Cardiovascular diseases are one of the major causes of mortality & morbidity worldwide. According to latest reports, coronary artery disease with prevalence of nearly 65 percent in women & 50 percent of men in the whole world is responsible for 50 percent of all deaths each year. In Coronary Artery Disease, arteries which are bound to supply blood & oxygen to heart muscle get narrowed. Patients may try primary treatments such as changing their lifestyle, taking medicines & even undergoing coronary angioplasty sometimes. If these treatments fail to provide relief, CABG surgery can prove beneficial. Coronary Artery Bypass Graft surgery is an acknowledged procedure which improves signs & symptoms of coronary artery disease. Count of patients undergoing this surgery is increasing in most countries due to its excellent results & efficiency.
What is Coronary Artery Bypass Graft?
Cardiovascular surgeons use CABG surgery to treat patients who have severe coronary heart disease. Coronary artery bypass graft is a medical procedure which is used for curing patients suffering from coronary heart disease. It averts blood around clogged portions of major arteries to improve oxygen supply & enhance blood flow to the heart. Outcome of this surgery usually is desirable. Many patients stay symptom-free for several years after CABG. Healthy routine & proper medications after surgery may help prevent arteries from becoming blocked again.
Main goals of CABG surgery include the following.
- Enhancing the quality of life by reducing angina & other symptoms
- Improving pumping of heart if it has been affected by a heart attack
- Reducing risk of a heart attack especially among patients having diabetes
- Improving patient’s chance of survival
- Allowing patients to resume an active lifestyle
Human heart needs constant supply of blood. Blood is supplied to heart by two major blood vessels known as the left & the right coronary arteries. Coronary arteries can become hardened & narrowed by build-up of fatty deposits referred to as plaques. This condition is called as atherosclerosis. Patients with atherosclerosis of coronary arteries develop coronary heart disease. Possibility of developing coronary heart diseases increase as the age increases. Patients are much more likely to be affected under following circumstances.
- If patients smoke
- They are obese or overweight
- They have a high-fat diet
- High cholesterol level
- Family history of heart-related diseases
Coronary heart diseases in patients can cause chest pain & restrict oxygen-rich blood supply to heart. While many patients can be treated with proper medications, severe angina may need a coronary artery bypass graft to improve this condition. Major risk associated with coronary heart disease is the probability of one of the plaques in coronary artery splitting or rupturing, developing into a blood clot. It can trigger heart attack like conditions in patients. Therefore, coronary artery bypass graft may prove to be an effective treatment option.
Coronary artery disease occurs when atherosclerotic plaque builds up in blood supplying arteries. Plaque is primarily a by-product of cholesterol. Accumulation of plaque can speed up by high blood pressure, excessive smoking, diabetes & elevated levels of cholesterol. Men, who are greater than 45 years of age & women above 50 years of age, are at higher risk for developing plaque. People having a family history of heart diseases are also prone to developing atherosclerosis. When arteries contract more than 55 – 70 percent, then blood supply beyond plaque becomes insufficient to meet oxygen demand of patients during exercise. However, 25 percent of patients do not experience chest pain at all despite lack of sufficient blood & oxygen supply. When a blood clot or thrombus develops on top of plaque, the coronary artery becomes entirely blocked causing a heart attack.
Coronary Artery Bypass Graft may be recommended to patients for various situations. Good candidates for CABG surgery can be identified on the basis of following conditions.
- Stable Angina – Chest pain or angina is considered stable when its severity, frequency, duration & precipitating factors remain the same & are not changing. Patients with stable angina may need CABG surgery if they have intolerable & persistent symptoms despite various medical treatments.
- Extensive Coronary Disease – Patients with comprehensive coronary heart disease, including hardening of coronary artery, multiple contracted coronary arteries & poor pumping of lower heart chamber, generally have longer life span when they undergo coronary artery bypass graft as compared with patients who have medical therapy or any other treatment.
- Risk of Cardiac Event in Future – Many patients are diagnosed as having higher risk for future cardiac miss-happening based upon an exercise test. Tests may indicate changes in electrocardiogram, poor exercise capacity or limited blood flow to various areas of heart. Flow of blood is sometimes measured with a myocardial perfusion test obtained immediately after exercise.
