Coronary Artery Bypass Grafting (CABG): A Lifesaving Treatment for Heart Patients
Heart disease—just hearing the term can be frightening. The heart is one of the most vital organs in the body, and with only one to rely on, any abnormality concerning the heart is never a minor concern.
Today, there are many treatment approaches available for cardiovascular disease, and CABG is one of the most effective options for patients with severe and complex coronary artery disease. In this Special Scoop edition featuring Asst. Prof. Dr. Chartaroon Rimsukcharoenchai, a cardiac surgeon who offers expert insights to inform and reassure patients regarding heart surgery.
Cardiovascular Disease: When Surgery Is Required
Coronary artery disease is often a silent threat that may go undetected with routine checkups. In many cases, it comes to light only when the condition has already progressed to an advanced stage or after a cardiac arrest. Early detection, while the body is still healthy without symptoms, is therefore highly desirable, allowing timely planning and intervention.
“If coronary artery plaque causing narrowing is present, an acute cardiac event can occur at any time. In the early stages, the efficiency of heart function may decline imperceptibly. Restricted blood flow to the heart muscle is like a ticking time bomb. When the artery narrowing becomes severe and extensive, and other treatments like medication, angioplasty, and stenting are no longer efficacious or possible, CABG becomes the unavoidable option of last resort. In this circumstance, it is not a condition that could be left untreated. As time passes, the risk of a heart attack or cardiac arrest is ever-present, with a significant risk of sudden death. However, timely surgical intervention can be life-saving,” the doctor explained.
CABG: Rerouting Blood Flow to Support Heart Function
Coronary artery bypass grafting, as the name implies, involves creating an alternative pathway for blood to flow around the blocked artery to the heart muscle, bypassing the blockage altogether. The procedure uses the patient's own blood vessels, typically veins in the leg or arteries in the chest or arm, as a graft.
“An advantage of bypass surgery is that restoration of blood flow is instantaneous after the grafting, which helps reduce the risk of deteriorating heart function and sudden death. In most instances, patients require only surgery once, and when successful, the benefits can last for 10–20 years or even longer.”
However, what patients should focus on is not just the success of the surgery or how long the grafts will last, but the post-surgery lifestyle and daily habit modifications that help prevent disease progression of all coronary vessels. Maintaining the health of the grafted and native coronary blood vessels depends largely on long-term lifestyle changes.
If patients continue with their previous unhealthy lifestyle, such as:
- Consuming ultraprocessed food: High in unhealthy fats, sugar, and sodium
- Physical inactivity: Little to no regular exercise or movement
- Heavy smoking
- Inadequate rest and high stress levels
These lifestyle factors can accelerate the progression of atherosclerosis, increasing the risk of new blockages forming in the grafts and other coronary arteries.
Adopting healthier habits after CABG — including healthy nutrition, regular exercise, weight control, stress management, good sleep hygiene, and smoking cessation — can significantly reduce the risk of disease progression or recurrence.
Limitations of CABG
The doctor outlined the following limitations of CABG:
- The surgery requires the use of a Heart-Lung Machine (Cardiopulmonary Bypass - CPB) and general anesthesia. Since it is a major surgical procedure, patients must undergo a thorough health assessment to determine if they are physically fit to handle the physiological stress of the surgery.
- Compromised vascular conditions: Surgeons will evaluate the coronary blood vessels pre-operatively to ensure maximal safety.
Nevertheless, CABG remains the gold standard treatment for coronary artery disease, offering predictable outcomes. An experienced cardiac care team engenders patient confidence and peace of mind during the procedure.
Is the Benefit Worthy of a Long Sternal Wound?
CABG typically involves a long incision through the sternum of about 10 centimeters. Harvesting blood vessels from the leg or arm requires creating additional incisions in those areas as well. Despite these incisional scars, from Dr. Chartaroon’s perspective, they are a worthwhile undertaking, as the surgery restores a patient’s quality of life.
“Every surgical procedure is for helping patients return to normal life. Many people worry that after heart surgery, they will become frail and feeble and unable to carry out daily activities. These are misconceptions. Every cardiac surgeon shares the same goal: to ensure that, after the surgery, patients regain their previous active life, just as they did before illness. While this journey may require a period of recovery and physical rehabilitation, our dedicated staff and medical professionals will be there to provide care and guidance starting from the immediate postoperative phase.”
For patients with coexisting conditions such as diabetes, hypertension, or kidney disease who may feel anxious about undergoing surgery, doctors explain that this is a very common scenario. These conditions often coexist with cardiovascular disease. The medical team will conduct a thorough health assessment and carefully plan management strategies before deciding to proceed with CABG. Therefore, patients need not be overly concerned.
During the postoperative recovery period, patients are cared for by a multidisciplinary team, including cardiac surgeons, medical specialists, and physical therapists. Structured phased rehabilitation, with clear guidance on activity instructions and restrictions, allows for timely recovery. Patients also receive support in managing underlying conditions, such as how to control blood sugar levels for diabetic patients and monitor blood pressure for those with hypertension, to ensure a smooth recovery and improved quality of life.
Current and Future CABG Technologies
Bypass surgery is now a standard and widely practiced procedure due to advances in technology and surgical techniques. In Thailand, there are numerous highly skilled and experienced cardiac surgeons. Looking ahead, emerging technologies include minimally invasive surgical techniques and "off-pump" procedures that eliminate the need for a heart-lung machine. However, currently, about 90% of bypass surgeries are still performed using the traditional open-chest approach. It remains the effective method with fewer surgical limitations compared to minimally invasive alternatives.
“I once had a patient who obstinately refused surgery. Despite ongoing discussions with his care team over the course of a year, the fear persisted. However, when the patient met me as the primary surgeon, I took the time to establish trust and provide clear, step-by-step explanations of the procedure—what it entails and what expected outcomes are. He gained confidence and ultimately agreed to the surgery. The key is to provide patients with clear, comprehensive information so they can truly understand and visualize the process. When patients are well-informed, surgery—whether minimally invasive or open—is far less intimidating than they initially conjure.”
Therefore, heart surgery today is no longer something to be fearful of. Seeking reliable information and engaging in open discussions with an experienced cardiac surgeon can help alleviate concerns and improve treatment outcomes, allowing patients to regain an active and fulfilling life.