CABG Surgery (Heart Bypass Procedure):
Step-by-Step Guide
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How CABG Works | Indications | Types | Procedure | Advances | Recovery | Risks | FAQ’s
CABG means Coronary Artery Bypass surgery also known as heart bypass procedure in which patients own arteries or veins are used to treat arterial blockages of heart.
Why is it performed?
CABG is Gold Standard treatment for coronary artery disease. When arteries of heart are blocked, it leads to chest pain or heart attacks and even lead to cardiac arrest. Our main aim is to supply blood distal to blockages in arteries by doing CABG so we can prevent heart attack and cardiac arrest.
Conditions that require bypass surgery
Patients with more than two blockages in coronary arteries or all arteries of heart have multiple blockages (triple vessel disease).
Blockage in left main artery of heart, young and diabetic patients with multiple blockages in arteries need CABG.
How Does Heart Bypass Procedure (CABG) Work?
Understanding coronary arteries and blockages
- There are left and right coronary arteries in heart.
- Left Main gives two main branches: left anterior descending artery(LAD), Circumflex Artery (LCX),
- LAD gives branches called diagonal arteries, LCX gives branches called obtuse marginal (OM) arteries.
- Right coronary artery (RCA).
- Blockages can happen in any of these arteries.
- When blockages happen in all three arteries it is called as Triple Vessel Disease in which CABG is best long-term treatment.
The role of grafts (arterial vs. venous grafts)
Two types of grafts are used: Arterial and Venous
- Arterial Grafts: Advantages: best grafts for bypass surgery. Works more than 15 years. Most commonly used arterial grafts are
- LIMA (Left anterior descending artery).
- RIMA (Right internal mammary artery .
- Radial artery
- Saphenous vein graft: Its vein removed from leg , commonly used graft.
Single vs. Multiple bypasses
- It depends on how many vessels are blocked.
- Single vessel bypass is mostly done for LAD blockage at its ostium (Origin).
- Multiple bypasses are done depending on multiple arteries are blocked.
- Multiple grafts can be done 4 or 5 in patient.
Indications: Who Needs CABG Surgery?
- Patients with severe coronary artery disease
- When multiple arteries are blocked, young patients, uncontrolled diabetic patients or patients with left main artery disease needs early surgery.
- When lifestyle changes and medications aren’t enough.
Comparing CABG Surgery vs. Angioplasty Procedure (Stenting)
- CABG is Gold Slandered treatment for coronary artery disease.
- Angioplasty (Stenting) is done in single or double vessel disease or in acute heart attack (PAMI).
- In rest all cases CABG should be performed for long term symptomatic relief.
Types of CABG Procedures
Traditional CABG (On-Pump Heart Surgery)
In this type of bypass Heart lung machine is used and heart is stopped. Then Bypass surgery is performed. This is called on-pump coronary artery bypass surgery. Previously this was common type of surgery. But now beating heart surgery is performed.
Off-Pump CABG (Beating Heart Surgery)
Now a days mostly preferred type of bypass surgery. No heart lung machine is used. Heart keeps on beating and surgery is performed on beating heart using stabilizers. This type minimizes all types of complications related to Heart Lung machine like stroke, organ damage, infections.
Minimally Invasive CABG
As we advance with time, we don’t cut any bone to open chest for bypass surgery. Surgery is performed from left side of chest with very small incision. Recovery after this surgery is very fast and patients can resume their work early.
Robotic-Assisted CABG
With robotic surgery we can perform CABG with Key holes without big incisions. Precision and perfection are very high with robotic surgery. Recovery is very fast.
Step-by-Step Guide: The CABG Surgical Procedure
Pre-operative Preparations
- This starts 4 days prior.
- Need to stop Blood thinners 4 days prior.
- Many blood tests are performed for fitness of surgery.
- Bath with medicated liquid soap will be started.
- Admission is done one day prior to surgery.
Anesthesia and Surgical Approach
- General anaesthesia will be given for this surgery.
- Central line and Arterial lines are put to monitor vitals.
- Patient will be given deep anaesthesia so he will not get pain during surgery.
