By Dr. Sanjay Kumar in CTVS at Paras Hospital Gurgaon, Paras Hospitals East & Patna.
Coronary Artery Bypass Grafting (CABG) Surgery
Coronary Artery Bypass Grafting (CABG) is a surgical procedure designed to restore normal blood flow to the heart in individuals with coronary artery disease (CAD). CAD occurs when the coronary arteries become narrowed or blocked, reducing the supply of oxygen and essential nutrients to the heart muscle.
Understanding the Procedure
CABG involves rerouting blood flow using a healthy blood vessel, known as a graft, to bypass the blocked or narrowed artery. These grafts are typically taken from:
- A vein from the leg
- An artery from the wrist
- An artery from the chest
Surgeons perform CABG by making an incision in the chest and opening the sternum (breastbone) to gain direct access to the heart. Over time, advancements in surgical techniques have enhanced the precision, safety, and success rates of this life-saving procedure. Commonly referred to as “cabbage,” CABG remains one of the most effective treatments for severe coronary artery disease.
Why is CABG Surgery Performed?
CABG surgery is recommended for patients with Coronary Artery Disease (CAD), a condition where narrowed or blocked coronary arteries restrict blood flow to the heart. This can lead to serious complications, including heart attacks.
Common Symptoms of CAD:
Patients requiring CABG may experience:
- Chest pain (angina) – A pressure or squeezing sensation in the chest
- Fatigue – Persistent tiredness and lack of energy
- Palpitations – Irregular or rapid heartbeat
- Abnormal heart rhythms (arrhythmias) – Irregular electrical activity in the heart
- Shortness of breath – Difficulty in breathing, especially during exertion
- Swelling in the hands and feet – A sign of poor circulation and fluid retention
CABG helps restore proper blood flow, relieving symptoms and significantly improving heart function and overall quality of life.
How is CABG Surgery Performed?
Coronary Artery Bypass Graft (CABG) surgery is a procedure that involves using a graft (a healthy blood vessel taken from another part of the body) to create a new pathway for blood to flow around a blocked or narrowed coronary artery.
Procedure Steps:
- Administering Anesthesia: The patient is given general anesthesia to ensure they remain unconscious and pain-free throughout the procedure.
- Identifying & Harvesting the Graft: Surgeons take a healthy blood vessel from the leg (saphenous vein), arm (radial artery), or chest (internal mammary artery).
- Making the Incision: A sternotomy (chest incision) is performed to access the heart.
- Connecting the Graft: The harvested blood vessel is attached above and below the blockage in the coronary artery to create a new blood flow route.
- Heart-Lung Machine (if used): In traditional CABG, a heart-lung bypass machine takes over heart function while surgeons perform the grafting. Off-pump CABG is done without this machine.
- Closing the Chest: The sternum is secured using wires, and the incision is closed with sutures.
Surgery Duration:
- The procedure typically lasts between 3 to 6 hours, depending on the number of bypass grafts required.
- Recovery time varies, but most patients stay in the hospital for about 5-7 days post-surgery.
CABG is a life-saving surgery that significantly improves heart function and reduces the risk of severe complications from coronary artery disease (CAD).
Risks Associated with CABG Surgery
While Coronary Artery Bypass Graft (CABG) surgery is a life-saving procedure, it comes with potential risks, including:
- Irregular heartbeat (Arrhythmia) – Temporary or permanent changes in heart rhythm
- Wound infection – More common in diabetic or immunocompromised patients
- Stroke – A possible risk due to changes in blood flow during surgery
- Heart attack – Although rare, there is a risk of cardiac complications during or after surgery
How to Prepare for CABG Surgery
Proper preparation before CABG surgery can help reduce risks and aid in a smoother recovery. Patients are advised to:
- Undergo Pre-Surgical Health Checks
- Screen for underlying medical conditions, such as dental infections, which may cause complications.
- Manage Diabetes and Personal Hygiene
- Diabetic patients should ensure blood sugar control and trim their nails to prevent infections.
- Plan for Post-Surgery Recovery
- Arrange for a caretaker or family spokesperson to assist at home after surgery.
- Quit Smoking Completely
- Smoking cessation is crucial as it reduces surgical complications and improves healing.
- Maintain a Healthy Lifestyle
- Eat a nutritious, balanced diet to strengthen the body before surgery.
- Avoid stress triggers and engage in gentle physical activity if permitted.
- Practice Stress Management Techniques
- Engage in meditation, deep breathing exercises, and listening to calming music to reduce anxiety before surgery.
Following these steps ensures a smoother surgical experience and enhances recovery after CABG.
What to Expect Before, During, and After CABG Surgery
Before the Surgery
To ensure a smooth Coronary Artery Bypass Graft (CABG) procedure, patients must follow these pre-surgery guidelines:
- Fasting Instructions: Follow the surgeon’s advice regarding food and water restrictions before surgery.
- Full-Body Shower: Take a thorough shower the day before surgery to minimize infection risks. In some cases, the medical team may assist.
- Rest Well: A good night’s sleep is essential. If necessary, the doctor may prescribe sleep aids to help with relaxation.
During the Procedure
Depending on the severity of the condition, the surgeon may opt for different types of CABG procedures:
- Minimally Invasive Heart Bypass Surgery (MICAS)
- A small incision is made in the chest, and a graft (usually taken from the leg) is harvested using an endoscope.
- The graft is then placed above and below the blocked artery, restoring blood flow.
- Off-Pump Heart Bypass Surgery (Beating Heart Bypass Surgery)
- Unlike traditional CABG, this procedure is done without using a heart-lung machine.
- The surgeon operates on the heart while it is still beating, using stabilizing tools.
- Robotic Heart Surgery
- Uses a robotic arm controlled by a surgeon to perform the surgery with smaller incisions.
- This technique reduces scarring, recovery time, and post-operative complications.
After the Procedure
- Immediate Recovery: Patients are moved to a recovery unit for monitoring.
- Minimally Invasive CABG: Discharge within 1-2 days, followed by at-home recovery.
- Traditional CABG: A Longer hospital stay may be required, depending on the patient’s health.
Can CABG Be Combined with Stents?
Yes! Hybrid suites now allow for simultaneous or staged CABG and stent procedures, offering more flexibility in treatment.
Over time, medical advancements have made CABG surgery safer, less invasive, and more effective. Ongoing research continues to improve surgical outcomes, making heart surgery even lower risk and more accessible in the future.
Final Thoughts
Coronary Artery Bypass Graft (CABG) surgery remains one of the most effective interventions for managing coronary artery disease (CAD). Many patients experience significant relief from symptoms and improved heart function for over a decade following the procedure. However, long-term success largely depends on lifestyle modifications and adherence to medical recommendations.
To maintain heart health and prevent future complications, patients are advised to:
- Follow a balanced, heart-healthy diet
- Quit smoking to reduce the risk of further arterial blockages
- Engage in regular physical activity as per medical guidance
- Manage stress through appropriate relaxation techniques
By adopting these changes, patients can enhance their recovery, improve overall well-being, and sustain long-term cardiac health. Consulting a cardiologist for regular follow-ups and monitoring is essential for optimal post-surgical care.