- Myocardial Infarction – Patients who have had heart attacks (myocardial infarction) may undergo CABG if other processes like stent placement are unsuccessful in treating blocked blood vessels.
Patients should not panic under these conditions, they should positively consult a cardiac surgeon for a suitable treatment as soon as possible to avoid further damage.
Diagnosing Bad Coronary Artery Condition
Cardiac surgeons will decide whether CABG surgery is necessary or not for treating patients on the basis of their symptoms & their response to given tests.
To figure out whether patients should undergo CABG surgery or not, a cardiac surgeon will perform a complete physical examination. Surgeons will check lungs, heart & pulse of patients. They may also ask details about observed symptoms patients have, such as shortness of breath or pain in chest as well as their duration. In addition to this, surgeons will also suggest several important tests to identify clearly which arteries are hardened & clogged, severity of clogging & whether patients have any serious heart damage.
An Electrocardiogram is a basic test which efficiently records the electrical activity of patient’s heart. It precisely measures rhythm of heart or how fast the heart is beating & whether it is steady or not. An EKG is able to show even minor signs of heart damage.
Echocardiography test uses sound waves to develop a moving image of patient’s heart. This test shows accurate shape & size of patient’s heart & how well heart chambers & valves are functioning. Echo can also show areas of heart muscle that aren’t contracting properly, regions of poor blood flow to the heart & any injury to the heart muscle caused by poor flow of blood.
Several heart problems are simpler to diagnose when patient’s heart is beating hard & fast. During stress testing, patients need to exercise for making their heart work hard & beat fast while heart evaluation is performed. If patients are not able to exercise, they may be given medications to raise their heart rate. Various heart tests are performed during stress testing which may involve echo, nuclear heart scanning & PET (positron emission tomography) scanning of the heart.
Coronary angiography test uses special X-rays & contrast dye to show internal details of patient’s coronary arteries. To get the dye into coronary arteries of patients, surgeon will perform a procedure called cardiac catheterization. A flexible & thin tube known as a catheter is inserted into blood vessel in patient’s neck, arm or upper thigh & dye is released into bloodstream of patients. With the help of X-rays, surgeon can track the blood flow & find blockages that may cause heart attacks.
Cardiac surgeons may suggest some medicines to patients prior to CABG for lowering their cholesterol levels & blood pressure as well.
There are various types of coronary artery bypass grafting procedures available for CAD patients. Surgeons will recommend the best option for patients based upon their health condition.
- Conventional Coronary Artery Bypass Grafting – Conventional CABG surgery is performed by surgeons when at least one main artery needs to be bypassed. Sternum or the chest bone of patients is opened to approach the heart. Important medicines are provided to stop the heart, while a heart-lung bypass machine regulates oxygen & blood throughout the body of patients during this surgical procedure. It allows doctors to operate upon a tranquil heart. After completion of surgery, the flow of blood is restored. Generally, patient’s heart starts functioning again on its own. Sometimes, mild electric shocks are given to make the heart function once again.
- Off-Pump Coronary Artery Bypass Grafting – This procedure is also referred to as beating heart bypass grafting. This kind of CABG surgery is slightly similar to conventional CABG as chest bone of patients is opened to access the heart. However, functioning of the heart is not interrupted & a heart-lung bypass machine is not used by the surgeons.
- Minimally Invasive Direct Coronary Artery Bypass Grafting – This procedure involves several small cuts on left side of chest between the ribs. This kind of surgery is used to bypass blood vessels at the front-side of heart.
Patients may have to undergo various tests like an EKG, blood tests etc to get prepared for coronary artery bypass graft surgery. Surgeons will explain to patients how to prepare for CABG surgery. Doctors will advise patients about what they should drink or eat, which medications to take & which activities they should stop prior to CABG surgery. Patients should avoid smoking & excessive drinking in order to recover faster. Patients are likely to be admitted to hospital on the day of the surgery.
Patients can use the following list of important questions to understand coronary artery bypass graft surgery during initial consultation with cardiac surgeons. In order to get best results from surgery, patients should be frank during this discussion with cardiac surgeons.
- Why is coronary artery bypass graft surgery the best treatment for me?
- Are there any medical tests that I will need to undergo prior to my CABG surgery?
