Cardiology

Coronary Artery Bypass Graft Treatment

Bypass Surgery

Coronary artery disease is a narrowing of the coronary arteries (blood vessels that supply the heart muscle with oxygen). It reduces the blood supply to the heart muscle, leading to angina and heart attacks.

What is Coronary Artery By-pass Grafting (CABG)?

Coronary Artery Bypass Graft surgery (CABG) is a kind of surgical procedure that is used to treat coronary artery disease (CAD). In CAD, a waxy substance known as plaque builds up 
inside the blood vessels that supplies oxygen and nutrients to the heart muscles which leads to narrowing of the coronary arteries. During this
procedure, the doctor surgically connects a healthy blood vessel from leg, arm or chest to the heart and creates a new pathway around the blocked or partially blocked 
artery to restore the blood flow.

What are the benefits of surgery?Page Image

The benefits of the coronary artery bypass surgery include:
• Reduces CHD symptoms.
• Improves pumping ability of the heart.
• Reduced risk of heart attack.
• Person is able to resume an active lifestyle.

What is coronary artery disease?

Coronary artery disease is the narrowing of the coronary arteries (blood vessels which supplies the heart muscle with oxygen). It reduces the blood supply to the heart muscle, 
which may lead to angina and heart attacks.

Causes of coronary artery disease
The most common cause of coronary artery disease is vascular injury with cholesterol plaque build-up in the arteries, also known as atherosclerosis. Reduced blood flow occurs when 
one or more than one of these arteries becomes partially or completely blocked.
The four primary coronary arteries which are located on the surface of the heart:
• Right main coronary artery.
• Left main coronary artery.
• Left circumflex artery.
• Left anterior descending artery.

These arteries bring oxygen as well as nutrient-rich blood to your heart. A heart is a muscle which is responsible for pumping blood throughout human body. According to the Cleveland 
Clinic, a healthy heart pumps approximately 3,000 gallons of blood through a body every day. Like any other organ or muscle, the heart must receive an adequate, dependable 
supply of blood in order to carry out its work. Reduced blood flow to the heart can cause symptoms of Coronary Artery Disease. Other rare causes of damage or blockage to a coronary 
artery also limits the blood flow to heart.

Who Needs Coronary Artery Bypass Grafting?

Coronary artery bypass grafting (CABG) is used to treat people who have severe coronary heart disease that could lead to a heart attack. CABG also may be used to treat people 
who have heart damage followed by a heart attack but still have blocked arteries. Your doctor may recommend CABG if other treatments, such as lifestyle change or medicine, aren't 
working. He or she may also recommend CABG if you have severe blockages in the large coronary arteries that supply a major part of the heart muscle with blood, especially, if 
your heart's pumping action has already been weakened. CABG may also be a treatment option if you have blockage in the heart that are not been be treated with angioplasty.

Your doctor will decide whether you should have CABG or not based on a number of factors, including:
• The presence and also severity of CHD symptoms.
• The severity and the location of blockages in the coronary arteries.
• Response to other treatments.
• Quality of life.
• Any other medical problems.
CABG may be done in an emergency case , such as during a heart attack.

What does the operation involve?

• The doctor will insert an intravenous (IV) line into the arm or hand. A device called, catheter, will be put in neck and the wrist to monitor the heart and blood pressure
• The anesthesiologist will continuously monitor the heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you are sedated (put into a deep sleep), 
a breathing tube will be inserted into throat and will be connected to a ventilator.
• The doctor will make a long incision in chest and divide the sternum (breastbone) in half, lengthwise to expose the heart.
• Once the chest is opened, the heart will be temporarily be stopped by the doctor and a heart-lung machine will be used to circulate blood in the body.
• The surgeon will then take a section of a healthy blood vessel from inside of chest wall (the internal mammary artery) or from lower leg, and will connect the ends around the 
blocked artery to divert the flow of blood.

What complications can happen?

Although complications from coronary artery bypass grafting (CABG) are uncommon, the risks may include:
• Wound infection.
• Bleeding
• Reaction to anesthesia.
• Fever.
• Pain.
• Stroke, heart attack, or even death.

A few patients develop a fever associated with chest pain, irritability, and decreased appetite. This is because of inflammation involving the lung and heart sac. This complication 
sometimes is seen from 1 to 6 weeks after surgeries that involve cutting through the outer covering of the heart. This reaction usually is very mild. However, some patients 
may even develop fluid build-up around the heart that requires treatment. Memory loss and other similar changes, such as problems while concentrating or thinking clearly, may occur 
in some people.These changes are more likely to occur in people who are older, or who have high blood pressure or lung disease, who drink excessive amount of alcohol. These side 
effects are often improved after several months of surgery. Use of a heart-lung bypass machine also increases the risk of blood clots forming in the blood vessels. Clots can travel 
to brain or other parts of body and may even block the flow of blood, which may cause a stroke or other issues. But Recent technical improvements in heart-lung bypass machines are 
helping to reduce the risk of blood clots forming.

Are there any alternatives to surgery?

For few people it is possible to have a percutaneous coronary intervention to widen or unblock an artery using a small inflatable balloon. Medication can also be used to 
relieve the symptoms of coronary artery disease.

How soon will I recover?

After the operation patient will be transferred to the cardiac intensive-care unit or high-dependency unit for a few days, and then to the ward. You should be able to go home within 
7 to 10 days. The healthcare team will tell you when the patient can return to normal activities. Regular exercises may help you to return to normal activities sooner. Most people 
make a good recovery, with relief from angina, but symptoms can sometimes show up.

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