Coronary artery bypass graft (CABG) surgery involves opening the chest and temporarily directing the blood through a heart-lung machine, which takes care of circulation while the heart is cooled, stopped, and repaired. Blockages in the coronary arteries are bypassed by harvesting a blood vessel from elsewhere in the body (sometimes one of the internal mammary arteries from inside the chest wall, sometimes a large, superficial vein in the leg, and sometimes both) and sewing it onto the coronary artery so as to reroute the blood flow around the blockage. Once the repair is complete, the heart is warmed and restarted, and the chest is closed.
No matter how routine's procedure sounds, it is still a major medical event. Despite superb success rates for patients, nearly everyone approaches the event differently. Whether patients admit their concerns before the operation or not, it is not uncommon for them to become uncharacteristically nostalgic, review their wills, or write soul-baring messages to their loved ones.
Fortunately, most professionals who care for bypass patients are sensitive to the patients' concerns and go out of their way to make the immediate and postoperative experience as easy as possible. Before surgery, most hospitals have orientation and education programs designed to put patients at ease.
How coronary artery bypass surgery is done?
The cardiac surgeon makes an incision down the middle of the chest and then saws through the breastbone (sternum). This procedure is called a median (middle) sternotomy (cutting of the sternum). Freezed salt water is used for cooling of heart and a preservative chemical is putted inside the heart through arteries. This process minimizes damage caused by reduced blood flow during surgery and is referred to as "cardioplegia." Before bypass surgery can take place, a cardiopulmonary bypass must be established.
To flow out the blood through the body, plastic tubes are placed inside the atrium with the help of plastic sheeting (membrane oxygenator) inside the heart-lung machine. The oxygenated blood is then returned to the body. The main artery of the body is crossly lamped during CABG surgery so that a bloodless field could be maintained for the allowance of bypasses for the connection of aorta.
How patients recover after coronary artery bypass surgery?
Sutures are removed from the chest prior to discharge and from the leg after 7 to 10 days. Instead, mini veins will work as saphenous veins small degree of swelling can be felt in that very area. Patients are advised to wear elastic support stockings during the day for the first four to six weeks after surgery and to keep their leg elevated when sitting.
Around six to eight weeks are taken for the diffusion of the swelling. Healing of the breastbone takes about six weeks and is the primary limitation in recovering from CABG surgery. An advice is given to patient for not lifting more than weight of 10 pounds or doing any heavy activity. It is also prescribed to them for neglecting any driving activities for the first four weeks to dismantle any injury that is likely to cause to the chest.
Patients can return to normal sexual activity as long as they minimize positions that put significant weight on the chest or upper arms. Return to work usually occurs after the six-week recovery, but may be much sooner for non-strenuous employment.
How does coronary artery disease develop?
The reason for the occurrence of coronary artery disease when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. It is also possible outcome that plaque could accumulate by smoking, high blood pressure, elevated cholesterol, and diabetes. Older people are more virgin to plaque development (greater than 45 years for men and 55 years for women), or if they have a positive family history of early heart artery disease.
The atherosclerotic process causes significant narrowing in one or more coronary arteries. If the coronary arteries become thin as compared to before around 50% to 70% then the blood supply under the plaque development becomes inadequate to meet the increased rate of oxygen demand during the exercise. The muscles that are present inside the heart are the origin of these arteries, are starved of oxygen.
Patients often experience chest pain when the blood oxygen supply cannot keep up with demand. Up to 25% of patients experience no chest pain at all despite documented lack of adequate blood and oxygen supply. These patient are at higher risk of heart attack as those of angina.
When a blood clot (thrombus) forms on top of this plaque, the artery becomes completely blocked causing a heart attack.
How is coronary artery disease diagnosed?
The resting electrocardiogram (EKG) is a recording of the electrical activity of the heart and can demonstrate signs of oxygen starvation of the heart (ischemia) or heart attack. Often, the resting EKG is normal in patients with coronary artery disease and angina. Treadmill and exercise test are taken as a symptom shower for patient of significant coronary artery disease (CAD) and a normal resting EKG. These stress tests are about 60 to 70% accurate in diagnosing significant CAD.
In case stress test won’t reveal the, greater accuracy can be achieved by adding a nuclear agent intravenously during stress tests. Addition of the nuclear imaging agent allows imaging of the blood flow to different regions of the heart, using an external camera. During exercise an area of heart with reduced blood flow, but normal blood flow comes at rest, signifies significant artery narrowing in that region.
Risks of CABG are:
Overall mortality related to CABG is 3-4%. During and shortly after CABG surgery, heart attacks occur in 5 to 10% of patients and are the main cause of death. About 5% of patients require exploration because of bleeding. This second surgery increases the risk of chest infection and lung complications. The stroke occurs in 1-2%, primarily in elderly patients. Mortality and complications increase with:
- age (older than 70 years)
- poor heart muscle function
- disease obstructing the left main coronary artery
Cost of CABG in India is $6,900 in the USA it is $100,000 in Uk it is 21,400
Coronary Artery Bypass Graft (CABG) - Total Price $6,900 in India
Coronary Artery Bypass Graft (CABG) Re-Do - Total Price $9,900 in India
Coronary Artery Bypass Graft (CABG) & Carotid - Total Price $9,000 are the approximate prices for CABG which is the fraction of cost where in western other countries.
The success rate of CABG is 95% in India.Cost is also very fraction of cost in western countries.