Coronary Artery Bypass Grafting- Surgery, Procedure

Coronary Artery Bypass Grafting is used for rerouting of the heart’s blood circulation. This will ensure that proper blood and oxygen supply will reach all the parts of the body. This is used for Coronary Artery Disease.

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How does CABD surgery work?

To understand how this operation works, one must know the normal physiology of the circulatory system. This is composed of the heart, arteries, veins and network of capillaries. The goal of this system is to bring sufficient blood, oxygen and nutrients to every part of the body. Any disturbance on any of the parts can cause serious damage to any organ.

The heart is the center of the system. Any defect on its structure can affect its function. One most common cause of heart problems is blockage. This can be due to blood clots, swelling from infection and arteriosclerosis. Arteriosclerosis is the accumulation of fats, calcium and other minerals in the blood. This would cause restriction or stoppage of blood flow. This causes heart attacks which can be fatal.

Coronary Artery Bypass Grafting Procedure

There are 2 ways to treat blockage in the arteries. This is either to widen it or creating another route for the blood. Blood rerouting is favored since it can be a long-term treatment. The technique is simple. Cut out blood flow to the blockage and direct it to the new course.

This is where Coronary Artery Bypass Grafting comes in. It is considered as one of the most common procedure done in the United States these days. Almost 500,000 of Americans have undergone this process.

The first part of the procedure is considering what arteries or vein to use for the procedure. This would depend on the extent and location of the blocked coronary artery. These are the commonly used blood vessel to be harvested and grafted:

Internal mammary or thoracic arteries

These are the most common vessels for grafting for long-term use. These arteries are rich supplies of oxygenated blood. At most cases, they are just attached to site below the blockage itself. Over 90% of the Coronary Artery Bypass Grafting procedure use this.

The radial artery

This artery is found in the wrist alongside the ulnar artery. Since the two arteries are closely located, no effects in blood flow and supply is reported even if one is cut off. Radial is more preferred then the ulna so as not to compromise blood supply to the hands. Calcium channel blocker medications might be needed after the operation. This is to prevent the radial artery from closing. The medication would not last for a lifetime. It can be stopped once stabilization is attained. Common complications would include numbness. It is however rare to have long-term sensory loss.

Saphenous veins

These are located in the legs. If this vein is used, a cut is made at the knee and at the groin. This is done to reduce scarring and other complications.

Gastroepiploic artery and Inferior epigastric artery

Their locations are near the stomach and the abdominal wall, respectively. These are the least used arteries for grafting for Coronary Artery Bypass Grafting.

Prior to the Coronary Artery Bypass Grafting prepping is done from the neck down to the lower abdomen. This is to safeguard the patient against infection. Antibiotics are also given to further strengthen the immune system. Coronary Artery Bypass Grafting is an open heart surgery; infection is most common if sterile technique is not observed properly.

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The chest is cut open. The exposed breastbone is then sawed to gain access to the heart. The heart is soaked in cold salt solution. This process is called cardioplegia. This temporarily stops the heart from pumping. This is done to prevent any heart tissue damage when blood flow ceases. A cardio-pulmonary bypass is done to act as a temporary pump.

Once this is established, the aorta is clamped in order to block blood flow to the area. To avoid compromising the aorta’s integrity, this should be done in less than 60 minutes. The grafted artery or vein is connected directly from the aorta to the site of blockage. This ensures that the best blood supply is available in the blocked area.

After the graft has been placed, steel wires are used to connect the sternum together. The chest incision is also closed. A chest tube is left in place to allow drainage. This is continually monitored for extensive bleeding or infection. In some cases, exploration is needed within 24 hours after surgery to investigate the cause of bleeding.

Duration of CABD surgery

Coronary Artery Bypass Grafting is done in 3-5 hours. The first few hours after the procedure, the patient is monitored in the Intensive Care Unit. If there are no complications, the chest tube can be removed 1-2 days after surgery. Vital signs, heart rhythm and sounds and oxygen saturation is carefully monitored. If the parameters are stable, the patient can be transferred to the common unit. It would take 3 to 5 more days of hospital stay before the patient can go out.

After the Surgery (Recovery)

It would take more than 2 to 6 months after the surgery to fully recover. Before this, lifting, frequent stair climbing and driving is prohibited. Medications used can include anti-blood clotting, beta blockers, nitrates, ACE inhibitors and lipid inhibitors. This prescription will run for several months.

Major complications could be fatal. These include embolism, heart attack, stroke and heart rhythm disorders. Mortality rate of Coronary Artery Bypass Grafting is relatively low at 3 to 4%. Mortality rate is increased with age, poor heart muscle and current conditions affecting the heart, lungs and kidneys.

Wound care is important to avoid infection. The incision should be kept dry and clean at all times. Most infections develop after 2 weeks. Signs and symptoms could include high-grade fever, pain in or near the incision, increase heart rate, tenderness, bleeding and pus. This requires immediate medical attention.

Lastly, it is highly recommended to switch to a healthier lifestyle after the Coronary Artery Bypass Grafting procedure. Proper diet through lean meat, fresh fruits and vegetables should be observed. Adequate exercise can be done as tolerated. Normally this would mean 3 to 5 times a week, 10 minutes each at moderate intensity. Have enough sleep and decrease stress. Stop smoking, alcoholic and caffeine intake.

Cost of Coronary Artery Bypass Graft Surgery

The cost of Coronary Artery Bypass Graft Surgery is quite expensive in US and UK, coming to $40000-$50,000. Due to medical tourism, a lot of people come to Asian countries like India where the cost can be $6500 for CABD surgery.

Coronary Artery Bypass Grafting Surgery Video

Check out the CABD surgery video to see how the procedure takes place:

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