Coronary Artery Bypass Graft CABG Surgery In India

Coronary Artery Bypass Graft CABG Surgery

CABG is the most common type of open-heart surgery in the United States. Doctors called cardiothoracic (KAR-de-o-tho-RAS-ik) surgeons do this surgery.

Other Names for Coronary Artery Bypass Grafting

Bypass surgery

Coronary artery bypass surgery

Heart bypass surgery

CHD isn't always treated with CABG. Many people who have CHD can be treated other ways, such as with lifestyle changes, medicines, and a procedure calledangioplasty (AN-jee-oh-plas-tee). During angioplasty, a small mesh tube called astent may be placed in an artery to help keep it open.

CABG or angioplasty with stent placement may be options if you have severe blockages in your large coronary arteries, especially if your heart's pumping action has already been weakened.

CABG also may be an option if you have blockages in the heart that can't be treated with angioplasty. In this situation, CABG is considered more effective than other types of treatment.

If you're a candidate for CABG, the goals of having the surgery include:

Improving your quality of life and decreasing angina and other CHD symptoms

Allowing you to resume a more active lifestyle

Improving the pumping action of your heart if it has been damaged by a heart attack

Lowering the risk of a heart attack (in some patients, such as those who have diabetes)

Improving your chance of survival

You may need repeat surgery if the grafted arteries or veins become blocked, or if new blockages develop in arteries that weren't blocked before. Taking medicines as prescribed and making lifestyle changes as your doctor recommends can lower the chance of a graft becoming blocked.

In people who are candidates for the surgery, the results usually are excellent. Following CABG, 85 percent of people have significantly reduced symptoms, less risk of future heart attacks, and a decreased chance of dying within 10 years.

Coronary Artery Bypass Graft CABG Surgery

For A Patient From United States

Procedures Name No. of Travellers No. Of Days In Hospital $ Sharing cost $ Single cost
Coronary Artery Bypass Graft(CABG) 1 8 Days(2days ICU+6days room) 6500 7500

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More About Coronary Artery Bypass Graft CABG Surgery

How a coronary angioplasty is performed

A coronary angioplasty is performed using local anaesthetic, which means you'll be awake while the procedure is carried out.

A thin flexible tube called a catheter will be inserted into one of your arteries through an incision in your groin, wrist or arm. This is guided to the affected coronary artery using an X-ray video.

When the catheter is in place, a thin wire is guided down the length of the affected coronary artery, delivering a small balloon to the affected section of artery. This is then inflated to widen the artery, squashing fatty deposits against the artery wall so blood can flow through it more freely when the deflated balloon is removed.

Frequently asked Questions About Coronary Artery Bypass Graft CABG Surgery

Coronary artery bypass grafting is a procedure performed on people who are suffering from severe heart conditions, such as coronary atherosclerosis or acute coronary syndrome. 

This condition results from plaque build-up overtime on the inner artery walls. The hardened arteries are not able to expand to their fullest capacity to let the blood flow through into the heart.

In the CABG procedure, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery bypasses the blocked portion of the coronary artery. The grafted artery thus becomes a new path for the oxygen-rich blood to flow to the heart muscle.

During a single surgery, the surgeons can bypass multiple coronary arteries.

CABG is performed under general anesthesia and the cost of the procedure in India can vary from Rs. 2,00,000 to Rs. 5,00,000 depending on the patient’s medical condition, the hospital amenities, and the surgeon’s fees. The entire procedure generally takes 3 to 6 hours to complete

You are eligible for coronary artery bypass grafting if you suffer from severe coronary artery disease which cannot be corrected with balloon angioplasty, laser angioplasty or stent placement. The surgery may be risky for you if you:

have other chronic health conditions, including peripheral artery disease, diabetes, high blood pressure, kidney or lung disease

consume a lot of alcohol

Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depends on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure

There are two different methods of performing CABG:

  1. On-pump CABG which is the traditional way and time honoured way of performing CABG

  2. Off-pump CABG which is the newer way. 

On-Pump CABG Procedure

On-Pump Coronary Artery Bypass Grafting involves the following steps:

  1. At the outset, you are administered general anesthesia by an anesthetist. 

  2. A breathing tube is inserted into your throat to help you breathe. 

  3. A catheter is placed in your bladder to drain your urine. 

  4. Once the anesthesia takes effect, the cardiac surgeon makes an incision over the breastbone called the sternum.

  5. He then saws (cuts) through the breastbone (sternum). This procedure is called a median (middle) sternotomy (cutting of the sternum).

  6. Once the sternum is cut, the surgeon proceeds to open the rib cage to get to the heart. 

Please Note: In the on-pump CABG procedure, your circulatory system is connected throughout to a cardiopulmonary bypass pump (or a heart-lung machine). This machine temporarily takes over the function of your heart and lungs through the course of the surgery, allowing your heart to be stopped while your surgeon performs the procedure of sewing the grafts into place. 

  1. The doctor takes a healthy artery or vein from your leg or chest.

  2. He now grafts or connects one end of the healthy artery above the blocked artery in your heart and the other end below the block. The grafts are sewn in place.This way, the blood flows through the newly grafted artery and goes around or bypasses the blocked part of the coronary artery to reach the heart.

