Coronary Artery Bypass Grafting: Purpose, Procedure, Benefits and Side Effects

It is a surgical procedure used for treating coronary artery disease (CAD). In this procedure, a healthy vessel from another part of the body, for example as of the leg or arm, is grafted onto the blocked coronary arteries. This helps restore blood flow to your heart.

• Off-Pump Coronary Artery Bypass (OPCAB): This type of surgery does not require a heart-lung machine, and is also sometimes referred to as 'beating heart bypass surgery'. It is less invasive than traditional CABG, and there may be fewer risks associated with it.
• Traditional Coronary Artery Bypass Grafting (CABG): This type of surgery requires the use of a heart-lung machine, which takes over the work of the heart and lungs while the surgeon operates on them. In this process, arteries or veins of other areas are used to bypass narrowed or blocked coronary arteries.
• Robotic-Assisted Coronary Artery Bypass Grafting (RACAB): This procedure uses a robotic device to assist in performing the same procedure as traditional CABG but on smaller vessels that are more difficult to access. The robot is able to perform complex manoeuvres that may be difficult for traditional CABG surgeons to accomplish due to its advanced technology and controls.
• Minimally Invasive Direct Coronary Artery Bypass (MIDCAB): During this type of CABG surgery, a few small incisions are made in the chest area which allows access to certain major blood vessels connected with coronary arteries that can be bypassed in order to improve blood flow around blocked vessels or narrowed passages in the artery wall.

• Improved blood flow: CABG redirects blood from one or more blocked arteries around the blocked part, allowing more blood to reach the heart muscle. As a result, your chest pain (angina) may decrease or even go away after the procedure.
• Lower risk of future cardiac events: About 85% of patients will show an improvement in their angina symptoms and over half will no longer need medications that are prescribed for angina. CABG also lowers your chance for future heart attacks, strokes, and even death due to coronary artery disease.
• Reduced risk for cardiac congestive failure: If a narrowed or blocked coronary artery prevents enough oxygen-rich blood from reaching your heart muscle, it can cause congestive failure, which can be life-threatening and require medications such as diuretics and/or drugs to reduce fluid retention in your lungs and lower pressure on your heart muscle wall so it can contract properly again and improve symptoms.

• It is a type of surgery used to improve the blood flow towards the heart.
• It is commonly done if one or more of the coronary arteries supplying oxygen-rich blood to the heart muscle are narrowed or blocked because of the occurrence of atherosclerosis which is a type of hardening and narrowing of the arteries.
• CABG can help improve symptoms such as chest pain, shortness of breath, fatigue, and palpitations due to lack of oxygen-rich blood flow to the heart muscles and can also help reduce risk for future heart attack or stroke.
• It is usually done by creating a bypass with a healthy artery or vein from another part of the body, usually from the chest wall or leg, which is then connected directly to one of the coronary arteries beyond the blockage in order to provide an improved route for oxygen-rich blood flow.

The main risks associated with Coronary Artery Bypass Grafting include:-

• You should inform your healthcare provider regarding all the medications you are taking, including any OTC medications or other supplements too.
• Don't smoke and also avoid drinking alcohol for a minimum of two weeks before your surgery.
• Eat a healthy diet and exercise regularly in the weeks leading up to your surgery.
• Before the CABG surgery make sure to have a complete physical examination of the body.
• Have any necessary dental work done prior to your procedure, as it can increase the risk of infection during and after CABG surgery.
• Make sure you have a ride home from the hospital after your procedure and make arrangements for a caregiver if needed for assistance once you return home from the hospital.

Coronary artery involves taking a healthy blood vessel from another part of the body, usually from the chest, leg, or arm, and using it to create a new path for blood to flow around the blocked or narrowed section of the coronary artery.

• It's important to note that CABG is a complex procedure and is typically only done when other treatments, such as medication or lifestyle changes, haven't worked.
• If you or someone you know needs CABG, it's important to discuss the procedure with a doctor and ask any questions you may have.

