Heart Bypass Surgery/Coronary Artery Bypass Grafting (CABG) in Delhi, India

Heart Bypass Surgery, a type of open heart surgery, is a procedure to treat individuals with blocked or narrowed coronary arteries. The aim of coronary artery bypass graft surgery is to restore blood flow to the heart muscle by creating a bypass around the narrow or blocked coronary artery.

Some reasons why CABG is performed include:

Restore Proper Blood Flow

CABG is performed to restore proper blood flow to the heart muscle in individuals with severe coronary artery disease. It addresses blockages or narrowing in the coronary arteries, which hampers blood supply to the heart. By creating new pathways using grafts, the surgery bypasses the obstructed areas, allowing improved blood flow and oxygen delivery to the heart.

Alleviate Angina

Angina, characterised by chest pain or discomfort, is a common symptom of coronary artery disease. CABG helps alleviate angina by improving blood flow to the heart muscle. By bypassing the blocked or narrowed arteries, the surgery reduces the strain on the heart and episodes of chest pain.

Reduce the Risk of Heart Attacks

Severe coronary artery disease can increase the risk of heart attacks or myocardial infarctions. CABG can significantly reduce this risk by bypassing the diseased coronary arteries and creating new pathways for blood flow. By restoring blood supply to the heart, the surgery helps protect against heart muscle damage caused by heart attacks.

Improve Heart Function

When coronary arteries are severely blocked, the heart may struggle to pump blood effectively, leading to reduced heart function. CABG aims to improve heart function by restoring proper blood flow. By ensuring adequate oxygen and nutrient supply to the heart muscle, the surgery helps improve overall heart performance and may enhance the individual's quality of life.

When Other Treatments are Inadequate

CABG is considered when other options, such as medication or angioplasty (a procedure to open narrowed arteries), are insufficient or unsuitable for the patient. It is often recommended for individuals with complex or extensive coronary artery disease, multiple blockages, or previous unsuccessful interventions. CABG provides a more comprehensive and durable solution to address severe coronary artery disease.

Every surgical procedure carries a degree of risk, and heart bypass surgery, being a type of open-heart surgery, is no exception. Numerous factors contribute to these risks, encompassing your age, the number of bypasses needed, and any other preexisting medical conditions the patient may have. Here are some of the risks of heart bypass surgery (CABG).

• Infections
• Arrhythmia (irregular heart rhythms).
• Heart attack because of post-surgery blood clotting.
• Kidney problems
• Strokes
• Poor wound healing
• Temporary Memory Loss

The patient's pre-existing health conditions also play a significant role in determining the specific risks associated with coronary artery bypass surgery. The likelihood of experiencing complications increases when the surgery is performed on an emergency basis.

Conditions such as arterial blockages in the legs, chronic obstructive pulmonary disease (COPD), diabetes, and kidney disease can heighten the risk of complications. To mitigate these risks, medications are generally administered prior to the procedure. These medications aim to regulate bleeding, manage blood pressure, and ward off infections. For individuals with diabetes, medications to stabilise blood sugar levels may also be provided during the surgical process.

• The doctor will take the patient's personal and family medical history.
• The patient will have to undergo a battery of lab, diagnostic and imaging tests like blood tests, chest x-rays, electrocardiograms (ECGs), echocardiograms, stress tests and more to ensure they are fit for the procedure.
• The doctor may start or stop certain medications before the procedure; they will also ask what the patient is using currently.
• It is advised that individuals quit smoking a few weeks before since it can interfere with healing.
• Exercising regularly before the procedure can help with post-operative healing.

• The patient is given general anaesthesia, and their heart is usually stopped temporarily with a machine so the surgeon can perform the procedure. The patient is then placed on a heart-lung machine, which takes over the functions of the heart and lungs during the surgery.
• The surgeon removes a healthy blood vessel, typically from the chest, leg, or arm, to use as a bypass graft.
• The surgeon then makes a small incision in the chest to access the heart and the coronary arteries. They will sew one end of the graft to the aorta (the main artery leading from the heart) and the other end to the coronary artery beyond the blocked or narrowed area.
• The graft is sewn securely in place, ensuring blood flows smoothly through it. It creates a new path for blood to reach the heart muscle, bypassing the blocked or narrowed area.
• After the graft has been secured, the surgeon will close the incision in the chest.