  3. With the graft securely in place, your surgeon uses electrical signals to restore your heartbeat and attaches a temporary pacemaker (a small device placed in the chest to control abnormal heart rhythms) to the heart.

  4. Once your heart is beating normally, the heart-lung machine is disconnected.

  5. Your surgeon then positions the rib cage back in place and wires the breastbone together.

  6. Finally, he sutures the incision. 

  7. A temporary drainage tube is inserted through the skin beneath the incision, which is hooked to a machine to help drain out extra air and blood. The tube is taken out in about a day or when the drainage is stopped.

off-Pump Coronary Artery Bypass Grafting involves the following steps:

  1. At the outset, you are administered general anesthesia by an anesthetist. 

  2. The doctor makes an incision to remove a vessel. Often this is a vessel taken from your chest wall or your leg.

  3. If you are undergoing traditional off-pump CABG, your doctor makes an incision down the middle of your chest to separate your breastbone.

  4. If you are undergoing a minimally invasive off-pump CABG, your doctor may make a small incision down the middle of your chest and separate part of your breastbone. Sometimes doctors use special instruments and a camera to do the surgery. In this approach, your doctor makes several small holes in your chest, between the ribs. Some doctors use robot-controlled arms to perform the surgery.

  5. Your heart will keep beating throughout the surgery, unlike on-pump CABG procedure where your heart stops functioning and the heart-lung machine takes over its function.

  6. Your doctor now grafts or attaches the removed vessel to the aorta, the main blood vessel going out to the body and the other end of the vessel to the blocked coronary artery, to bypass the blockage.

  7. Once the grafting is complete, the doctor wires your breastbone back together (if necessary).

  8. Finally, he sutures the incision. 

The off-pump CABG procedure is generally preferred for :

  • patients with aortic disease precluding bypass

  • patients at a higher risk of complications from the on-pump procedure, such as:

    • those suffering from ventricular dysfunction

    • those suffering from renal insufficiency

    • those suffering from diabetes

    • those who are of advanced age

    • those suffering from chronic lung disease

Some possible surgical risks for coronary artery bypass surgery include:

  • High fever

  • Infection

  • Bleeding or infection at the site of the incision

  • Reaction to the anesthesia

  • Blood loss

  • Developing a blood clot that could affect the lungs

  • A sudden heart attack or stroke

  • Death during the surgery

  • Abnormalities with heart rhythm called arrhythmia

  • Chronic pain in sternum or breastbone (wound site) 

  • Pneumonia

  • Difficulty in breathing

  • Kidney failure

  • Impairment of cognitive functions

  • Pain in the chest and fever for up to six months

Complications can arise during or after coronary artery bypass surgery, which include:

  • No proper blood flow to the heart due to bypass not functioning properly.

  • Blocking of the new bypass blood vessel.

  • Death during surgery due to heart not functioning or responding.

  • Nerve damage in the leg from where the graft (blood vessel) was taken.

  • Pain and swelling in the legs.

The benefits of coronary artery bypass surgery are:

  • Relief from chest pain or angina.

  • A decreased risk that the coronary arteries will become completely occluded, which decreases the risk of a heart attack.

  • Results last longer as a surgical revascularization is long lasting than a stent procedure.

Alternatives to coronary artery bypass grafting include:

Medications that dilate your blood vessels to allow normal blood flow. The doctor may prescribe medications, such as beta-blockers, nitrates, calcium channel blockers, and lifestyle changes, such as to quit smoking, eating a more heart-healthy diet and exercising. These changes can effectively alleviate your heart condition. 

  1. Balloon Angioplasty
  2. Coronary Stenting
  3. Laser Angioplasty

The pre-procedure guidelines you need to follow before undergoing a coronary artery bypass grafting are:

  • You need to discuss your complete medical history with your doctor prior to the surgery and let him/her know of any other medical conditions that you suffer from, apart from the heart-related conditions. You also need to mention if you are allergic to any substances.

  • Prior to the surgery, the following tests will be performed:

  • chest x-ray
  • urine test

  • electrocardiogram (ECG)

  • blood tests

  • You will be advised to stop taking drugs containing blood thinners such as aspirin for at least 5 days before the surgery, since these medicines may lead to severe bleeding during and post the surgery. 

  • Your doctor will advise you to stop smoking for at least two weeks prior to the surgery. Smoking will interfere with the healing process as people who smoke tend to have more mucus in their lungs, which is difficult to remove after surgery.

  • You will be advised not to take anything orally (food, liquids or tablets) at least 12 hours prior to the surgery. You may be given special instructions from your doctor if you are a diabetic. 

  • The day before surgery, you may be asked to scrub your abdomen and legs several times with a special soap to kill germs. This procedure may vary in different medical facilities.

  • You need to let the doctor know about the different medications you are currently taking, including herbal supplements.

  • You need to sign a consent form prior to the surgery. 

  • An anesthesiologist will explain about the anesthesia dosage that will be given to you and the side effects that may occur from it, prior to the procedure. 

  • It will be wise to ask your cardiologist about the side effects of the surgery and if you need to take any precautions in advance.