Coronary artery bypass graft surgery (CABG) is a procedure that helps to treat coronary artery disease. Coronary artery disease is narrowing of the coronary arteries, which are the blood vessel that supplies oxygen and nutrients to the heart's muscles. Coronary artery disease is caused due to the build-up of fatty material called plaque in the arteries walls, which limits the supply of oxygen-rich blood to the heart's muscles.
Blocked or narrowed arteries can be treated by bypassing a blocked portion of the coronary artery with a tiny piece of a healthy blood vessel from another part of the body. Grafts or blood vessels used for the bypass procedure could be pieces from a vein in the leg or an artery in the chest. An artery from the wrist can also be sued. One end of the graft is attached above the blockage, and the other is below the blockage. Blood will bypass the blockage by channelling the new graft to reach the heart muscle. This is called a coronary artery bypass graft.
Traditionally, in CABG treatment in Hebbal, Bangalore the doctor will make a large incision on the chest, temporarily stopping the heart's functioning. The doctor will cut the breastbone to open the chest lengthwise and spread it apart. Once the heart is exposed, doctors insert tubes into the heart so that blood can be pumped through the body via a heart-lung bypass machine. This is necessary to pump blood when the heart is stopped.
Although the traditional method is still done, less invasive measures have been developed to bypass blocked coronary arteries. Procedures in which the heart pump need not stop are called “off-pump” procedures. Other minimally invasive procedures like keyhole surgery and robotic procedures are also used.
Preparing for coronary artery bypass graft
Before a bypass, the doctor will discuss medical history and conduct required tests to ascertain your health. You will be asked to refrain from eating or drinking at least 8 hours before the procedure.
Procedure for coronary artery bypass graft
The procedure requires a stay in the hospital. Generally, the procedure is the same and varies in some cases. The standard practices are,
The patient will be asked to remove any jewellery or other metal objects that will interfere with the procedure.
Patients will be asked to change into the hospital gown and empty their bladder.
Patients will lie on their backs on an operating table.
The anesthesiologist will continuously monitor heart rate, breathing, oxygen levels and blood pressure during the surgery.
After the patient is sedated, a breathing tube will be inserted into the throat, and the patient will be connected to a ventilator to help to breathe during the surgery.
A nurse or doctor will insert an intravenous line in the arm or hand. Catheters will be put in the neck and wrist to monitor heart rate and blood pressure and take blood samples.
A catheter is inserted into the bladder to drain urine.
The part of the skin over the surgical area will be cleansed with an antiseptic solution.
Once everything is in place, the doctor will make an incision in either the legs or one of the wrists to access blood vessels for grafts. Once the vessels are removed, the doctor will close the incision.
The doctor will make an incision from below Adam’s apple to a little above the navel.
The doctor will also cut the sternum across the length in half. The doctor will then separate the halves of the breastbone and spread them to expose the heart.
Coronary artery bypass graft surgery-on-pump procedure
The doctor will temporarily stop the heart's functioning to sew the grafts to the small coronary arteries. Tubes will be inserted into the heart so that blood can be pumped through the body by a heart-lung bypass machine.
Once the blood has been diverted, the doctor will stop the heart by injecting a cold solution.
Once the heart stops, the doctor will conduct the bypass graft by sewing one end of the section of the vein over a tiny opening made in the aorta and the other on a tiny opening made in the coronary artery located below the blockage. Suppose the internal mammary artery inside the chest is used as a bypass graft. In that case, the lower end of the artery will be cut from inside the chest and sewn over the opening made in the coronary artery below the blockage.
If the patient has several blockages, more than one bypass graft will be done.
Once the bypass grafts are checked, the doctor will let blood circulation through the bypass machine back to the heart, and the tubes to the machine will be removed. The heart will start functioning; however, a minor electric shock may be needed to restart it.
Temporary wires may be attached to pace your heart. These could be connected to a pacemaker, and the heart will initially be paced during recovery.
Procedure for coronary artery bypass surgery (Off-Pump)
Once the doctor opens the chest, they will stabilise the area around the artery to be bypassed with a special tool or instrument.
The rest of the heart will continue to function as expected and pump blood to the rest of the body.
The heart-lung bypass machine and the person who manoeuvres it will be kept on standby just in case it is needed.
Doctors will conduct the bypass graft by sewing one end of the section of the vein over a tiny opening made in the aorta and the other over a tiny space created in the coronary artery just below the block.
More than one bypass graft may be done if there is more than one block and wherever it is located.
Before the chest is closed, the doctor will examine the grafts to ensure they function correctly.
Completion of procedure for both methods
The doctor will sew the sternum together with tiny wires ( similar to the ones that are used to repair a broken bone)
Doctors will insert tubes into the chest to drain blood and other fluids from the heart.
Doctors will sew the skin over the sternum back together.
The doctor will put a tube through the mouth or nose to the stomach to drain all fluids.
The doctor will then apply a sterile bandage or dressing.
Consult with a team of experts at Manipal Hospitals to get details of treatment.