Arterial heart bypass, also known as coronary artery bypass grafting (CABG), is a surgical procedure used to treat coronary artery disease (CAD). CAD occurs when the coronary arteries, which supply oxygenrich blood to the heart muscle, become narrowed or blocked due to the buildup of plaque (atherosclerosis). This can restrict blood flow to the heart and lead to chest pain (angina) or even a heart attack. During a coronary artery bypass grafting procedure, the surgeon creates new pathways for blood to flow around the blocked or narrowed arteries. This is achieved by taking a healthy blood vessel, often from the patient's leg, chest, or arm, and using it to bypass the blocked part of the coronary artery. The new blood vessel is grafted onto the coronary artery above and below the blockage, creating an alternate route for blood to reach the heart muscle. The bypass grafts allow blood to flow freely again, restoring oxygen and nutrient supply to the heart muscle, reducing symptoms, and improving heart function. This procedure can relieve chest pain, improve exercise tolerance, and reduce the risk of a heart attack in patients with severe coronary artery disease. Coronary artery bypass surgery is typically recommended for individuals who have significant blockages or multiple narrowings in their coronary arteries that cannot be effectively treated with medications or less invasive procedures like angioplasty and stenting. It is often performed when the narrowing is severe and is affecting the quality of life or posing a significant risk to the patient's health. As with any surgical procedure, coronary artery bypass grafting carries some risks and potential complications, such as infection, bleeding, blood clots, or adverse reactions to anesthesia. However, it is generally considered a safe and effective treatment for selected patients with advanced coronary artery disease
- Anesthesia The patient is taken to the operating room, and anesthesia is administered to induce unconsciousness and ensure the patient doesn't feel any pain during the surgery. Typically, general anesthesia is used, which means the patient is completely asleep and does not feel anything during the procedure.
- Incision Once the patient is under anesthesia, the surgeon makes an incision in the chest to access the heart. Traditionally, a median sternotomy is performed, which involves cutting through the breastbone (sternum) to open the chest cavity. In some cases, minimally invasive techniques may be used, which involve smaller incisions and special surgical instruments.
- Heart-Lung Bypass Machine The surgeon connects the patient to a heartlung bypass machine (cardiopulmonary bypass). This machine temporarily takes over the function of the heart and lungs, allowing the surgeon to work on the heart while it is not actively pumping blood.
- Harvesting Grafts The surgeon then harvests the grafts, usually from the patient's own blood vessels, which will be used to create the bypasses. The most commonly used grafts are the internal mammary artery (IMA) and saphenous vein. If arterial grafts are available (IMA or radial artery), they are preferred due to better long-term patency rates. For the internal mammary artery (IMA), a small incision is made along the chest wall, and the IMA is carefully dissected from its origin. For saphenous vein grafts, a larger incision is made in the leg, usually around the knee or ankle, and the vein is harvested.
- Bypass Grafting The surgeon then prepares the heart for grafting by temporarily stopping it or using other techniques to stabilize the heart. The grafts are then carefully sewn (anastomosed) to the coronary arteries, creating the bypass pathways. The other end of the graft is connected to the aorta or another artery to provide a source of blood flow
- Restarting the Heart Once the bypass grafts are in place and functioning correctly, the heart is restarted, and the heart-lung bypass machine is gradually discontinued. The heart resumes pumping blood on its own.
- : Closing Incisions The surgeon carefully inspects the bypass grafts and the heart to ensure everything is working properly. After confirming the success of the procedure, the chest incision is closed using sutures or staples, and the skin incisions are closed with stitches.
- : Postoperative Care The patient is transferred to the recovery area, where they are closely monitored by medical staff. Recovery time in the hospital can vary, but patients typically stay for several days to ensure proper healing and recovery.
- Anaesthesia