Coronary artery bypass surgery

Coronary artery bypass surgery also known as coronary artery bypass graft (CABG) surgery, is a surgical procedure used in coronary artery disease. During the procedure, blood is drawn from obstructed or clotted arteries in an alternative path, which helps to supply the heart with oxygen and to feed it.

CABG surgery - why is this operation done?

Like all organs, the heart needs a supply of blood. Blood is supplied via the right and left coronary arteries. Over time, these arteries are obstructing, and fat deposits, or plaques, accumulate in them. This process is called atherosclerosis, referred to as coronary artery disease. It develops with age, the risk of its development also increases with cigarette smoking, excess weight and fatty foods.

Coronary artery disease can cause angina, a chest pain that develops as a result of a lack of oxygen-saturated blood supply to the heart. Some angina is treated with medications, and in severe cases the heart bypass surgery is done to enhance heart nutrition. Another risk associated with this disease is accumulation of plaques and subsequent blood clot formation. A blood clot blocks the blood supply to the heart, causing a heart attack. The bypass surgery is recommended to prevent a heart attack.

Procedure

During the coronary artery bypass surgery a blood vessel is taken from another part of the body - mainly the chest, leg or shoulder - and sewn to the upper and lower part of the obstructed or blocked area of the coronary artery. A new blood vessel is called a graft. The number of grafts depends on the severity of coronary artery disease and the degree of obstruction of the blood vessels. The procedure is done under general anesthesia, the patient is asleep during the operation. Basically the coronary artery bypass surgery lasts 4-5 hours.

Recovery

After the coronary artery bypass surgery a patient needs to stay in the hospital for at least 7-10 days. The recovery period is individual. One day after returning home the patient can sit on a chair, walk after 3 days, and after 5-6 days climb the stairs. The patient will be able to return to a normal lifestyle meaning: work, drive a car and have sex, after 6 weeks. Most people recover completely within 12 weeks.

Coronary artery bypass surgery risks

Like all types of surgery, coronary artery bypass surgery carries a risk of complications. Their number is quite mild and curable; the complications include irregular heartbeat, wound infection, stroke and heart attack.

After surgery

After coronary artery bypass surgery, many people experience an improvement in symptoms, relieving chest pain and shortness of breath. The risk of developing a heart attack is also reducing. However, it is important to analyze that the bypass surgery is not a cure for coronary artery disease if you does not change your lifestyle, the grafted blood vessels will obstruct again and coronary artery disease will recur. In some cases it is necessary to repeat the bypass surgery, or to widen the grafted blood vessel through coronary angioplasty.

Is there an alternative?

The main alternative to the coronary artery bypass surgery is coronary angioplasty. This is a less invasive surgery in which the damaged area is repaired by stenting. Recovery after coronary angioplasty is faster than during coronary artery bypass surgery, but there is a high chance of repeating this procedure, it is not recommended in case of multiple obstruction of the coronary arteries.

Pre-hospital examination

Before the surgery you will be sent to a pre-hospital clinic where you will be examined. The clinic will conduct physical examination and ask you about your medical history. They will also conduct an X-ray, blood test and electrocardiogram. During an electrocardiogram, electrodes are attached to the hands, feet, and chest to record heart impulses.

While you are at the pre-hospital clinic, you will be asked if you:

are taking any medications
have ever had anesthesia before
are allergic

Smoking cessation is recommended because smoking increases the risk of developing a breast infection, hinders wound healing, and increases the risk of blood clots forming.

What happens before coronary artery bypass surgery?

Before you undergo the coronary artery bypass surgery, the surgeon will discuss with you all aspects of the procedure. This will allow you to ask questions and fully understand the process. You should not take food or drink for 6 hours before surgery as it is administered under general anesthesia. You may want to take a small amount of water 2 hours before the operation.

Process of the operation

Coronary artery bypass surgery usually lasts 3-6 hours. However, surgery may be prolonged, it depends on the number of blood vessels. The bypass grafts are harvested – frequent vessels are the internal thoracic arteries, radial arteries and saphenous veins.

The number of blood vessels depends on the coronary artery disease. Many people need grafting of 3-4 vessels. The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure.

One of the grafted blood vessels is always the left internal thoracic artery. Surgeons prefer it because unlike other blood vessels it does not obstruct from time to time. When all the blood vessels are ready for grafting, the surgeon will make an incision in the middle of the breast and split the breast bone in the middle, this way it will reach the heart.

During surgery, blood is connected to the mechanical heart apparatus. The heart then stops temporarily with the help of medication, after which the blood vessels begin to be grafted. After the graft is attached, the heart is restarted with the help of an electric shock. The patient’s sternum is fixed with metal threads, and finally the skin will be sutured.

Coronary artery bypass surgery - new surgical techniques

Off-pump coronary artery bypass (OPCAB) - many surgeons today perform off-pump coronary artery bypass surgery. This is one of the forms of conventional coronary artery bypass graft. During an ordinary bypass surgery an artificial heart apparatus is used to supply blood to the whole body bypassing the heart. During the off-pumped surgery this artificial heart apparatus is not used. New blood vessels are sewn to the heart during the heartbeat. According to the National Institute for Health and

Care Excellence (NICE), these procedures are just as successful as coronary artery bypass graft.

Advantages of the operation:

Less time is required than during coronary bypass grafting
It reduces the risk of bleeding during surgery
The risk of developing complications (e.g. stroke) is lower
The hospital stay is relatively short

The highly qualified team of New Hospitals Cardiology Department, using the latest equipment, ensures the diagnosis and treatment of a full range of heart diseases in accordance with modern standards.

To book a consultation contact us: 032 2 190 190