- Harvesting grafts (Internal Mammary Artery, Saphenous Vein, Radial Artery)
- Depending on age and diabetes levels grafts are harvested.
- Most commonly used grafts are internal mammary arteries and Saphenous vein.
- In young patients we most commonly use total arterial grafts like LIMA and RIMA.
- Graft placement and restoring blood flow
- Grafting is done mostly on beating heart using stabilizer called octopus.
- Grafts are put beyond blockages to restore blood supply.
Closing the Chest and Post-operative Monitoring
- Sternum is closed with sternal wires or bands.
- Chest tubes will be there for 3 to 4 days post-surgery.
- Patient will be shifted to ICU post-surgery for 2 to 3 days.
- Most of the time patient is removed from ventilator on the same day or next day.
- Most patient walk on day 2 of surgery.
Latest Advances in CABG Surgery
- Use of arterial grafts for longer-lasting results,
- Hybrid procedures combining CABG & stenting.
- Innovations in minimally invasive techniques.
- Role of AI and robotics in cardiac surgery.
Recovery After CABG Surgery
Hospital Stay and Immediate Post-op Care
- Post surgery patient will stay in hospital for 5 to 6 days.
- Once all drainage tubes are out and patient starts walking, we can discharge the patient.
- We advise patient to be active at home also.
- Chest belt will be given to patient to wear post-surgery for 45 days.
Managing Pain and Wound Healing
- Kidney safe pain killers are given to patient for 7days post-surgery.
- Pain gets minimal after 2 days of surgery.
- Wound non healing and infections can happen in uncontrolled diabetic patients, chances are around 3%.
Resuming Daily Activities and Work
– Patient can resume daily activities after 20 days of surgery.
– Can resume work in one month.
When to Seek Medical Attention
- If Patient becomes very weak, having giddiness, recurrent chest pain.
Risks and Complications of CABG Surgery
Common Risks (infection, bleeding, arrhythmia, stroke)
- Chances of complications are very less if surgery is done by skilled cardiac surgeon.
Long-term Complications
- Chest wall pain can happen in some patient, in less than around 2% cases.
How Risks are Minimized with Advanced Techniques
- As we are doing CABG on beating heart many complications of bypass surgery are prevented.
CABG Surgery vs. Other Heart Treatments
CABG vs. Angioplasty (Stenting) – Which is Better for You?
- If one or two blocks are there then we can do angioplasty.
- If more than three blockages or left main disease or single block at origin of artery then need to do CABG.
CABG vs. Medical Management
- Medical management is given to very old patients, not fit for surgery or having associated co morbidities. Medical management is not full proof treatment.
Life After CABG: Long-Term Heart Health
- Walking for 30 min is best exercise post-surgery. Active life is must.
- Need to avoid deep fried items, red meat.
- Strict diabetes control is must.
- Poat CABG patient will need very less medicines.
- 6 monthly follow up is required.
- Active healthy life style, strict diabetes control and no tobacco is must to prevent future blockages.
Frequently Asked Questions (FAQs) About CABG Surgery
How long does CABG surgery take?
- 3 to 4 hours.
Will I feel pain after the surgery?
- There will be mild pain for 2 to 3 days.
What is the recovery time after CABG?
- Open heart surgery recovery time is 15 days and minimal invasive surgery is 8 days.
Is CABG a permanent solution?
- It works as permanent solution as it works for many years. But maintaining good lifestyle and preventing risk factors is important.
How soon can a patient return to normal activities?
- Can resume normal activities within 20 days.
What is the success rate of CABG?
- Success rate of CABG is 99% provided done by skilled cardiac surgeon, condition of heart at the time of surgery.
Can the bypassed arteries get blocked again?
- LIMA and RIMA works for 25 to 30 years approximately.
- Radial artery works for 15 years approximately.
- Vein graft works for 10 to 15 years approximately.
How often should I follow up after CABG?
- Every 6 monthly.
How soon can I return to normal activities after CABG?
- Light activities (walking): Within a few days.
- Driving: After 4-6 weeks.
- Returning to work: 6-8 weeks (varies by job).
- Strenuous activities: After 3-6 months (based on doctor’s advice).