In CABG, the surgeon grafts a few new vessels and literally bypass the existing blockage. Let us imagine an everyday scenario. There is always a traffic blackspot at the same junction. The engineer then built a flyover to bypass this roadblock and allow traffic to flow smoothly beyond it. This exactly what the heart surgeon does in coronary artery bypass grafting.
This is an open chest surgery carried out under general anaesthetics. Patient with severe multiple vessels disease and diabetes will often be referred for bypass surgery. It is the most frequently performed surgery by the heart surgeon with excellent result. The operation takes about 2 hours and you will be expected to stay in intensive care unit for 1 to 2 days post operatively and a further 4 to 5 days recuperating in the ward.
While the recovery time and subsequent time out may take 1 to 2 months most patients do get back to full recovery with a very good long term outcome.
- Isn’t open heart surgery too risky for me?
- The risk versus benefit of any major decisions must be carefully evaluated let alone something as important as your heart. In severe multiple vessels heart disease, the risk of not unblocking these arteries can significantly limit our life expectancy so the risk of not having the operation may be much higher than going through it. The surgeons employ a set of internationally adopted risk profiling criteria to estimate the risk of the operation. This will be discussed in details during the consultation and allow you to make an informed decision.
- My health will never be the same after this operation?
- This is simply not true. Vast majority of patients make an uneventful recovery. In a few months you will be back to your active routine lifestyle. In fact, a lot of the patients felt a second lease of life as their heart are once again able to get a healthy supply of blood and oxygen through the new grafts.
- I heard about minimal invasive coronary artery bypass (MIDCAB) surgery. Can you tell me more about this “keyhole” surgery?
- In a very selected group of patients they may only need a single bypass graft to the blocked left coronary artery. Skilled surgeons can do a small incision between the left ribs and free up the rib cage artery (internal mammary artery) and graft it to the heart. This has the added benefit of a smaller scar, much faster recovery and no extra surgical wound in the leg.
It is also possible to combine coronary angioplasty with this MIDCAB surgery in a hybrid approach. Here the surgeons will put a single graft and the cardiologist place stents in the other 2 vessels hence unblock all the arteries. These are highly specialized procedures and careful discussion amongst the surgeon, the interventional cardiologist and the patient should take place before committing to it.