Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (coronary arteries) become hardened and narrowed due to atherosclerosis. This condition, known as coronary artery disease, is the leading cause of death in the US for both men and women. As CAD progresses over many years, fatty deposits called plaque build up inside the coronary arteries. This blockage reduces the flow of oxygen-rich blood to the heart muscle. If this flow is reduced too much, angina, heart attack, or other serious problems can occur.
The Coronary Artery Bypass Grafting Procedure
Coronary Artery Bypass Grafting is a surgical treatment done to improve blood flow to the heart. During CABG surgery, a healthy artery or vein from the chest, leg or arm is attached to bypass blocked portions of the coronary arteries. This creates an alternate path for oxygen-rich blood to flow to the heart muscle. The procedure is performed under general anesthesia and, for most people, takes between 3 to 6 hours to complete.
First, the surgeon will cut through the breastbone to open the chest cavity and expose the heart. Next, blood flow is temporarily diverted from its normal path to use an artificial heart-lung bypass machine while the grafts are attached. A section of a vein or artery is harvested from elsewhere in the body, such as the arm or leg. The surgeon then creates graft attachments from the graft vessel to points on the coronary arteries past and before the blocked areas. This allows blood to flow around the blockages through the new bypass graft conduits. Multiple grafts can be attached as needed to improve circulation. Once all grafts are in place, blood flow is returned to the heart and the chest is closed.
Coronary Artery Bypass Grafting Suitable Candidates
CABG surgery is typically recommended for people diagnosed with significant blockages (greater than 70% narrowing) in two or more of their coronary arteries. Doctors consider factors like degree of blockage, location of blockages, reduced heart function, and stress test results to determine if CABG may improve symptoms or reduce risk of future heart problems. In general, the procedure is often performed on individuals with:
- Significant blockages, especially of the left main coronary artery or 3-vessel disease
- Prior heart attack and still obstructed arteries
- Angina symptoms that don't improve with medication or angioplasty
- Reduced heart function and edema from past heart attack
- Diabetes and multi-vessel disease
Recovery After CABG Surgery
Many patients typically stay in the hospital for 4 to 7 days after CABG to monitor for signs of complications and begin the recovery process. The sternum needs time to heal after being cut open for the procedure. Activity is restricted for 6-8 weeks to allow the breastbone and graft sites time to fully strengthen.
Common aftereffects during initial recovery include breastbone or chest pain, shortness of breath, fatigue, and constipation from medication side effects. Physical therapy and daily walking helps regain stamina and lung function over the first month. Most people gradually return to regular light activities around 4-6 weeks, but some limitations like heavy lifting may remain for 3 months. Regular follow-up visits with the cardiac surgeon ensure the grafts are functioning well. With proper recovery, CABG significantly improves quality of life and reduces future cardiac risks for people with advanced CAD.
Reducing Risks of CABG Surgery
While CABG offers improved blood flow to the heart muscle, the open-heart surgery itself carries risks that must be weighed against potential benefits for each individual patient. Advancements in surgical techniques and tools have significantly reduced CABG morbidity and mortality rates over time, though risks still include:
- Bleeding - Excessive bleeding at the surgical sites may require blood transfusions.
- Infection - Any type of invasive surgery risks infection of the chest incision, sternal wound or bypass graft sites. Antibiotics help reduce this risk.
- Heart attack - Rarely, portions of the heart muscle receive inadequate blood flow during surgery and develop damage.
- Stroke - Air bubbles or clots can dissolve and block blood vessels leading to the brain during surgery.
- Pneumonia - Patients are at risk due to reduced lung function and deep breathing exercises after surgery.
- Arrhythmias - Heart rhythm problems like atrial fibrillation may develop due to inflammation or ischemia during surgery.
- Graft failure - Over time, bypass grafts themselves can become blocked again, necessitating repeat procedures.
Quitting smoking, controlling medical conditions like diabetes and high blood pressure, maintaining a healthy lifestyle and weight can help optimize a patient's heart health before CABG to lower surgical risks. Outcomes have significantly improved at high volume medical centers with experienced cardiac surgery teams. With proper surgical candidacy evaluation, risks are carefully weighed against long-term health benefits for each individual patient.
The Success of CABG Surgery
CABG has proven to be one of the most effective treatments for coronary artery disease. When performed on appropriately selected patients, bypass surgery has been shown to:
- Reduce angina symptoms in over 90% of individuals, dramatically improving quality of life.
- Decrease the risk of future heart attacks by approximately 50% over long-term follow-up.
- Lower the need for future revascularization procedures like repeat CABG or stenting in vessels grafted during the original surgery.
- Improve survival rates compared to medical management alone in patients with advanced multi-vessel blockages. Average life expectancy increases by 10 years post-CABG.
- Enjoy a low mortality rate of under 3% at high-volume medical centers performing over 150 procedures annually.
While no intervention guarantees lifelong patency of bypass grafts or prevention of future blockages, CABG provides many individuals years of continued improved blood flow to otherwise significantly obstructed heart muscle. Innovations like minimally invasive surgical techniques and arterial grafts now used in some cases provide even better outcomes. With appropriate patient selection and adherence to post-op care recommendations, CABG surgery remains a durable and relatively low-risk option to reduce symptoms and prevent future cardiac events from coronary artery disease.
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