Also read - Robotic Heart Bypass Surgery

Life after heart bypass surgery or coronary artery bypass graft (CABG) can be a significant transition. This procedure is typically performed to improve blood flow to the heart muscle when coronary arteries become narrowed or blocked due to coronary artery disease. After undergoing CABG surgery, individuals often experience positive changes in their health and lifestyle. Here's what life may be like after bypass surgery.

Recovery Period

The immediate post-surgery phase involves recovery in the hospital. It can take 4-6 weeks or more to make a full recovery. Most patients stay in the hospital for a few days to a week, depending on their condition and the complexity of the surgery. During this time, medical professionals closely monitor vital signs, pain management, and overall recovery.

Physical Rehabilitation

After discharge, a structured rehabilitation program is often recommended. Cardiac rehabilitation helps patients gradually regain their physical strength and endurance through exercises, education on heart-healthy lifestyle choices, and emotional support. This phase can last for several weeks or months.

Medications

Medications are often prescribed to manage various aspects of heart health, including blood pressure, cholesterol levels, and blood thinners to prevent clot formation. It's crucial to take these medications as prescribed and attend regular follow-up appointments with a healthcare provider.

Diet and Lifestyle Changes

A heart-healthy diet is essential to prevent further blockages and maintain overall cardiovascular health. This diet typically involves reducing saturated fats, cholesterol, sodium, and added sugars while increasing fibre, fruits, vegetables, and whole grains. Smoking cessation is critical, and alcohol consumption should be moderated. Regular exercise, as recommended by a healthcare provider, is also important.

Emotional Well-being

Recovering from heart surgery can be emotionally challenging. Many individuals experience anxiety, depression, or stress during this period. Open communication with healthcare providers and seeking emotional support from friends, family, or support groups can be helpful.

Monitoring

Ongoing medical monitoring is essential to assess the progress of recovery and manage any potential complications. Regular check-ups, electrocardiograms (ECGs), stress tests, and blood tests are common components of post-bypass surgery care.

Return to Normal Activities

Most individuals can gradually return to their normal activities, including work and hobbies, as they recover. However, the timeline varies from person to person, and it's crucial to follow the guidance of healthcare providers regarding resuming specific activities.

Long-Term Maintenance

Life after bypass surgery often involves a commitment to long-term heart health. This includes taking medications as prescribed, attending follow-up appointments, maintaining a heart-healthy lifestyle, and addressing any emerging cardiac issues promptly.

Quality of Life

Many people experience an improved quality of life after bypass surgery. They often regain energy, have fewer symptoms of heart disease, and enjoy a better overall sense of well-being.

It's important to remember that recovery experiences can vary, and each individual's journey is unique. Close collaboration with healthcare providers, adherence to recommended lifestyle changes, and a strong support system can contribute to a successful and fulfilling life after bypass surgery.

1. Why is coronary bypass surgery done?

Coronary bypass surgery is done to restore blood flow to the heart when the coronary arteries become blocked or narrowed due to atherosclerosis (buildup of fatty deposits). It bypasses the blocked arteries by grafting blood vessels from other parts of the body to create new pathways for blood to reach the heart muscle.

2. What conditions are treated by heart bypass surgery?

CABG is primarily used to treat coronary artery disease (CAD) and angina (chest pain) and reduce the risk of heart attacks. It can also be performed in some cases of severe heart valve disease or when other treatments have failed.

3. Who needs to have a heart bypass surgery procedure?

CABG is recommended for individuals with significant blockages in their coronary arteries that cannot be adequately managed with medications or other less invasive procedures. The decision to undergo CABG is made based on the severity of the condition and the individual's overall health.

4. How common is CABG surgery?

The frequency of CABG surgery varies by region and population but is relatively common, especially among older adults with coronary artery disease.

