CORONARY ARTERY BYPASS GRAFT SURGERY

What is CABG?

Coronary Artery Bypass Grafting (CABG), also known as Coronary Artery Bypass Surgery & popularly Heart Bypass or Bypass Surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. Obstructed coronary artery means when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue.

Clinical Presentation : 

A) Typical :

·          Angina

·         Chest discomfort

·         Breathlessness

·         Jaw Pain

B) Atypical :

·         Syncope

·         Vomiting

·         Unexplained sweating

·         Epigastric- discomfort

·         Myocardial infarction

·         Dyspnoea

·         Arrhythmia

·         Cardiac failure

·         Sudden death

·         Silent Ischemia

Indications for CABG :

·         Left main disease

·         Left main equivalent

·         Critical TVD

·         MI with its Mechanical complications

·          Chronic total occlusion

·         Length of lesion 13-18 mm - 30% re-stenosis

·         Bifurcation and ostial lesions

·          Vessel size  < 2.5mm - 37%  re-stenosis

                                    > 3.5mm - 7% re-stenosis

·          Diffuse In - stent Stenosis

·         Diabetes - better results with CABG

·         It is performed to relieve angina (a pain that radiates in the upper left quadrant of the body due to the lack of oxygen reaching the heart).

·         Unsatisfactorily controlled by maximum tolerated anti-ischemic medication

·         Prevent or relieve left ventricular dysfunctions (eg. LVH), and/or reduce the risk of death.

Symptoms for the procedure

Symptoms of coronary artery disease may include, but are not limited to, the following:

·         Chest pain

·         Fatigue

·         Palpitations

·         Abnormal heart rhythms

·         Shortness of breath

What are two main approaches of CABG?

Arterial Grafting :

The left internal thoracic artery (internal mammary artery) is diverted to the left anterior descending branch of the left coronary artery.

Venous Grafting :

In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow.

Why Desun is Superior in performing CABG?

A) Regularly performing Off-pump CABG :  A coronary artery bypass graft (CABG) is done without putting the patient on the heart-lung machine. Off-pump CABG permits surgery on multiple vessels within the heart by mechanically stabilizing it. Off-pump surgery is minimally invasive, as compared to surgery on the heart-lung machine.

Advantages:

·         Less number of Mortality rate

·         No aortic cannulation -> less risk of dissection, embolism

·         No atrial cannulation -> less atrial injury, arrhythmias

·         No cross-clamping -> less risk of plaque embolism, CVA, MI

·         No activation of co-agulation, kallikrein, inflammation caused by tubing -> less co-agulopathy, less bleeding, less transfusion

·         No cardioplegia -> no K+ load, fluid load, coronary air embolism

·         No risk of bypass machine failure -> air embolism

·         less equipment

·         less staff requirement

B)            Desun Performs minimally invasive cardiac surgery : Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeon’s hands through these small incisions in performing the operations.          

Standard Sternotomy Incision This 8 to 10 inch incision splits the entire breastbone.	Mini-Sternotomy Incision This 4 to 5 inch incision just splits the upper third of the breastbone.

Mini-Thoracotomy Incision This 3 to 4 inch incision is made between the ribs whereby no bone is cut.

Port-access Incision Robotic instruments are passed through several 1/2 inch incisions between the ribs.

What are the benefits of minimally-invasive cardiac surgery?

Minimally invasive surgery confers many advantages over standard approaches derived largely from the reduced trauma to the chest wall tissues. The benefits of minimally invasive cardiac surgery include:

·         Smaller incisions

·         Smaller scars

·         Reduced infection risk

·         Less blood loss

·         Less pain

·         Shorter hospital stays : Stays after minimally invasive operations are from 3 to 5 days compared to 5 to 7 days for traditional sternotomy-based cardiac operations.

·         Fewer physical restrictions : Patients undergoing standard incision cardiac operations are restricted from driving an automobile or lifting objects weighing more than 5 pounds while patients undergoing minimally invasive cardiac surgery are not subject to these restrictions

·         Shorter recovery time : Recovery times after minimally invasive operations are from 2 to 4 weeks compared to 6 to 8 weeks for standard sternotomy-based cardiac operations.