Coronary Artery Bypass Grafting (CABG) or simply a “bypass” is a surgical procedure to improve the blood supply to the heart muscle when its natural arteries have significant blocks; blocks that reduce blood flow and cause exertion related symptoms like chest pain or discomfort (also called angina) or a heart attack. In this surgery, the block is bypassed using an alternate channel of blood supply (a graft), thus improving flow to the heart muscle and relieving the effects of a deficient blood flow to the heart muscle. People who suffer from severe coronary artery disease (CAD) are typically recommended this surgery.
Prior to the operation, it is important to ensure that the patient is fit for surgery. A detailed medical history and some routine investigations are carried out to assess one’s fitness to stand the procedure. Risk factors like diabetes and hypertension should be controlled, and if one is smoking, it should be completely stopped. Treatment for associated diseases like those of lung or kidney is continued.
If your doctor suggests getting a Coronary Artery Bypass Grafting, be sure to ask him the following five questions:
1. Do I really need a CABG?
If you have a documented coronary artery disease and have disabling symptoms despite full medications, CABG should be considered esp. if there are multiple blocks, there are high-grade stenosis, you have diabetes or your heart function is subnormal. Even if there are no symptoms, high-grade blocks especially the main left-sided artery and poor heart function indicate that a CABG would be beneficial. On the other hand, if the heart function is normal and the blocks in the arteries are lower down in the course of the arteries, and symptoms are well controlled with drugs, surgery could be deferred.
2. Why can’t I go for a Coronary Angioplasty instead?
Contrary to what many people believe, bypass surgery and coronary angioplasty are not necessarily interchangeable options, and angioplasty is often not as effective as surgery in many conditions of coronary blocks. It is now established (through several studies world over) that long-term results of CABG in the situations named above are far better than with angioplasty.
3. What are the possible risks of CABG?
In a busy hospital with a well experienced team, the surgery can be very safe. However, its risks to life can vary from as low as 1% to as high as 25-30%. Risks are higher in patients older than 70 years of age, in women, in patients having additional problems (e.g. a patient with a recent stroke, a patient on dialysis or a patient on domiciliary oxygen), in situations where surgery is done as an emergency treatment and when some additional procedure is to be carried out besides bypass surgery. Risk is also higher if the pumping power of the heart is Low (less than 30-35%).
4. Does bypass surgery remove the blockages?
No, the blocks are not removed but are bypassed using alternate conduits of blood supply from either legs/arms or the arteries at the back of the breastbone.
5. How soon can you get back to work?
It would depend on the nature of your work and your pre-operative status. In most cases, once the pain related to surgery subsides, one can get back to full activity within 3 to 6 weeks. Inability to resume work is often related to one’s mental make-up and will power.
Dr. Anoop Ganjoo is a Cardiac surgeon at the Indraprastha Apollo Hospitals in Delhi. After getting his entire medical education (MBBS, MS, MCh) from AIIMS, New Delhi, he obtained an advanced fellowship at a renowned university in USA. he has over 2 decades of rich professional experience, and has been associated with Apollo Hospital for more than 13 years. Dr. Ganjoo specializes in adult cardiac surgeries especially Bypass Surgery and Redo CABG, Valve Repair and Replacement, Thoracic Surgery and Peripheral Vascular procedures.
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Dr. Anoop Ganju is a Senior Consultant in the Cardiology Department of Indraprastha Apollo Hospital . He completed his medical education from AIIMS, New Delhi. He then went on to persue a fellowship from USA and has two decades of professional experience in the field. He has been associated with Indraprastha Apollo since the last 13 years. Dr. Ganju is an accomplished professional in his field and his specialities include: Adult Cardiac surgeries- CABG, Valve Repair, Thoracic Surgery and Peripheral Vascular work .
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