Often pronounced as ‘cabbage’, Coronary Artery Bypass Graft Surgery (CABG) is one of the most common surgeries performed today. Also called bypass surgery, it was first performed in the 1960s and since then has undergone many technical and clinical developments.
What is CABG Surgery?
This surgery is performed when the coronary arteries, the arteries that supply blood to the heart, are blocked. The treatment involves creating a new pathway for the blood to reach the heart muscle. In CABG, a blood vessel, like a vein from the leg or an artery from the arm or the chest wall, is removed to bypass the narrowed or blocked coronary artery. The blood vessel that is used to bypass the artery is called a graft and is used to restore the blood flow to the heart.
The Substitute Blood Vessel
The substitute blood vessel for the blocked artery can be taken from the chest, legs, or arms. Grafts chosen from these parts of the body are safe to use as there are several other pathways to help the blood flow to and from those tissues, making it safe for the medical procedure. However, it has been observed that the internal mammary arteries that are in the chest give the best long-term results, with more than 90% of the replaced vessels performing well even after 10 years. In addition to this, saphenous veins from the leg or the radial artery from the wrist can also be used for the procedure. Sometimes CABG is performed with all artery grafts and sometimes the vessels used are a combination of arterial and venous grafts. Based on the number of coronary arteries that are blocked, a patient may need to undergo one or more bypasses.
Benefits of The Surgery
The surgery is performed to help heart patients in the following ways:
- Reduces the risk of a heart attack
- Manages the blockage of blood flow to the heart
- Improves the blood flow and oxygen supply to the heart
- Relieving chest pain (angina)
- Improves the ability for indulging in physical activity
How is The Surgery Performed?
As the surgery is related to the heart, people often panic. However, there is no need to as CABG is a very simple and standard medical procedure. In a traditional bypass heart surgery, an incision of about 6 to 8 inches is made down the centre of the breastbone for allowing direct access to the heart. The patient is then connected to the heart-lung bypass machine, which allows for the blood to circulate. The heart is then stopped, thus allowing the surgeons to perform the procedure.
Types of Bypass Surgery
- Off-Pump Heart Bypass Surgery
- Minimally Invasive Heart Bypass Surgery
- Robotic Heart Surgery
Off-Pump Heart Bypass Surgery
In case of an off-pump heart bypass surgery, the procedure is performed while the heart is still beating. Here, the heart-lung bypass machine is not used. However, with advanced operating equipment, surgeons can hold certain portions of the heart while bypassing the blocked artery. During the surgery, barring the portion undergoing the bypass, the rest of the heart continues to pump and circulate blood.
Minimally Invasive Heart Bypass Surgery
The minimally invasive heart bypass surgery (MICS CABG or MICAS) is a technique in which the surgeon approaches the heart through the side. A small incision of 4 cm is made on the side of the left chest to approach the heart. By splitting the muscle and without having to cut any bones, the surgeon can enter the chest through the ribs. The vessel from the leg that is used as the graft is removed using the endoscopy procedure (the endoscope is a thin surgical tube that has a light and camera at the end). This procedure is called Endoscopic Vein Harvesting (EVH). Minimally invasive heart bypass surgery has many advantages, like less pain, a positive effect on breathing, very less blood loss, low risks of infection, and an early discharge from the hospital.
Robotic Heart Surgery
Robotic heart surgery is one of the latest advancements in the bypass medical procedure. With the help of robotic-assisted techniques, surgeons can perform the surgery in a closed-chest, beating heart environment using much smaller incisions as compared to other types of bypass surgery. However, the patient might have to undergo some tests prior to the surgery as it is important to check if they are fit for robotic heart surgery.
Future Development
Over the years, heart surgery has seen a lot of development. From being a rarely performed surgery, it has become quite a common procedure today. There have also been major advancements in the procedure with the introduction of robotic heart surgery, minimally invasive surgery, and so on, making heart surgery safer and more accepted. Today, development for ‘hybrid suits’ that allow for simultaneous or staged CABG and stenting procedures is being done. With these, continued research into various approaches, medical inventions, and methods may make heart surgery less invasive, and lower the risks even further in the future.
