What is Coronary Artery Bypass Surgery (CABG)?

When you have multiple blocked coronary arteries, a heart bypass surgery can improve the blood flow through arteries. Your cardiac surgeon will use blood vessel grafts to re-establish the blood flow to your heart muscles. In the operation, the surgeon will attach these grafts above and below the blocks. It creates a new network for blood flow. Another name for heart bypass surgery is Coronary Artery Bypass Graft surgery or CABG.

If the blocks are small and not many, then an angioplasty or a cardiac catheterization may help. But if your blocks are long, severe, or multiple (triple vessel disease), then a bypass surgery is indicated. 

A heart bypass surgery team will consist of cardiac surgeons, anaesthetists, cardiac nurses, and other operation theatre staff. The duration of the surgery will be around two to three hours. Complete recovery will take about seven to twelve days. Heart bypass surgery has a success rate of more than ninety-nine percent. Most of those who have surgery will have an incident-free healthy life.

Heart Bypass Surgery - When to do?

You may be advised a bypass surgery, if your angiography shows:

• Blocks in more than one coronary artery (> 70 % stenosis in each)
• Block in the left main coronary artery 
• Triple vessel disease
• Calcified stenotic lesions with expected difficulty in angioplasty
• Proximal LAD lesion
• Complete cut-off (100 %) occlusion of a coronary artery
• Diabetic patient or lower EF with multiple coronary artery blockages
• Blocked stents (In stent restenosis)

Heart Bypass Surgery – What to expect?

• The patient is generally admitted in the hospital the night before day of surgery.
• Your anaesthetist will visit you for a brief check-up and you will be asked to not have any food the previous night. On the morning of surgery, the hospital staff will take you to the operation room one hour before the surgery. The surgeon and anaesthetist will then have a final look at your health status. If everything is fine, preparations for giving you general anaesthesia will begin. You will begin to sleep within a few moments of anaesthesia and will remain so for the rest of the surgery.
• The surgeon will start by making a midline incision on your chest. Next, the surgeon will divide the breastbone in the middle to reach the chest cavity where your heart lies.
• Once the chest is open, the surgeon initially harvests the blood vessel conduits from the chest wall and either your arm or leg (if needed).
• In most cases, bypass surgery by Dr. Manish Hinduja is on beating heart only(off-pump).
• During beating heart bypass surgery, surgeon will attach the grafts above and below the blockage. The blood will then start flowing through the graft. Once happy with the function of heart, your surgeon will close the chest with wires. The surgical incisions will be closed using sutures or staples.
• Few patients may undergo minimally invasive coronary bypass surgery. In this, the surgeon will make a smaller incision (compared to other modes) in the rib cage. It has advantages of early recovery, less blood loss, no fracture on chest and lesser wound healing related complications.
• You will be moved to the recovery room. You might have breathing assistance if necessary. After an hour or two, you will start waking up. You will find that there is a dressing over the chest. There will also be some wires that connect your body to some monitors around you. These are to observe the way your body is recovering from surgery. 

Beating Heart CABG - How it is done?

In most cases, CABG can be performed on beating heart, i.e. without the use of the heart-lung machine or need for arresting the heart. In this technique of "beating heart" (also called off-pump) CABG, a mechanical stabilizing device and/or a mechanical positioner (also called the 'Octopus- evolution' and the 'Starfish' devices) is used to limit the movement of the heart to help the surgeon in performing the surgery while the heart is beating.

The main benefits of off-pump surgery include a shorter hospital stay and recovery time, less bleeding, less blood transfusion, less potential for infection, reduced stroke rates, faster ambulation and less trauma.

Choice of conduits: The choice of conduits continues to be the universal use of the Left internal mammary artery bypass (LIMA) to the Left anterior descending artery (LAD). The choice of the other conduits would be either pedicled RIMA, a free radial artery and the standard reversed autologous reversed saphenous vein graft. Dr. Manish Hinduja prefers to perform total arterial CABG wherever possible, to enhance the long-term outcome of bypass surgery for the patient.

Recovery from Heart bypass surgery during hospital stay

• While you recover from the effect of anaesthesia in the ICU, the intensivist and nurses will keep a close watch on your vital functions. Plastic tubes are left in place in chest to allow any drainage of excess blood from in and around the heart. The chest tubes are removed a day after the surgery. Your doctor will prescribe pain killers to relieve pain. You will go back to your room usually in 2 days, unless there is a problem or you need extra care.
• You will be able to sit up in your bed the day after surgery. Liquid food is preferable in the first two days. After two days, you can have solid diet if your appetite is back.
• While in the ward, you will have to walk a few steps now and then. You will also have to do a few coughing exercises to improve your lung function. It will also help to prevent lung infections like pneumonia.
• Once your medicines are optimised, wound is healthy and you feel confident enough (usually five or six days after surgery), you will go back home from hospital.

After-effects of Bypass Surgery

Heart bypass is a major operation that has some short-term effects on your body. The after-effects are natural, and everyone having the surgery will have one or the other. Some of the after-effects that you can expect are:

• Tiredness
• Difficulty in sleeping
• Tingling or pricking sensation in the area of blood vessel grafts
• Constipation
• Feeling less hungry than before
• Pain in the back
• Muscle pain or cramps 
• Feeling emotionally low
• Mood swings

There is no need to worry about these after-effects. All these after-effects are temporary and you will be back to normal within a few days.

Risks and complications

Although the complication rate with a routine off pump CABG is very low in our surgeon’s hands (0.9%), there are certain risks associated with CABG procedure worth mentioning.

• Bleeding
• Heart attack
• Stroke
• Infection
• Irregular heartbeats

Dr. Manish Hinduja is ranked by multiple agencies and families as the “safest bypass surgeon” and “best heart surgeon in Mumbai for bypass surgery”. An experience of more than 10 years and over 7000 successful surgeries with a remarkable international experience marks him as one of the top heart surgeons in Mumbai. He has also received the award of Best heart surgeon in Mulund and Thane area by Rotary club Mulund area.