Coronary artery bypass grafting in India

Coronary artery bypass grafting (CABG) is a medical procedure which aims at improving the blood flow to the heart. This surgery is done to treat people who are suffering with serious coronary heart disease.

Coronary heart disease is a disease in which a plaque gets formed within the arteries and further affects the proper blood flow to the heart. The function of these arteries is to supply oxygen-rich blood to your heart.

Plaque is made up of fat, cholesterol, calcium, and other substances that are found in the blood. It can narrow or block the coronary arteries and reduce blood flow to the heart muscle. Angina, Shortness of Breath, and, in some cases, Heart Attack can also occur if the blockage is severe.

Coronary artery bypass grafting (CABG) is one treatment used for coronary heart disease. At the time of CABG, a healthy artery or vein from the body is grafted, or connected to the blocked coronary artery. The blocked portion of the coronary artery gets bypassed by the grafted vein or artery.

With the creation of a new path, oxygen-rich blood is routed around the blockage to the heart muscle. As many as four major blocked coronary arteries can be bypassed during one surgery.

Coronary heart disease isn't always treated with coronary artery bypass grafting (CABG). Many people who have coronary heart disease can be treated other ways, such as with lifestyle changes, medicines, and a procedure called angioplasty. At the time of angioplasty, a small mesh tube known as stent is placed in an artery to help keep it open.

Coronary artery bypass grafting (CABG) or angioplasty with stent placement can be some of the options if you have severe blockages in your large coronary arteries, especially if your heart's pumping action has already been weakened.

Coronary artery bypass grafting (CABG) can also be a better choice if there are blockages in the heart that can't be treated with angioplasty. In this situation, coronary artery bypass grafting (CABG) is considered more effective than other types of treatment.

One may need to go through the surgery again if grafted arteries or veins get blocked, or if new blockages start in arteries that were not blocked prior to the procedure. Making lifestyle changes and taking prescribed medicines as your doctor advises can reduce the chance of a graft becoming blocked.

Why might I need Coronary artery bypass grafting (CABG)?

Your doctor performs coronary artery bypass grafting (CABG) to treat a blockage or narrowing of one or more coronary arteries to restore the blood supply to your heart muscle.

Symptoms of coronary artery disease may include:

•    Chest pain
•    Fatigue (severe tiredness)
•    Palpitations
•    Abnormal heart rhythms
•    Shortness of breath
•    Swelling in the hands and feet
•    Indigestion

There are no early symptoms if coronary artery disease is not so severe, yet the disease will continue to progress until there’s enough artery blockage to cause symptoms and problems.

If the blood supply to your heart muscle continues to go down as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow cannot be restored to the specific area of the affected heart muscle, the tissue dies.

Types of Coronary artery bypass grafting (CABG)

Minimally invasive direct Coronary artery bypass grafting - In minimally invasive direct coronary artery bypass grafting (CABG), small incisions are made on the left side of the chest, between the ribs. This type of surgery is mainly performed to separate the blood vessels in the front of the heart. Minimally invasive direct coronary artery bypass grafting (CABG) initiates faster recovery, has fewer complications, and causes less pain following the surgery.

Traditional Coronary artery bypass grafting - In traditional coronary artery bypass grafting (CABG), the chest bone is opened to operate the heart. This surgery is often performed to bypass at least one major artery. Medicine is given to stop the heartbeat so that the doctor can operate on a still heart. The heart-lung bypass keeps on transporting the blood and oxygen throughout the body.

Off – Pump Coronary artery bypass grafting (CABG) - This type of Coronary artery bypass grafting (CABG) is similar to traditional CABG because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump Coronary artery bypass grafting (CABG) is sometimes called beating heart bypass grafting.

What risks will I face while undergoing the coronary artery bypass grafting procedure?

Some possible surgical risks for Coronary artery bypass grafting (CABG) include:

•    High fever
•    Infection
•    Bleeding or infection at the site of the incision
•    Reaction to the anesthesia
•    Blood loss
•    Developing a blood clot that could affect the lungs
•    A sudden heart attack or stroke
•    Death during the surgery
•    Abnormalities with heart rhythm called arrhythmia
•    Chronic pain in sternum or breastbone (wound site)
•    Pneumonia
•    Difficulty in breathing
•    Kidney failure
•    Impairment of cognitive functions
•    Pain in the chest and fever for up to six months

Before a Coronary artery bypass grafting (CABG)

Before performing the surgery some diagnostic test is carried out. These diagnostic tests give the complete picture of your heart.

Echocardiography- This test gives the moving image of your heart by producing sound waves. This test also shows the size and shape of your heart and checks if all the valves and chambers are working.

Electrocardiogram (EKG) - The electrical activity of the heart is, recorded via this test. This test also measures the heartbeat count of your heart.

Coronary angiogram- This test involves the use of dye to show the blood moving through your arteries.

Stress Test – A cardiac stress test is a cardiological test that determines the heart’s ability to respond to external stress in a controlled clinical environment. The stress response is often induced by intravenous pharmacological stimulation or by exercise.

What are the benefits of coronary artery bypass grafting (CABG)?

The benefits of coronary artery bypass grafting (CABG) are:

•    Relief from chest pain or angina.
•    The risk gets decreased about completely choking the coronary arteries, which decreases the risk of a heart attack.
•    Results of CABG last longer as surgical revascularization is long lasting than a stent procedure.

