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Heart Bypass Surgery – Best Explained by Dr. Sanjeev Malhotra of Max Hospital, Gurgaon
Coronary Artery Bypass (CABG) Surgery
More About Heart Bypass (CABG) Surgery
A coronary artery bypass grafting (CABG) is a surgical procedure used to treat coronary heart disease. It diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart. A coronary artery bypass graft involves taking a blood vessel from another part of the body – usually the chest, leg or arm – and attaching it to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft.
Indications for CABG (When is CABG required?)
Coronary artery bypass graft is generally required for patients with the following medical conditions:
- Severe coronary heart disease (CHD), also known as coronary artery disease
- Heart damage following a heart attack with blocked arteries
- Severe blockage in the large coronary arteries with a weak pumping heart
The following signs and symptoms can indicate a coronary artery disease that may require a CABG:
- Fatigue (severe tiredness)
- Chest pain
- Shortness of breath
- Abnormal heart rhythms
- Swelling in the hands and feet
- Angina: When the narrowing of the arteries becomes critical, patient can develop symptoms like chest pain or shortness of breath. This is called as angina.
- Heart Attack: It can be major or minor heart attack. At times the patient may suffer from a heart attack or myocardial infarction.
Diagnosis for CABG
Your doctor will whether you are the right candidate for CABG depending upon the following factors:
- Existence and severity of coronary heart disease
- Medical stage and location of blockages in your coronary arteries
- How you respond to other treatments
- The state of your health
- Other underlying medical conditions
Medical Tests for Detecting Heart Bypass Graft (CABG) Treatment
A general physical examination is done. Tests are performed to find out which arteries are clogged, how much they're clogged, and whether there's any heart damage. Usually, the following tests are advised:
- EKG (Electrocardiogram): This test is performed to detect and records the heart's electrical activity
- Stress Test: Various tests are performed while the heart is working hard due to physical exercises
- Echocardiography: The test provides information about the size and shape of the heart and how well the heart's chambers and valves are working using sound waves
- Coronary Angiography: This test helps the doctor find blockages that can cause a heart attack. It is done using dyes to study the flow of blood through the coronary arteries.
CABG Surgical Procedure
A coronary artery bypass graft involves taking a blood vessel from another part of the body – usually the chest, leg or arm – and attaching it to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft. The number of grafts needed depend on how severe the coronary heart disease is and how many of the coronary blood vessels are narrowed. A coronary artery bypass graft is carried out under general anaesthetic, which means you'll be unconscious during the operation. It usually takes between three and six hours.
Types of CABG
There are various types of CABG procedures. The traditional method is an open heart surgery and there is a non-traditional approach that is minimally invasive.
This is an open surgery done under general anesthesia and takes about 3 to 5 hours to perform. Hospital stay varies between 7 to 9 days. In the traditional method, the following steps are taken before, during and after the surgery.
- Patient is given general anesthesia
- An incision is made down the center of the chest to get to the heart
- Medicines are given to stop the heart as well as to protect it
- A heart-lung bypass helps blood filled with oxygen to flow throughout the body working as a replacement for the heart
- An artery or vein is taken from parts of the body (eg. chest or leg) to be used as a graft for the bypass
- After the grafting is done, blood flow to the heart is restored and the heart resumes its functions
- Patient is disconnected from the heart-lung bypass machine
- Tubes are inserted into the chest to drain fluid
- Wires are used to close the chest bone
- Stitches or staples are used to close the skin incision
Non-traditional Coronary Artery Bypass Grafting
Again, in non-traditional coronary artery bypass grafting, there are two types of procedures. (1) Off-Pump CABG (2) Minimally invasive CABG.
- Off-Pump CABG: Also known as beating heart bypass grafting, off-pump coronary artery bypass grafting is done without using a heart-lung bypass machine and performed while the heart is still beating. In this procedure, a mechanical device is used to steady the area of the heart where grafting is applied.
- Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Grafting: MIDCAB grafting can be of several types and differs significantly from traditional bypass surgery. As the name suggests, this is a less invasive procedure and only a small incision is made on the chest to get to the heart.
MIDCA is usually done when one or two coronary arteries need to be bypassed. A series of incisions that are usually 3 inches long are made between the ribs on the left side and often the left internal mammary artery is used for the graft. No heart-lung bypass machine is used during the procedure.
Port-access Coronary Artery Bypass: In this procedure, artery or vein grafts are used and procedure is performed through small incisions in the chest. The surgeon also uses a heart-lung bypass machine.
Robot-assisted technique: The latest in modern CABG technique, very small incisions are made and a video camera inserted inside the heart assists the surgeon to use remote-controlled instruments to perform the surgery. Sometimes a heart-lung bypass machine is used.
Some of the complications related to CABG includes:
- Wound infection
- Heart attack
Factors Affecting Cost of Treatment
The following factors will determine the average treatment cost of your coronary artery bypass grafting surgery:
- Choice of hospital and rooms
- Skill, experience and reputation of the surgeon
- Fees: Doctor, Surgeon, Anesthesiologist, physiotherapist, special nurses, dietician, etc.
- Whether it’s traditional bypass or minimally invasive (Minimally invasive cost more)
- Diagnostic procedure charges
- Cost of medications and doctor visits
- Length of stay in hospital
- Duration of monitoring in the ICU (especially applicable for open heart surgeries)