Cardiac Sciences

Coronary Bypass Surgery: Why It’s Done, How It Works, and What to Expect

admin Sep 20, 2024

Introduction

Coronary artery disease (CAD) is indicated as a global health concern with increasing morbidity and mortality. In this disease, the arteries of the heart restrict the blood flow to the heart. Symptoms include chest pain, palpitations, and shortness of breath, which can eventually result in heart attacks. Coronary bypass surgery is used to treat CAD to restore the blood flow to the heart and reduce the risk of adverse outcomes. Despite there being numerous developments in cardiac therapeutic interventions in the last three decades, coronary artery bypass graft (CABG) remains a sanctified therapy with evidence-based recommendations since it creates wonder not only by relieving symptoms but also by significantly decreasing mortality due to ischemic heart diseases.

Why is CABG done?

The purpose of CABG is to lower the risk of heart attack if an individual is suffering from CAD. In most cases, this surgery becomes the standard treatment for CAD, as the condition can progress silently, without noticeable symptoms, until significant artery blockage occurs, leading to serious health issues. Such blockages are the fat deposits that narrow the arterial walls, reducing the supply of oxygen-rich blood.

Another approach for treating blocked or narrowed arteries is bypassing the blockage by taking a new, healthy blood vessel from another part of your body and reconnecting it to bypass the blocked section of the coronary artery. Blood vessels used to bypass the blockage are called grafts, and they come from a vein in the leg, an artery in the chest, or even an artery from the wrist. This surgery is called coronary artery bypass surgery. Other than CAD, the doctor may use CABG for other heart diseases, such as angina.

CABG types

Single bypass surgery: It involves forming a new pathway using a single graft to bypass one blocked coronary artery, restoring blood flow to the heart muscle. This type of surgery is recommended for severe narrowing of a single artery to restore blood flow and enhance the overall function of the heart, preventing further damage.
Double bypass surgery (CABG x2): It involves forwarding circulation around two blocked coronary arteries. This method is recommended when multiple coronary arteries are diseased.
CABG x3 (Triple bypass surgery): Triple bypass surgery is performed when the heart is diagnosed with multiple blocked blood vessels. This kind of method entails rerouting blood circulation using other parts of body vessels to augment the blood flow to the heart muscle.
CABG x4 (Quadruple bypass surgery): Quadruple bypass surgery treats severe forms of CAD by constructing four bypass grafts, rerouting blood around multiple major blocks in the coronary arteries. This advanced procedure is employed to optimise myocardial revascularisation.

CABG procedure

An anaesthesiologist may insert a special line to monitor the patient’s blood pressure prior to the administration of general anaesthesia. Once the patient is sedated, a breathing tube is inserted, and a central line, along with a catheter, is placed to monitor heart and lung function. The surgical site is cleaned, a median sternotomy is performed to expose the heart, and the left internal mammary artery is harvested for bypass grafting. While this is going on, an assistant harvests a vein from one of the patient’s legs to use as another bypass graft.

Once the necessary blood vessels are ready, the surgeon gives the patient a blood thinner and connects the heart to a machine that takes over its pumping function. The heart is then temporarily stopped to allow the surgeon to attach the grafts to the blocked coronary arteries. After completing these connections, the heart is restarted, and the surgeon checks the grafts for good blood flow. Finally, the chest is closed with wires, and the patient is transferred to the intensive care unit for close monitoring and recovery.

What to expect after a coronary bypass surgery?

Recovery: The healing can take several weeks and may sometimes extend to several months. You’ll need to spend several days in the hospital after the surgery.
Rehabilitation: Cardiac rehabilitation comprises exercise, education, and counselling to recover from a cardiac condition and live a healthy life.
Medications: You may require taking medication for your entire life with the aim of avoiding the formation of blood clots and low-density lipoprotein cholesterol.
Lifestyle Changes: This includes having heart-friendly diets, exercising, and stress management, among others.

Conclusion

Coronary bypass surgery is a major interventional surgery, but it saves many lives, especially for people with severe coronary CAD. Nevertheless, if you are suffering from CAD symptoms, consult the doctor about the possible ways of treatment and whether bypass surgery can be helpful for you.

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