Coronary Artery Bypass Grafting
Overview
Coronary Artery Bypass Grafting(CABG) is a type of surgery that rearranges the blood flow to the heart. Cardiovascular surgeons use this technique to open partially or fully clogged coronary arteries (arteries that supply blood to the heart).
Coronary artery disease (CAD) occurs when a plaque (fat, blood clots and calcium deposits in blood vessels) develops in the coronary artery. When a plaque narrows down the coronary arteries, oxygen rich blood flow to the heart decreases. The condition is manifested by typical symptoms, such as chest pain (also called as angina) and shortness of breath.
In order to overcome the problem, the stenotic or clogged segment is bypassed using a healthy artery or vein, called graft. Surgeons can bypass more than one coronary artery during an operation.
CABG allows regression of symptoms by restoring oxygen-rich blood flow to the heart. Thus, severe heart failure, risk of future heart attack and other heart problems can be eliminated, while normal functioning of the heart is restored. However, grafting is not the only treatment option for coronary heart diseases. Other treatment options include lifestyle changes, medications, and percutaneous coronary intervention (PCI), also known as coronary angioplasty.If your major coronary arteries are severely clogged and pumping function of the heart is weak, CABG or PCI is one of the two treatment options.
Why is this procedure done?
Your doctor will determine if you need a coronary artery bypass graft to open the clogged coronary artery. In this end, the location and severity of the narrowing or occlusion, cardiac functions, the heart tissue, response to other treatments and active symptoms of the diseases will be evaluated in detail by various laboratory tests and imaging studies. You will have ECG and echocardiography and all results will be consulted with relevant specialists. The purpose of this comprehensive investigation is to determine if CABG is the best and the right choice for you.
Coronary artery bypass grafting is indicated when multiple vessels are clogged, one of the main coronary arteries is severely clogged, and the pumping function of heart is poor.The main purpose of the coronary artery bypass graft is to eliminate or bypass the clogged coronary artery(ies). Therefore, it will not help the irreversible heart problems caused by underlying heart disease or the occlusion.
Furthermore, recurrence of clogging is possible after CABG is performed to bypass the clogged coronary artery, if you do not follow certain lifestyle changes.Coronary artery bypass surgery aims to increase the quality of life by relieving the symptoms, normalize functioning of the heart and to reduce the risk of future heart disease and heart attack.
Types of Grafts
By examining all your vessels that may be a graft, the best type of graft for your condition is determined. These grafts may be an artery or a vein. While the most commonly used arterial graft is the internal thoracic artery or the internal mammary artery, the most commonly used venous graft is the saphenous vein in your leg.
Risks
As the case for all surgeries, there are some risks involved in coronary artery bypass grafting.Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.
Patient selection is important in coronary artery bypass grafting.
Some of the risks that can be faced in a Coronary Artery Bypass Grafting are listed below;
• Infection in the incision line
• Cardiac rhythm disorders
• Heart attack
• Memory problems
• Chest pain
• Shortness of breath
• Problems that involve lungs or kidneys
Our expert surgery team will employ all practices to minimize the risk of complications and our cardiovascular surgeons will preoperatively inform you about risks listed above and all other potential complications and will address all your concerns.
Preparation
The first phase of preoperative preparation is same in all Medicana Hospitals. Once your doctor determined that the most appropriate treatment option for your disease is coronary artery bypass surgery, your health status is checked to see if you may undergo a surgery. If necessary, you will be started on life style changes and diet to prepare you better for the surgery. At the same time, the concomitant diseases, which will increase the likelihood of complications in the surgery, are also treated.After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.
When these preparations are completed and you reach the pre-operative phase, the following procedures are performed.
• Review of health history
• A detailed physical examination
• Evaluation of cardiac functions and the heart structure with ECG, Echocardiography and coronary angiography and determination severity of occlusion and tissue damage.
• Necessary laboratory tests and radiology studies
• Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications
You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.
Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better. After coronary artery bypass grafting, it will take several weeks to recover.
Surgery and early postoperative period
Coronary Artery Bypass Surgery is an open heart surgery that is carried out under general anesthesia. Surgery takes about 4 to 6 hours.After general anesthesia is administered, the sternum, also known as the breastbone, is cut and the chest cavity is exposed. At this stage, your surgeon will continue the surgery with the "on-pump (beating heart)" or "off-pump (non-beating heart)" method according to the preoperative plan. For “on-pump” CABG, your heart is stopped and a device, called heart-lung machine, takes over breathing function of lungs and pumping function of the heart. In off-pump CABG, your heart continues beating throughout the surgery.
Subsequently, the surgeon takes an artery in the rib cage (internal mammary artery) or a vein from calf called saphenous vein and prepares the graft. The clogged coronary artery is bypassed by connecting one end of the graft before the stenotic or occluded segment and the other end after the stenotic segment.If your condition allow and your surgeon considers it appropriate, minimally invasive technique can be used. In this method, your rib cage is not completely opened. Instead, a small incision is made on the chest wall and the surgery is performed using video imaging methods.
You will be transferred to the intensive care unit for regular close monitoring, after the surgery is completed. During your stay in the intensive care unit, all your vital signs (heart rate, blood pressure, breath rate and other vital signs) will be closely monitored. At this stage, you will breathe through a tube that is placed in your throat.
When your follow-up in the intensive care unit is over, you will discharged to the patient room. After a few days of follow-up here, you will be discharged. Before you are discharged, your medications will be planned and prescribed and, suggestions will be made that you need to take into account after the surgery (time to start work, engage in daily life activities and do exercise and sex life etc).
You should see your surgeon for follow-up visits that are scheduled before you are discharged.If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.
Results
Results of surgery are usually perfect. Surgery regresses or completely eliminates angina symptoms in most patients. Although the symptoms can recur, many people stay asymptomatic for many years. Long-standing results depend on the use of medications as instructed by your doctor and carefully following the health lifestyle suggestions. Do not smoke or quit smoking, if you are a smoker, and you need to maintain optimal body weight and control your blood pressure, blood glucose and blood lipids well. You may also need to start a cardiac rehabilitation program based on your doctor’s directions. In this program, exercises will be planned that you need to do after CABG surgery.It is very important in terms of your health that you attend follow-up visits at pre-scheduled dates and you follow the suggestions made at each visit.
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