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The doctors and staff at Apollo hospitals are pleased that you are considering us for your Coronary artery bypass surgery. We would like to take the time to briefly discuss the process of undergoing Coronary artery bypass surgery. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Coronary artery bypass surgery. This information is designed to offer additional information on your preparation before surgery, the surgery itself, and the road to recovery after your procedure.

What is a CABG or Bypass surgery?

Coronary Artery Bypass Grafting (CABG) is a surgery that enhances blood flow to the heart through the coronary arteries. It is indicated for people who suffer from severe Coronary Heart Disease (CHD) also called Coronary Artery Disease.

CHD is a disorder in which an component called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. If the blockage is severe, angina, shortness of breath, and, in some cases, heart attack can occur. The term Angina refers to chest pain or discomfort due to lack of optimal flow of blood to the heart muscle.

CABG is one treatment for CHD. During CABG, a healthy artery or vein from your body is connected or grafted to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new passageway and oxygen-rich blood is channelled around the blockage to the heart muscle.

Why is CABG done?

Your doctor will talk to you whether coronary bypass surgery or an alternative artery-opening procedure such as Angioplasty or stenting, is right for you.

Coronary bypass surgery is an option if:

  • You have severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes Angioplasty and stenting will help, but for some types of blockages, coronary bypass surgery may be the best option.
  • You have more than one diseased coronary artery and the heart's main pumping chamber, which is the left ventricle, isn't functioning well.
  • Your left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
  • You have an existing blockage for which angioplasty is not suitable, you have had a previous angioplasty or stent placement that hasn't been successful, or you've had stent placement, but the artery has narrowed again (restenosis).
  • Coronary bypass surgery may also be performed in emergency situations, such as a heart attack, if your doctor sees that you're not responding to other treatments.

The surgery does not treat the principal heart disease that produced blockages in the first instance. So, even if you undergo a coronary bypass surgery, changes in lifestyle are still a necessary part of management after surgery. Medications are routine after the surgery to lower your blood cholesterol, ease the risk of developing a blood clot and help your heart function as well as possible.

CABG
Coronary Artery Bypass Grafting (CABG)

How do you prepare for a CABG?

To prepare for the surgery, the doctor will give you specific instructions about any restrictions and changes in your diet or medications you should follow before surgery. You would need several pre-surgical tests, like chest X-rays, blood tests, an electrocardiogram and a coronary angiogram. A coronary angiogram is a type of X-ray procedure that uses dye to visualize the coronary arteries. You will be advised to get admitted one or two days prior to the surgery and anti-platelets are withheld three to seven days prior to the surgery depending upon the Anti-platelets used.

Be sure to make arrangements for the weeks following your surgery. It will take about four to six weeks for you to recover to the point where you can resume driving, return to work and perform daily chores.

What you can expect

During the procedure

Coronary bypass surgery requires general anaesthesia. The number of bypasses required is subject to the location and severity of blockages in your heart.

  • The surgeon cuts down the center of the chest, along the breastbone. The surgeon then spreads open the rib cage to expose the heart. After the chest is opened, in the earlier versions of this surgery, the heart was temporarily stopped and a heart-lung machine took over, to circulate blood to the body. Today, most CABG procedures are Off-pump or beating-heart surgeries. This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize the area of the heart the surgeon is working on.
  • The specialist takes a section of healthy blood vessel, often from inside the chest wall (the internal mammary artery) or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.

There are other surgical procedures your surgeon may use such as Minimally Invasive Coronary Bypass surgery. In this procedure, a surgeon performs coronary bypass through a smaller incision in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area. Variations of minimally invasive surgery may be called port-access or keyhole surgery.

After the procedure

Coronary bypass surgery is a major operation. Expect to spend a couple of days in the intensive care unit after coronary bypass surgery. Here, your heart, blood pressure, breathing and other vital signs will be continuously monitored.

Immediately after your surgery

General anesthesia is used during the CABG procedure, so you may be unconscious for several hours after surgery. While you are still unconscious, you will probably be taken to the intensive care unit, a special ward reserved for people who have just had significant surgeries. You might be in this unit for one to three days. A longer stay does not mean that your CABG surgery was not successful. It may mean, for example, that it is taking more time for your anaesthesia to wear off or for fluid in your chest to drain.

As you wake up, you may notice several sensations. You will probably feel very groggy. Anaesthesia can make you feel nauseated, so your stomach may feel queasy. You may also notice immediately that you cannot swallow or speak because of the tube placed in your throat to help you breathe.

Although the effects of anaesthesia usually help with the discomfort from CABG surgery, you still may experience some pain after you are awake. To relieve this discomfort, your nurse will give you pain medicine through your intravenous (IV) line directly after surgery.

Getting out of the intensive care unit

When your condition has improved, you will be transferred from the specialized ward to a regular cardiac care unit, sometimes called a step-down unit. You are usually transferred there when:

  • Your breathing tube has been removed.
  • You are able to take medicines orally.
  • Invasive tubes and monitoring requirements are reduced. You may no longer need the urinary catheter that was placed in your bladder.
  • When you are in the step-down unit, you may be able to move in and out of bed.

Barring any complications, you are likely be discharged from the hospital within eight days (two to three days in the ICU and two to three days in the ward), although even after you have left the hospital, you may find it difficult to perform everyday tasks, or even walk a short distance.

Expect a recovery period of about six to twelve weeks. In most cases, you can return to work, begin exercising and resume sexual activity after four to six weeks, but make sure you have your doctor's approval before doing so.

Results

Post-surgery, majority of the patients feel better and may remain symptom-free for as long as 10 to 15 years.

Life after CABG

While bypass surgery improves blood supply to the heart, it does not cure the underlying Coronary Artery Disease. Your results and long-term outcome will depend in part on taking your medications to prevent blood clots, lower blood pressure, lower cholesterol and help control diabetes as directed, and following healthy lifestyle recommendations, such as:

  • Quit smoking
  • Following a healthy-eating plan, such as the DASH diet
  • Maintaining a healthy weight
  • Exercising regularly
  • Managing stress

Get in touch with the hospital and your medical team or call 1066 if:

  • If you have high fever
  • Rapid heart rate
  • New or worsened pain around your chest wound
  • Reddening around your chest wound or bleeding or other discharge from your chest wound

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