mindset, consuming nutritious food, ensuring adequate rest, minimizing stress, and incorporating regular exercise into the routine are encouraged to improve overall health and quality of life.
- The cardiologist will conduct a physical examination to assess the results of the treatment. If there are no abnormalities or complications, the patient can return home.
What is coronary artery bypass grafting aftercare?
- Take the prescribed medication on time and attend the doctor's appointment as scheduled to evaluate symptoms and monitor treatment outcomes.
- Typically, the surgical wound will gradually heal within 7 days. Individuals who have had surgery can remove the bandage and shower.
- The breastbone or sternum will gradually fuse within 4–8 weeks. Overall symptoms will gradually improve 6–12 weeks after surgery.
- Those experiencing unusual symptoms such as fever, palpitations, bruising, swelling, chest tightness, nausea, vomiting, or severe pain in any area should seek medical attention right away.
- Refrain from smoking, drinking alcohol, or eating high-fat or high-sugar foods.
- Refrain from lifting heavy objects, avoid strenuous activity for 2 months, and refrain from driving for 6–8 weeks.
- Exercise or physical activities can be resumed 4-6 months after surgery, depending on each individual's physical strength.
- Get enough sleep, avoid stress, eat nutritious foods, and exercise regularly.
What are the complications of coronary artery bypass grafting?
Complications from coronary artery bypass grafting may include heart arrhythmia, bleeding, infections, delirium, kidney failure, paralysis, heart attack, or sudden cardiac arrest. However, these complications are extremely rare. Overall, the surgery is considered safe and has a 98% success rate.
What are the benefits of coronary artery bypass grafting (CABG)?
- CABG treats severe coronary artery disease and coronary artery stenosis in some difficult locations.
- CABG saves the lives of patients suffering from heart attacks, acute coronary syndrome, or sudden cardiac arrest.
- CABG is used to treat coronary artery disease in patients who cannot be treated with balloon angioplasty and stents due to the risk of coronary artery rupture.
- Reduces chest pain and shortness of breath.
- Reduces the risk of stroke.
- Reduces the risk of heart arrhythmia.
- Short-term hospitalization
- Allows patients to regain a healthy heart.
Coronary Artery Bypass Grafting at MedPark Hospital
MedPark Hospital's Cardiology Center, Bangkok, Thailand is led by a team of experienced cardiovascular surgeons and cardiologists who are ready to diagnose and treat difficult and complex coronary artery disease and myocardial ischemia, utilizing coronary artery bypass grafting technique combined with state-of-the-art medical technology and equipment integrated with medical techniques to provide the best possible treatment outcome, as well as a post-treatment cardiac rehabilitation program guided by a skilled physical therapist and a multidisciplinary team to provide post-treatment follow-up to prevent complications, shorten recovery time, and foster the patient to have a healthy heart, which aids in longest-living.
FAQ
- What is the success rate of coronary artery bypass grafting?
According to the study's findings, individuals who undergo coronary artery bypass grafting, both on-pump CABG and off-pump CABG, have a 98% success rate, with improved blood circulation, decreased chest pain, and the potential to prevent heart attacks. - Is coronary artery bypass grafting safe?
With cutting-edge AI, surgical technology improves surgery efficiency and safety, minimizes the impact on blood vessels and nearby organs, and increases the survival rate of individuals with severe coronary artery disease and myocardial ischemia significantly. - What is the recovery time for coronary artery bypass grafting?
Typically, individuals who undergo coronary artery bypass grafting will gradually recover within 6-12 weeks, depending on the individual's physical fitness. - What is the average life expectancy after coronary artery bypass grafting?
According to the study's findings, patients who undergo coronary artery bypass surgery (CABG) and follow their doctor's advice on maintaining good health, changing their eating habits and lifestyle, and exercising regularly can live for more than 20 years.
