Coronary Artery Bypass Graft Surgery (CABG)

The definition of Coronary Artery Bypass Surgery (CABG - pronounced "cabbage") is a procedure where a surgeon makes new routes (bypass) around blocked or narrowed coronary arteries with one or more grafts (traditional grafts are blood vessels from the patient's arm or leg) allowing increased blood flow to the open grafts past the blockage to supply blood to heart muscle.  The procedure is sometimes done in emergency situations and can be life-saving.
 

Major indications that a person may need CABG are to avoid blood clots and/or arteriosclerosis that block blood supply to the heart and are major causes of heart attacks, and to reduce or stop symptoms of coronary artery disease (CAD) and to preserve heart muscle from damage or muscle death that can lead to disability or death of the patient. Failure of medication to treat CAD or the patient is not a candidate for stenting to treat CAD are other reasons that may require CABG surgery.

In general, the CABG procedure begins with general anesthesia and intubation followed by sawing through the breastbone.

• The heart is cooled with a preservative and then a cardiopulmonary bypass machine (“heart-lung machine”) that takes over as a pump for the heart and also functions as a lung) is started .
• The bypass machine is placed so the aorta can be clamped off to allow bypass grafts to be attached to the aorta in a bloodless surgical field.
• Then bypass grafts are attached to a coronary artery beyond the blockage.
• The heart/lung machine is taken off and the heart takes over after rewarming as the pump that moves the blood.
• The breastbone is then wired back together.
• Other items like breathing tube and chest tubes are removed as the patient continues with recovery.
• Statistics suggest about 5% of new CABG patients need a redo or exploration due to bleeding after surgery.

There are several types of CABG surgery:

1. Traditional: Chest is open..
2. Pump assist: Heart/lung machine used
3. Off pump: No use of heart/lung machine
4. Nontraditional: Small incisions are made with chest closed.
5. Single bypass: One artery is bypassed.
6. Double bypass: Two arteries are bypassed.
7. Triple bypass: Three arteries are bypassed.
8. Quadruple bypass: Four arteries are bypassed
9. Quintuple bypass: Five arteries are bypassed, which makes it  difficult due to getting good bypass vessels

Risks of getting CABG surgery may include:

• Death (3%-4%)
• Heart Attacks (5%-10%)
• Redo for bleeding (5%)
• Stroke (1%-2%)
• Women may have higher statistics due to advanced age and smaller arteries
• Chest infections

In general, sutures or staples are removed after about 7-10 days, leg swelling may continue for about 6-8 weeks as does the breastbone discomfort (the primary source of limiting activity). 

Many patients are recommended to go through a rehabilitation program for 12 weeks after exercise stress testing. Return to work in a non-strenuous job often can begin after 6 weeks.

During and after CABG surgery, heart attacks occur in about 5%-10% of patients.

Overall mortality related to coronary artery bypass graft surgery is about 3%-4%.

In general, about 90% survive five years post surgery and about 74% survive 10 years.

An average cost for a simple CABG varies from about 40 thousand to about 75 thousand dollars in several countries with the US usually charging the highest cost. However, costs still vary and usually increase depending on the complexity of the surgery. India has the lowest reported cost of under 2000 dollars.