“All you need to know about CABG”
— Get Well in India
Coronary artery bypass grafting (CABG) is a surgical procedure to improve blood flow to the heart and treat coronary artery disease (CAD).
The chances of heart diseases pertaining to the coronary arteries increase with age and with smoking, obesity and oily and high fat food intake.
Food rich in saturated fats and trans fats leads to Cholesterol deposits called plaque to form inside the coronary arteries. As time passes, the plaque becomes harder or even break free. The deposits narrow the coronary arteries and this decreases the flow of oxygenated blood to the heart. The reduced oxygenated blood flow can cause pain or discomfort in the chest area. This is called angina. The plaque can also form blood clots which obstruct the flow of blood flow through coronary blood vessels. This obstruction can cause what is called a `heart attack’.
It is in such cases that the artery bypass grafting procedure is performed. A healthy artery or vein from another part of the body is removed and attached to the blocked coronary artery. This artery or vein creates an alternate path for blood to flow to the heart muscle.
In other words, the CABG procedures basically vastly improves flow of blood and oxygen to the heart. In doing so, it relieves chest discomfort or angina and this enables the patients to lead the normal and active lifestyle.
While CABG procedures are normally successful and help patients live a normal life, it is possible that the patients may develop blockages again and therefore may require to undergo the CABG procedure again. Lifestyle changes and medicines can help prevent recurrence of blockages in arteries.
CABG or for Coronary Artery Bypass Grafting is also known as
- Coronary artery bypass surgery
- Heart bypass surgery
Dr. Devi Shetty
Dr. Anvay Mulay
The following symptoms indicate that a person may need to undergo the Coronary artery bypass grafting (CABG) :
- Chest pain
- Heaviness in arms
- Shortness of breath
- Swelling in hands and feet
- Abnormal heart rhythms
- Heart attack
If a disease related to the coronary arteries is suspected, then a detailed investigation is required to be done. Tests can include:
Blood tests to check the levels of electrolytes, blood cells, clotting factors and hormones in the blood and presence of specific enzymes and proteins.
Electrocardiogram (ECG): It records the electrical activity of the heart when at rest. This shows changes that indicate the heart muscle is not receiving enough oxygen. Electrical activity of the heart will be recorded using electrodes placed on the arms, legs and chest.
Exercise ECG/ Exercise Tolerance Test (ETT): It is meant to evaluate the heart’s response to exercise and stress. It includes walking on an exercise treadmill or riding an exercise bike for a few minutes. Continuous ECG and blood pressure and symptoms of coronary artery disease such as shortness of breath, and pain in the chest, jaw or arm are noted.
Echocardiography: It uses ultrasound waves to capture movements of the heart as it beats. It measure the dimensions of the heart, view the structures of the heart and assess damage to heart muscle.
Stress Echocardiography: This test involves inserting medications into the bloodstream through a drip while the echocardiogram is being performed. These medications stimulate the heart and mimic the effect of exercise.
Angiogram: This is a diagnostic test. It involves inserting a catheter into an artery in the wrist or groin. The catheter is threaded up through the artery, into the aorta and is positioned at the entrance to the coronary arteries. An x-ray dye containing iodine is injected through the catheter. The dye is able to be seen on an x-ray screen and produces an outline of any narrowing or blockages in the arteries. Heart function and efficiency can also be assessed during this test.
CT Angiography: It is also called as computerised x-ray technology. It uses several cross sectional x-ray images to create three-dimensional images of the heart. A contrast dye is injected through a vein in the arm and x-rays are taken. The three-dimensional images can indicate narrowings, fat deposits and calcium in arteries.
Nuclear Isotope Imaging: This involves injection of a radioactive compound called a tracer into the bloodstream. Computer generated pictures of the tracer are then taken as it moves through the heart. These pictures are used to assess the heart’s functioning and to identify narrowed or blocked blood vessels.
Stages & Treatment Details
There are two kinds of Heart Bypass Surgery:
- On Pump Procedure: This is the traditional or conventional procedure which is performed while the heart is stopped. A cardiopulmonary bypass machine or the heart-lung machine or the pump is used to provide blood supply to the rest of the body when the heart is stopped. Pipes (cannulas) are placed in the heart to drain impure blood. The pump purifies the blood and sends it back to the heart. The bypass grafts are then placed and the heart is restarted. When it resumes adequate function, the pipes are withdrawn and the cardiopulmonary bypass machine is disconnected.
- Off Pump Procedure: This is an advanced and modern method of performing the CABG procedure. It is also called Minimally invasive heart surgery. It is performed with the heart beating and without the use of the heart-lung machine. No pipes are placed in the heart. Grafts are attached to the heart while it is constantly moving and filled with blood. Special devices mechanically stabilize the relevant part of the heart so that the suturing can be performed. This is a highly specialized procedure and has benefits such as a lower risk of stroke, neurocognitive dysfunction, organ dysfunction, and atrial fibrillation.
The patient needs to spend couple of days in an intensive care unit after the CABG procedure. Medicines will be given to you to control blood circulation and blood pressure. After you are discharged, you will have to take special care as full recovery takes 6 to 12 weeks. You should not have any sexual activity for minimum 4 weeks. You can start driving after 3 to 8 weeks and resume office after six weeks.
Avoid heavy lifting and extremes of shoulder movement (eg, as in tennis, baseball, and golf) for six to eight weeks after surgery to allow for complete healing of the breast bone (sternum).
Exercise has consistently been shown to improve cardiovascular health. The intensity and duration of exercise should be adjusted according to the severity of a person’s heart disease.
Watch and distinguish incisional discomfort from chest pain (angina) you may have experienced prior to surgery. Contact your physician if you are experiencing chest pain.
If your chest or leg incisions do not appear to be healing, notify your physician.
You will need to visit your doctor for regular checkups and undergo tests such as KG (electrocardiogram), stress testing, echocardiography, and cardiac CT.
Lifestyle changes may be recommended such as in diet, quitting smoking, regular exercise and managing stress, education on heart healthy living.
Medicines may be needed to be continued to manage pain during recovery and to lower cholesterol and blood pressure and to prevent blood clots.
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