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Coronary Artery Bypass Surgery: Overview

Coronary artery bypass surgery, also coronary artery bypass graft (CABG), and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the heart muscle. The surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, called ‘off-pump’ surgery.

History

The technique was pioneered by Argentine cardiac surgeon René Favaloro at the Cleveland Clinic in the late 1960s. Currently, about 500,000 CABGs are performed in India every year.

Terminology

The surgery has several terminologies, the most frequently used being CABG (pronounced cabbage), pluralized as CABGs (cabbages). More recently the term aortocoronary bypass (ACB) has come into popular use. Arteriosclerosis is a common arterial disorder characterized by thickening, weakened elasticity, and calcification of arterial walls, decreasing the blood supply. Atherosclerosis is a common arterial disorder marked by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layer of the walls of large and medium-sized arteries.

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Number of bypasses

The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure. A double bypass means two coronary arteries are bypassed (e.g. the left anterior descending (LAD) coronary artery and right coronary artery (RCA)); a triple bypass means three vessels are bypassed (e.g. LAD, RCA, left circumflex artery (LCX)); a quadruple bypass means four vessels are bypassed (e.g. LAD, RCA, LCX, first diagonal artery of the LAD) while quintuple means five. Less commonly, more than four coronary arteries may be bypassed.

The coronary angiogram is reviewed prior to surgery and the blockages in the coronary arteries are identified. The surgeon will estimate the number of bypass grafts prior to surgery, but the final decision is made in the operating room upon examination of the heart.

Indications for CABG

Several alternative treatments for coronary artery disease exist. They include:

  1. Medical management (statins, antihypertensives, smoking cessation, tight blood sugar control in diabetics)
  2. Percutaneous coronary intervention (PCI)
  3. Both PCI and CABG are more effective than medical management at relieving symptoms. CABG is superior to PCI in multivessel CAD (more than one diseased artery), although the ARTS II registry suggests PCI with drug-eluting stents (DES) may be not inferior to CABG.

Prognosis

Prognosis following CABG depends on a variety of factors, but successful grafts typically last around 10-15 years. In general, CABG improves the chances of survival of patients who are at high risk (meaning those presenting with angina pain shown to be due to ischemic heart disease), but statistically after about 5 years the difference in survival rate between those who have had surgery and those treated by drug therapy diminishes. Age at the time of CABG is critical to the prognosis, younger patients with no complicating diseases have a high probability of greater longevity. The older patient can usually be expected to suffer further blockage of the coronary arteries.

Procedure

  • The patient is brought to the operating room and moved onto the operating table.
  • An anaesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the person unconscious.
  • An endotracheal tube is inserted and secured by the anesthetist or assistant (e.g. respiratory therapist or nurse anesthetist) and mechanical ventilation is started.
  • The chest is opened via a median sternotomy and the heart is examined by the surgeon.
  • The bypass grafts are harvested – frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins. When harvesting is done, the patient is given heparin to prevent the blood from clotting.
  • In the case of “off-pump” surgery, the surgeon places devices to stabilize the heart.
  • If the case is “on-pump”, the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart.
  • One end of each graft is sewn onto the coronary arteries beyond the blockages and the other end is attached to the aorta.
  • The heart is restarted; or in “off-pump” surgery, the stabilizing devices are removed. In some cases, the Aorta is partially occluded by a C shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
  • Protamine is given to reverse the effects of heparin.
  • The sternum is wired together and the incisions are sutured closed.
  • The person is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days).

Why choose India for Coronary Artery Bypass Surgery?

India has become the most preferred medical tourism destination in the world. Most of the foreign patients seeking quality medical treatments and care choose India to get it done at reasonable prices. Indian hospitals have the most dedicated team of healthcare professionals who are internationally recognized in the field of research, diagnosis and treatment for coronary artery bypass surgery.

Coronary Artery Bypass Surgery Cost in India:

The coronary artery bypass surgery cost in India is about $4000-$5000 only. Even after adding the cost for travel and accommodation, the cost for coronary artery bypass surgery in India will help you save about 50-80% of the cost for the same in developed nations.

If you are really seeking treatments for the Coronary Artery Bypass Surgery, kindly fill up the form for a free consultation with our expert cardiologists. You will be provided with thorough analysis and suggestions regarding the Coronary Artery Bypass Surgery you are seeking for.
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