Coronary Artery Bypass Grafting: Indications, Procedure, and Recovery

26 February,2024

CABG, or coronary artery bypass grafting, is one of the most widely performed open heart surgery. The recent data shows that over 4,00,000 CABG procedures are done yearly. If you are suffering from blocked arteries that cannot be managed through dietary changes, medications, and angioplasty, you might have been recommended heart bypass surgery. 

Robert Goetz performed the first heart bypass surgery in 1961. The procedure has seen significant improvements since then. Today, most cardiac surgeons opt for minimally invasive techniques rather than open heart surgery. It has the advantage of reducing the recovery time and the associated risks.

This blog aims to educate you on what CABG is, who requires it, what the procedure is, and recovery afterward. 

What is CABG?

Coronary artery bypass grafting or heart bypass is a type of cardiac surgery that helps improve the blood flow to the heart muscles. The surgery works by bypassing the blocked/clogged arteries. During CABG, the surgeon takes grafts from healthy blood vessels in the legs/forearm/chest. The graft helps in rerouting the blood flow by making a new pathway.

Depending on the number of blood vessels blocked, the surgeon will perform one of these procedure – 

• Single Bypass: For repair of a single blocked artery
• Double Bypass: To correct two blocked arteries
• Triple Bypass: Done when three arteries are blocked
• Quadruple Bypass: Repairing four blocked arteries

The risk of having severe cardiac issues such as heart failure and cardiac arrest depends on the number of arteries blocked. The time duration and complexity of the surgery also increase if there are multiple blocked arteries.

Who Performs Coronary Artery Bypass Grafting Surgery?

A cardiac surgeon specializing in vascular surgery performs CABG. It is a major procedure involving a team of skilled medical professionals. These include:

• Cardiac surgeon: A cardiothoracic and vascular surgeon is the leading person in CABG surgery. These surgeons are experts in performing various heart, lung, chest, and blood vessel procedures. 
• Anesthesiologist: An anesthesiologist is a physician who will administer drugs that will make you unconscious. They will explain the potential risks of anesthesia before the procedure. Anesthesiologists will also help in making the pain management plan once the surgery is complete. 
• Paramedical Staff: Operating room nurses and technical staff will assist the surgeon throughout the procedure. Intensive care and cardiac nurses will be assigned to you after the surgery. A rehabilitation team of physiotherapists, occupational therapists, dieticians, and counselors will help you during the recovery.

Who Requires Heart Bypass Surgery?

CABG is recommended for patients who have CAD (coronary artery disease). In CAD, the arteries carrying oxygenated blood to the heart muscles get blocked. Angioplasty and stenting are usually advised for treating narrowed arteries. However, if the patient is having multiple blockages, a heart bypass surgery is recommended.

A suitable candidate for CABG surgery is someone who has –

• Blockages in the left coronary artery
• Multiple narrowed coronary arteries
• Angina (chest pain) that is difficult to manage with medications
• Heart attack due to CAD
• Severe cardiac arrest that affects the pumping capacity of the heart

How is CABG Performed?

• Preparation: Before surgery, patients undergo a thorough evaluation, including medical history assessment, physical examination, and diagnostic tests such as electrocardiogram (ECG), echocardiogram, and coronary angiography. These tests help the medical team assess the extent of coronary artery disease and plan the surgical approach.
• Anesthesia: CABG surgery is performed under general anesthesia, ensuring that the patient remains unconscious and pain-free throughout the surgery.
• Incision: To access the heart, the cardiac surgeon makes an incision in the chest, typically along the sternum (breastbone). Sometimes, the surgeon may use minimally invasive techniques involving smaller incisions and specialized instruments.
• Harvesting Grafts: Healthy blood vessels, known as grafts, are harvested from other body parts, such as the leg (saphenous vein) or the chest wall (internal mammary artery). These grafts will be used to bypass the blocked or narrowed coronary arteries.
• Bypass Grafting: The surgeon attaches one end of the graft to the aorta (the main artery leaving the heart) and the other to the coronary artery beyond the blockage. This creates a detour or bypass route for blood flow, bypassing the obstructed segment of the coronary artery.
• Completion and Closure: Once the bypass grafts are in place, the chest incision is closed using staples or sutures. Chest tubes may be inserted to drain extra fluid and prevent complications like pneumothorax (collapsed lung).

Are There Any Risks Involved in Heart Bypass Surgery?

While CABG surgery is generally safe and effective, it carries inherent risks and potential complications, including:

• Bleeding: Excessive bleeding during or after surgery.
• Infection: Risk of surgical site infection or pneumonia.
• Stroke: Although rare, there is a slight risk of stroke during or after CABG surgery.
• Arrhythmias: Irregular heart rhythms may occur, requiring medical intervention.
• Graft Failure: In some cases, bypass grafts may become blocked or narrowed over time, necessitating additional treatment.

Pre-existing conditions like kidney disease, chronic obstructive pulmonary disease, diabetes, etc., increase the chances of complications.

What is the Recovery Process after CABG?

The recovery period following CABG surgery varies from patient to patient but typically involves the following stages:

• Hospital Stay: Patients generally remain hospitalized for 4 to 7 days following CABG surgery. The hospital stay depends on the procedure's complexity and the patient's overall health.
• Monitoring and Care: During the hospital stay, patients will be closely observed for signs of complications, and medications will be administered to prevent infection, manage pain, and minimize the risk of blood clots.
• Physical Therapy: Upon discharge, patients are encouraged to participate in cardiac rehabilitation programs to improve cardiovascular fitness, strength, and overall well-being. These programs include supervised exercise sessions, lifestyle counseling, and emotional support.
• Medication Management: Patients may be prescribed medications to manage blood pressure and cholesterol levels and to prevent blood clots. It's essential to adhere to the prescribed medication regimen and attend follow-up appointments with the healthcare provider.
• Lifestyle Modifications: Adopting a heart-healthy lifestyle is crucial for long-term recovery and preventing future cardiovascular events. It includes engaging in regular physical activity, quitting smoking, maintaining a balanced diet, and managing stress effectively.

To Conclude

Coronary Artery Bypass Grafting (CABG) surgery remains a mainstream treatment option for severe coronary artery disease. The surgery offers relief and an improved quality of life for lakhs of patients worldwide. While the procedure involves risks and challenges, advancements in surgical techniques and comprehensive perioperative care have significantly enhanced outcomes and reduced complications.