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| SURGERIES OF THE HEART |
Coronary Artery Bypass Graft Surgery
(CABG)
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A Coronary Artery Bypass Graft operation, which is sometimes referred to as CABG, is a type of heart surgery done to reroute or bypass, blood around clogged arteries and to improve the supply of blood and oxygen to the heart. These arteries are often clogged by the buildup of fat, cholesterol and other substances. The narrowing of these arteries is called Atherosclerosis. It slows or stops the flow of blood through the heart's blood vessels and can lead to a heart attack.
GRAFT
A graft is a blood vessel that has been created to bypass a blocked artery. It is usually taken from the internal mammary artery in the chest or the saphenous veins from the leg. The graft is attached above and below the area in the artery where there is blockage, so that the blood can use the new, unblocked path to flow freely to the heart.
REASONS FOR THE PROCEDURE
A CABG is performed to re-establish blood supply to the heart muscle. It is often recommended in cases of:
* Severe blockages in the main artery or obstructions in several blood vessels
* Persistent chest pain not improved with drug therapy (angina)
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
* Pre-existing heart condition
* Lung disease, especially chronic obstructive pulmonary disease ( emphysema )
* Prior heart attack or bypass surgery
* Advanced age
* Surgical urgency
* Obesity
* Diabetes
* Smoking
* High blood pressure
* Thyroid disease
BEFORE THE PROCEDURE
The doctor will likely do the following:
* Physical exam
* Chest x-ray
* Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle
* Coronary angiogram – a test to determine the extent and location of blockages in blood vessels in the heart
In the days before the surgery:
* Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by the doctor.
* The night before, eat a light meal and do not eat or drink anything after midnight.
* Arrange for a ride to and from the hospital.
* Arrange for help at home after returning from the hospital.
DURING THE PROCEDURE
The patient is given the following during the surgery -
* General Anesthesia
* IV fluids
* Oxygen
* Catheter, placed in the bladder to drain urine
* A heart-lung machine to maintain blood circulation and cool the blood and body temperature.
PROCEDURE
The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine pulls blood from the heart, adds oxygen to it, and pumps it back into the bloodstream.
To harvest a blood vessel to graft into the heart, the surgeon detaches an artery from the chest wall, or make one or several incisions in the leg and remove a section of vein from the leg. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions. When the grafts are in place, the blood (and thus the body temperature) is rewarmed to normal temperature, and therapeutic electric shocks are used to start the heart beating again. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.
There is a less invasive approach to coronary artery bypass grafting, called Minimally Invasive Coronary Artery Surgery . The purpose of this surgery is the same, to bypass the clogged arteries, but the technique and indications are different. Patients who have only one or two clogged arteries can be grafted by this method.
In this technique, a small incision is made in the chest, over the site of the clogged artery. The surgeon usually uses an artery from inside the chest wall to bypass the obstruction. The key difference in this technique is that the surgeon operates while the heart is beating, thus avoiding the use of the heart-lung machine.
TIME TAKEN FOR THE PROCEDURE
4-5 hours.
POSTOPERATIVE CARE
* Take medications as directed by the doctor. These may include:
- Blood pressure medications
- Digitalis, to help the heart pump more strongly
- Anti-arrhythmics, to keep the heart's rhythms regular
- Blood thinners, to prevent blood clots from forming
* To reduce the risk of fluid buildup in the lungs,one should breathe deeply and cough 10-20 times every hour.
* If a leg vein was removed, elevate the legs above the heart while sitting and do not cross legs.
* The day after surgery, try to walk with help.
* Dressings will be removed in a day or two; pacing wires and chest tubes will be removed after a few days.
* Internal stitches will dissolve; staples will be taken out 5-7 days after surgery.
* Small paper strips on incisions will peel off and can be removed one week after discharge.
* Once home, one should only take medications approved by the doctor, and check the temperature twice daily, and weigh yourself every morning.
* Follow activity and cardiac rehabilitation program as recommended by the doctor to speed recovery and improve cardiovascular health.
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| Last Modified :
Monday, May 11, 2009 |
Compiled and edited by the Editorial team and
approved by Expert panel of h4heart.com
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