• Schedule pre-operative tests such as blood tests to assess liver or kidney function, an electrocardiogram, chest X-ray and a stress test.
• Stop having alcohol or smoke before the surgery.
• As some medicines may interfere with the procedure or increase bleeding risk including blood thinners and NSAIDS therefore make sure to ask your doctor regarding usage of medicines.
• Fast 8 hours prior to the surgery and have someone available to drive you home afterward as anaesthesia will be used during the procedure
• Keep family updated on your progress before the surgery so they can be with you during recovery if needed

• The surgeon assesses the extent and location of blockages, checks the vessels in the leg, and measures your body’s oxygen level.
• The surgeon then marks your chest and bypasses the artery area with ink to clearly identify which vessel will be grafted.
• An IV (intravenous) line is placed for electrolytes, drugs, fluids, nutrition or blood transfusions if necessary.
• An incision is made in the chest wall and a portion of ribs may be moved aside temporarily to gain access to the heart muscle.
• A heart-lung bypass machine is attached to clean the patient's blood while they are on bypass (this circulatory procedure can last from two-four hours).
• Once all grafts have been connected, the patient is taken off bypass and all connections are checked by a final pressure test before closure of incision
• After closure of incision chest tubes placed near the site of surgery drain excess fluid or air from within chest cavity post process
• Last but not least ECG monitoring during Surgery helps in assessing cardiac health during Surgery based on monitored output like Heart rate fluctuations etc

• Close the chest incision with sutures or staples.
• Remove the bypass graft and its tubes from the chest.
• If needed, reapply antibiotics to prevent infection around the surgical area.
• Place dressings over the incision site to protect it while healing and stem any bleeding that still may occur.
• Check that vital signs are stable before releasing the patient from recovery into their room or home if possible depending on state guidelines surrounding COVID-19 pandemic restrictions
• Monitor the patient's recovery progress during regular follow-up visits with their surgeon, cardiologist, and primary care doctor as necessary for a successful postoperative healing process

Generally, the average cost of CABG in India ranges from Rupees 1.25 Lacs to 2.25 Lacs ($1700-3100).

• Eat a balanced diet that is low in fat and cholesterol to promote healing, lower cholesterol levels, and reduce strain on the heart.
• Choose lean cuts of meat, such as skinless chicken or turkey, fish, and beans as sources of protein.
• Eat plenty of fruits and vegetables for essential vitamins and minerals, as well as fibre for digestive health.
• Increase intake of whole grains for added fibre and B vitamins for energy production.
• Include dairy products in your diet for calcium and other nutrients that are important for healing and overall health.
• Drink plenty of water to stay hydrated and help flush toxins from the body.

Yes, coronary artery bypass grafting (CABG) is generally considered safe. Although there is a risk of complications associated with any type of surgery, the risks associated with CABG are low. Overall, about 95 percent of patients who undergo the procedure have successful outcomes without serious medical issues.

Yes, coronary artery bypass grafting (CABG) is a major surgery and can be painful. CABG involves accessing the heart through an incision in the chest, which is a source of pain and discomfort.Patients typically receive general anaesthesia during the procedure, which helps to reduce most of the pain associated with CABG.

• Recovery from Coronary Artery Bypass Grafting (CABG) usually takes 4-6 weeks.
• During this time, patients will be monitored closely by medical staff.
• Patients are usually able to return home in 2-4 days after the procedure and will be given specific instructions for how to manage their recovery.
• Generally, people should avoid strenuous activity and heavy lifting for a period of four to six weeks.

• Common CABG side effects may include:-
• Wound infection or bleeding at the surgical site
• Heart arrhythmias
• Pneumonia or other respiratory problems
• Breathing difficulty due to pain medication, such as morphine
• Temporary disruptions in the normal electrical signals of the heart, which can cause dizziness and fainting of water
• Abnormal clot formation in blood vessels or veins, which can lead to stroke or heart attack in rare cases.
• Numbness or pain around the incision site that usually diminishes over time.

• Get plenty of rest: Patients should get at least 8 hours of sleep during their first night following CABG surgery, and should take short naps during the day when they can.
• Walk frequently: Gradually increase walking several times a day, starting with a few minutes at a time until they are able to walk longer distances comfortably.
• Avoid lifting heavy objects: It is important for patients to avoid lifting heavy objects or engaging in strenuous activity for at least two months following CABG surgery, as this may increase the risk of dying from a heart attack or other cardiac event.
• Eat healthy foods: Eating nutritious foods with low levels of salt, sugar and fat can help keep the heart healthy and reduce long-term risks after CABG surgery.
• Attend all follow-up appointments: Patients must attend all follow-up appointments with their health care team in order to monitor changes in their condition and consider any necessary lifestyle changes or additional treatments if required by their doctors following CABG surgery.

The CABG procedure is a life-saving procedure. It can provide relief from chest pain and reduce the risk of heart attack and death from CAD. However, the long-term success of CABG depends on many factors such as age, presence of other medical conditions, lifestyle changes after surgery, etc. People should discuss their options with their doctor to find the best treatment option for them.