- How will you perform my CABG? Will you use a heart-lung machine?
- What will be the length of my chest incision?
- What can I do to ensure a successful CABG surgery & recovery?
- How long will I be in the hospital after my CABG?
- Considering my medical history, do you have concerns about potential surgical complications?
- How will I feel after my CABG is complete?
- What type of care is required now & ongoing after coronary artery bypass graft surgery?
- Can I get aid with making suitable lifestyle changes, such as stopping smoking, exercising & adopting a healthy diet?
Patients should clear all doubts related to coronary artery bypass graft surgery & then only proceed further with surgery.
The entire procedure for CABG surgery can be explained in following steps.
- General Anesthesia – Coronary artery bypass grafting is performed under the influence of general anesthesia. CABG surgery generally takes four to six hours of time span to complete.
- Incision – Cardiac surgeons create an incision in breast-bone (sternum) for opening the chest of patients & gaining access to the heart. If cardiac surgeons use internal mammary artery, it is separated from the chest wall. Whereas, if a radial artery is being used, it is eliminated from arm or leg of the patients. For attaching bypass vessel to coronary artery, the heart needs to be stopped temporarily using chemicals.
- Heart-Lung Machine – When patient’s heart is stopped, blood circulation is regulated with a heart-lung machine. This machine works like the heart & lungs, supplying blood & oxygen to the body. Medications, nutrients & vital fluids may be added to the blood while it passes through the heart-lung machine.
- Completion – Cardiac surgeons sew one edge of the graft onto the aorta & another edge to a portion of coronary artery beyond the narrowing, & thereby bypass the diseased region. In this way, a CABG surgery is performed.
After surgery, patients will have to spend 1 – 2 days in an ICU where their heart rate, oxygen level & blood pressure will be regularly monitored. Patients may get essential medications through an intravenous line to control blood circulation & blood pressure. During this span, patients will also have bandages on the chest incision & on the regions where a vein or artery was taken off for grafting. Patients will be shifted to another hospital room once they become stable & will be discharged after a few days time. Cardiac surgeons will give them specific guidelines for recovering at home as given below.
- How to take care of healing incisions
- How to identify signs of infection
- When to contact the surgeon & make follow-up appointments
Complete recovery from CABG surgery may take 8 to 12 weeks of time or even more. Surgeons will advise patients as to when they can start physical activities again. For a healthier recovery, patients must obey all these instructions given by cardiac surgeons.
While undergoing CABG surgery, patients must keep in mind the risks & complications associated with it. A few of them are listed below.
- Adverse reactions to anesthesia
- Discomfort or itching
- Muscle tightness around shoulders
- Chest pain
- Blood clot
- Wound infection & bleeding
- Heart attack or even death
These complications can be minimized by taking proper medications & obeying instructions of respective cardiac surgeons.
Patients who undergo coronary artery bypass graft surgery can have greatly improved results. Main outcomes of CABG surgery include the following.
- CABG surgery is extremely helpful in relieving angina & other severe conditions of the heart.
- It improves long-term survival of patients suffering from stenosis of multiple arteries or low heart muscle pump function.
Most patients remain free from these symptoms for 12 – 15 years after CABG surgery. In addition to this, patients will have a healthy heart if they maintain a healthy diet & daily exercise routine.
Medical Tourism in India for Best Coronary Artery Bypass Graft Surgery
India is the top-most medical tourism destination for providing cardiac surgeries & treatments to international patients. Success rate of coronary artery bypass graft is very high in India. Overseas patients can avail high-class cardiac surgeries like CABG at the most economical costs. They can save up to 70 percent of cost on treatment for CABG surgery procedures as compared to cardiac treatments in other western countries like the UK, Australia, Canada, & United States.
Affordable CABG Surgery with Travcure Medical Tourism
Travcure Medical Tourism is a foremost provider of quality coronary artery bypass graft procedure & other cardiac surgeries in India. Travcure has an excellent network of cardiac surgeons & cardiologists who are well-experienced in managing CABG surgeries. Compassionate & dedicated medical experts at Travcure wholeheartedly assist global patients & additionally provide rejuvenation packages for a peaceful healing vacation at an exotic resort following CABG surgery in case you are inclined to make your healthcare journey a memorable experience.
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