5. What is the recovery time?

Recovery time after CABG surgery varies from person to person but typically involves a hospital stay of several days followed by a period of several weeks to months for complete recovery. Many people can return to their normal activities within a few months.

6. Why might I need coronary artery bypass surgery?

As mentioned earlier, you might need CABG if you have significant blockages in your coronary arteries that are causing chest pain, restricting blood flow to the heart, or putting you at risk of a heart attack.

7. What should people expect before the surgery?

Before surgery, individuals will undergo a thorough evaluation, including medical tests, to assess their overall health. They will also receive instructions on how to prepare for the surgery, which may include dietary changes, medication adjustments, and lifestyle modifications.

8. What are the chances of surviving heart bypass surgery?

The survival rate for CABG surgery is generally quite high. The exact outcome depends on various factors, including the patient's overall health, the number and severity of blockages, and the skill of the surgical team.

9. What are the disadvantages of heart bypass surgery?

CABG is a major surgical procedure with potential risks and complications, including infection, bleeding, graft failure, and adverse reactions to anaesthesia. It also involves a recovery period and lifestyle changes.

10. Can heart bypass surgery be repeated?

In some cases, CABG can be repeated if new blockages develop or if previous grafts become blocked. However, the decision to repeat the surgery depends on the patient's individual circumstances.

11. How serious is heart bypass surgery?

CABG is a serious surgical procedure, but it is often necessary to treat life-threatening heart conditions. The risks and benefits should be carefully weighed by the medical team and the patient.

12. What is the life expectancy after heart bypass surgery?

Life expectancy after CABG surgery can vary widely depending on the individual's health, lifestyle choices, and adherence to post-surgery recommendations. Many people experience improved quality of life and a reduced risk of heart-related complications.

13. What happens 10 years after bypass surgery?

Ten years after CABG surgery, many individuals continue to experience improved heart health, reduced symptoms, and a lower risk of heart attacks. However, it's essential to maintain a healthy lifestyle and follow up with healthcare providers regularly.

14. What is the success rate of bypass surgery?

The success rate of CABG surgery is generally high, with most patients experiencing relief from angina and improved blood flow to the heart. Success can vary depending on individual factors and the specific circumstances of each case. It's essential to discuss expected outcomes with your healthcare team.

15. What are the alternate name(s) for heart bypass surgery?

Heart Bypass surgery is also referred to as Coronary artery bypass grafting or CABG.

16. Who is a candidate for CABG?

Patients who may be considered for a CABG procedure include:

• Those with significant blockages in multiple coronary arteries.
• Those with left main coronary artery disease.
• Those with coronary artery disease and diabetes.
• Those who cannot be treated with medications or other less invasive procedures like angioplasty.

Other factors that may be considered include the severity of their symptoms, the patient's age and their overall health.

17. How long does artery bypass surgery take?

Artery bypass surgery can take anywhere between 3-6 hours, depending on the extent of the condition.

18. Is it better to use an artery or vein for bypass surgery?

Yes, arterial grafts have better longevity.

19. Can you live with blocked arteries?

Yes, one can live with blocked arteries, but it can make one prone to heart attacks and risk to life. People should take care of this by eating a healthy diet, exercising regularly and visiting the doctor regularly.

20. What is the most common complication after open heart surgery?

Complications after open heart surgery include poor wound healing, bleeding, pneumonia, and arrhythmia, to name a few.

21. How many arteries can be bypassed?

We have 3 coronary arteries; these coronary arteries and their branches are bypassed. The number of grafts depends on the number of arteries that are critically blocked.

22. Is CABG a major surgery?

Yes, any cardiac surgery is a major surgery.

23. What are the benefits of heart bypass surgery?

Some of the benefits of CABG include:

• Improved blood flow to the heart.
• Reduced risk of heart attack and other heart-related complications.
• Improved quality of life.
• Can lead to a longer life expectancy compared to non-surgical treatments for CAD.

Reviewed by Dr. Dinesh Chandra - Principal Consultant, Cardiac Surgery (CTVS) on 14-Dec-2023.

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