Are there any alternatives to coronary artery bypass grafting?

Alternatives to coronary artery bypass grafting include:

•    Medications that dilate your blood vessels to allow normal blood flow. The doctor may prescribe medications, such as beta-blockers, nitrates, calcium channel blockers, and lifestyle changes, such as to quit smoking, eating a more heart-healthy diet and exercising. These changes can surely ease your heart problems.
•    Balloon Angioplasty
•    Coronary Stenting
•    Laser Angioplasty

What time will it take to recover from coronary artery bypass grafting procedure?

The recovery period from coronary artery bypass grafting differentiates from patient to patient. It generally takes around 6 to 12 weeks. The healing of the breastbone alone takes 6 weeks.
 

Are the results of coronary artery bypass grafting permanent?

The results overall seem to be good in patients who have undergone the surgery, though if performed as an emergency surgery, the risk of complication increases. The results can also vary from patient to patient depending on each patient’s overall health condition. Your doctor may also recommend a cardiac rehab program that can act as a supplement to improve your overall health and well-being.

How will I get to know if the coronary artery bypass grafting procedure I went through is a success?

The imaging and x-ray tests taken during follow-up visits post the procedure, will clearly show whether the procedure has been a success and the blood flow to the heart has returned to normal. If not, further treatment may be required.

Recovery from Coronary Artery Bypass Grafting (CABG)

Patients are taken immediately to an intensive care unit after a coronary artery bypass grafting (CABG) and are kept their overnight for observation. You will then be required to stay in hospital for another 4-7 days as you recover from the procedure.

In most of the cases, a ventilation machine will be used to help with breathing for the first few hours, which is generally passed down the throat. Once you are fully over the effects of the anesthesia and can begin to breathe by yourself to some extent, the machine can be adjusted accordingly. The breathing tube is only taken off when you are fully capable of breathing yourself.

It is vital that you frequently cough and take deep breathes in the days following a coronary artery bypass graft. However this may seem peculiar and can cause some discomfort but it prevents the growth of mucus in the lungs and further lowers the risk of pneumonia developing.

The area where the incision was made around the chest might also cause some discomfort for days and weeks after the surgery. Pain can be reduced by taking medication, but it is vital that any painkillers you take are recommended by your cardiologist this is because traditional painkillers like aspirin and ibuprofen can increase the chance of a bleed occurring. In order to control the level of bleeding and keep your blood pressure stable, drips will be used in the days immediately after the surgery.

Once you have been cleared to leave the hospital, your recovery will continue at home. Infection is a greater risk that usually happens with open heart surgery and it is therefore important that you keep the incision area clean and dry. Any pain, swelling or abnormal color around the incision site should be checked as soon as possible.

Which are the best hospitals for Coronary Artery Bypass Grafting (CABG) in India?

Some of the best hospitals for Coronary Artery Bypass Grafting (CABG) in India are:

•    Fortis Escorts Hospital, New Delhi
•    Asian Heart Institute, Mumbai
•    Apollo Hospital, Chennai
•    Fortis Escorts Hospital, Bangalore
•    Artemis Hospital, Gurgaon
•    Medanta – the Medicity, Gurgaon
•    Max Super Specialty Hospital, Delhi
•    Fortis Memorial Research Institute, Gurgaon
•    Indraprastha Apollo Hospital, New Delhi
•    BLK Super Specialty Hospital, New Delhi
•    Global Hospital, Chennai
•    Sharda Hospital, Delhi
•    Paras Hospital, Gurgaon
•    Nanavati Hospital, Mumbai
•    Manipal Hospital, Bangalore
•    Narayana Hospital, Bangalore
•    Continental Institute of Cardiovascular Sciences, Hyderabad

What is the cost of coronary artery bypass grafting (CABG) in India? 

The cost of coronary artery bypass grafting (CABG) in India is very less as compared to rest of the countries. Cost of coronary artery bypass grafting (CABG) in India will be near to about Rs. 3 Lakhs to Rs. 5 Lakhs.

What is the cost comparison of coronary artery bypass grafting (CABG) in India to other countries?

•    Cost of coronary artery bypass grafting (CABG) in India will be around Rs. 4 Lakhs ($6,000).
•    Cost of coronary artery bypass grafting (CABG) in Turkey will be around Rs. 6 Lakhs ($8,000).
•    Cost of coronary artery bypass grafting (CABG) in Mexico will be around Rs. 10 Lakhs ($14,000).
•    Cost of coronary artery bypass grafting (CABG) in Thailand will be around Rs. 13 Lakhs ($19,000).
•    Cost of coronary artery bypass grafting (CABG) in Poland will be around Rs. 15 Lakhs ($22,000).
•    Cost of coronary artery bypass grafting (CABG) in Spain will be around Rs. 17 Lakhs ($24,000).
•    Cost of coronary artery bypass grafting (CABG) in UK will be around Rs. Rs. 20 Lakhs ($28,000).
•    Cost of coronary artery bypass grafting (CABG) in Australia will be around Rs. 22 Lakhs ($32,000).
•    Cost of coronary artery bypass grafting (CABG) in USA will be around Rs. 60 Lakhs ($90,000).