This is an open-heart surgery used to treat coronary artery disease. We also call this CABG or Cabbage. CABG stands for Coronary Artery Bypass Graft. In bypass surgery.
- Coronary artery disease means fatty blockages within the coronary arteries. This prevents the flow of blood to cardiac muscles. The cardiac surgeon uses healthy pieces of blood vessels taken from the chest wall and the patient’s arm to redirect blood. These new blood vessels are called grafts. Sometimes the surgeon does this by attaching a graft above and below a blockage, creating a bridge over the blockage called Y technique
- Venous grafts mean veins are taken from the legs
- Arterial grafts mean arteries taken from the arm or chest wall ( LIMA, RIMA and Radial)
- overall Arterial grafts longevity is much better than venous grafts
- With an increasing incidence of diabetes, blood cholesterol and increasing longevity, many patients are presenting with multiple blockages as their first presentation.
- This group of patients do very well with Coronary artery bypass surgery.
- The total occlusion of a blood vessel for more than 3 months, long length of blockages, small calibre of vessels, calcium deposition within a blood vessel, these are all factors favouring Bypass surgery over the stent.
- Some patients do have problems in continuing blood thinners for a lifetime, this group of patients also do well with CABG.
- However, If a patient is having a major ongoing heart attack, the patient is at very high risk for the immediate surgery and emergency angioplasty is better option to stabilise the patient on that day and then take him for CABG after stabilising for a better outcome
- CABG is an open heart surgery done by a cardiac surgeon.
- Arteries supplying chest wall and arm are used as conduits and veins taken from the legs are used as conduits to bypass the blocks
- the patient stays in the hospital for an average of 7 days
- post bypass surgery, aggressive cardiac rehabilitation is advised to promote faster and complete recovery to normal
What is cardiac rehabilitation?
Cardiac rehabilitation (cardiac rehab) is a scheduled program to bring back the cardiac patient to his normal life after a major cardiac event.
It focuses on Exercise, diet, and control of risk factors.
Trained cardiac physiotherapist, cardiac nurse and dietitian help the patient, under the guidance of your cardiologist.
Exercise: Cardio exercise and breathing exercises are started monitoring heart rate and cardiac symptoms. These exercises are gradually escalated in a structured fashion. The patient is educated about warm-up, which exercises for how many minutes and stretching.
Diet: post Bypass, it is usual to have a decreased appetite. The program starts with encouragement to eat properly to a choice of proper foods to avoid weight loss and for muscle building
Fruits, vegetables, and foods with fibre are encouraged.
Psychological Counselling: Patients can have many unanswered queries about this major event in his life and our trained counsellor help patient to open up and relieve from the unnecessary anxiety and depression arising out of it.
Weight management :
for obese individual, calorie restriction aimed at reducing body weight and for a malnourished person, adequate calorie and protein intake are planned.
Smoking: it has to be stopped. Nicotine replacement, medicines and counselling is given for the help
When can I start Driving?
This depends on the severity of the heart attack you had. Ask your doctor and he will guide you further based on your Echo report and exercise capacity.
The patient should continue to follow up with a physician for control of diabetes, blood pressure and other risk factors.
After Bypass surgery, the patient can develop blocks again?
Yes, Getting bypass surgery does not change the underlying disease. Patients native ( his own ) blood vessel blockages can increase further but the patient does not develop any problem as these blocked blood vessels are already bypassed.
If Risk factors remain uncontrolled, or patient stops medicine, grafts ( newly put vessels) can also get blocked suddenly causing a heart attack
Can Bypass surgery patient undergo repeat bypass?
Yes, nowadays, with younger age patients developing coronary artery disease at an early age. They are operated in their fifties and after 10-15 years the grafts degenerates. At this time, the patient requires another procedure and either angioplasty or redo bypass can be done.
When Bypass surgery is advised to any patient, the Doctor has taken that decision to reduce chances of second heart attack with longer survival.
Many stable patients who are a candidate for bypass surgery, do not go for the surgery and continue for medical management. These patients are not going to have an immediate problem. They do have angina on exertion and they manage that with Sorbitrate. However, this does not remove the block and they are at risk for life-threatening heart attack.
What precaution I should take before bypass surgery?
We need to stop your blood thinner tablet a few days before the scheduled date of surgery. Your surgeon will guide you for this
We start lung exercise before the surgery to improve lung capacity
We admit patient one day before surgery for preoperative workup and then further instructions are based on the findings of those reports.
Does the surgeon remove my heart?
No, we do not remove the heart from the body. Many surgeries are done with beating heart.
For a few minutes when the heart is stopped to attach the grafts, the patient is kept on a heart-lung machine which does the job of heart for time being.
How long I will be in a hospital?
Most commonly patient stays in ICU for 2 days and then in the room for the next 3 to 5 days depending upon individual recovery pattern.
patient is encouraged…