CABG

Coronary Artery Bypass Graft Surgery (CABG) is a medical technique employed for addressing Coronary Artery Disease (CAD). This disease, also known as coronary heart disease (CHD), involves the constriction of coronary arteries, which are responsible for delivering vital oxygen and nourishment to the heart muscle. It occurs due to the accumulation of fatty substances within artery walls, causing a reduction in their diameter. Consequently, this accumulation restricts the flow of oxygen-enriched blood to the heart muscle.

Why is Coronary Artery Bypass Graft Surgery needed?

Your team of heart care professionals will collaborate with you to determine the suitability of CABG. This group may encompass your cardiologist, the heart specialist, and a cardiothoracic surgeon (a practitioner focused on procedures involving the heart, lungs, and chest).

Surgery might not invariably be the optimal choice for everyone. Depending on your general well-being and concurrent conditions, your care unit could suggest you the right treatment. CABG might be advantageous in situations where you have:

• Coronary heart disease accompanied by persistent angina (chest discomfort) unresponsive to medication, or a history of cardiac arrest connected to irregular heart rhythms
• Diabetes
• Experienced a heart attack due to coronary heart disease that can't be adequately addressed through PCI (Percutaneous coronary intervention)
• Multiple obstructed coronary arteries or substantial plaque buildup in the primary left coronary artery that might be challenging to manage with PCI
• Severe heart failure impacting the heart's ability to effectively pump blood

The pre-evaluation is pivotal for ascertaining the appropriateness of CABG as a viable approach and for mitigating possible risks in the perioperative and postoperative periods. Below is an overview of the pre-evaluation process:

Blood Testing: The blood for recommended testing should be drawn within 30 days before your scheduled procedure. Keep in mind that you shouldn't eat or drink anything for 6 hours before this test.

Chest X-Ray: This examination provides the insight into the chest, lungs, heart, large arteries, ribs, and diaphragm. No specific preparation is needed for this test.

Electrocardiogram (ECG): An ECG measures the heart's electrical activity. Electrodes will be placed on specific areas of your body (chest, arms, and legs). This generates a graphical representation (tracing) that can indicate heart-related conditions. No special preparation is required for this test.

Pulmonary Function Test (PFTs): These tests gauge how effectively the lungs take in and release air, as well as how well they manage gases like oxygen. There's no need for preparation, and the test usually takes an hour.

Carotid Doppler/Ultrasound Study (Carotids): This ultrasound assesses carotid arteries for blockages or narrowing that could increase stroke risk. No special preparation is needed. The test typically lasts 30 minutes.

Ankle-Brachial Index (ABIs): This non-invasive test checks for artery blockages in your legs or arms, which could indicate peripheral artery disease. It's important as peripheral artery disease elevates the risk of heart attack, stroke, poor circulation, and leg pain. No preparation is necessary, and the test takes about an hour.

Surface Echocardiogram (Echo): This non-invasive evaluation examines heart valves, chambers, and overall function. No specific preparation is required for this 30-minute test.

Vein Mapping: This non-invasive assessment creates a "map" of leg veins, aiding the surgeon in preparation for bypass graft surgery. No preparation is needed. The test typically takes 30 minutes.

Trans-esophageal Echocardiogram (TEE): This invasive test examines heart valves, chambers, and function. It also assesses the diameter of the aorta. The entire process takes about 1 hour, with 2-3 hours for anesthesia recovery.

ECG-gated SPECT Myocardial Perfusion Imaging (Stress Test): This cardiac scan measures blood flow in the heart muscle at rest and during exercise. A special tracer is injected into a vein, and pictures are taken after exercise. The test may take 3-6 hours.

Heart Catheterization (Cath): It is an invasive test examining coronary blood vessels for blockages. You should not eat or drink for 6 hours before this procedure, and you'll need someone to drive you home afterward. An IV contrast dye is used, and recovery takes about 4-6 hours.

Computed Tomography Scan (CT): This scan assesses the aorta, lungs, and organs. It identifies aneurysms and other issues, aiding surgery preparation. An IV contrast dye is used, and you shouldn't eat for 6 hours before or drink for 2 hours before the test. The scan takes about an hour.

Cardiac Magnetic Resonance Imaging (MRI): This detailed test examines heart structure and function, requiring you to be metal-free due to the MRI's magnetic field.

The Coronary Artery Bypass Graft Surgery involves creating new pathways for blood to bypass the blocked or narrowed arteries, using blood vessels harvested from other parts of the body. During your time in the operating room, you can anticipate the following procedures:

• Administration of Anaesthetics: A combination of medications is delivered through an intravenous (IV) line and a mask to induce a pain-free, sleep-like state. This state is known as general anaesthesia.
• Use of Breathing Apparatus: A breathing tube is inserted into your mouth, connecting to a ventilator—a machine that takes over your breathing during and immediately after the surgery.
• Heart-Lung Machine: Throughout the surgery, a heart-lung machine maintains blood circulation and oxygen supply throughout your body. This process is referred to as on-pump coronary bypass.

Coronary Artery Bypass Graft Surgery usually spans between 3 to 6 hours, contingent on the number of blocked arteries. Typically, a surgeon creates a lengthy incision along the center of the chest, following the breastbone. The rib cage is opened to reveal the heart. Following the chest's opening, the heart is temporarily halted using medication, and the heart-lung machine becomes operational. A section of healthy blood vessel, often taken from inside the chest wall or the lower leg, is extracted. This healthy tissue, known as a graft, is connected below the blocked coronary artery, establishing a new route for blood to bypass the obstruction. The procedure may involve the use of multiple grafts.

After the surgical procedure is completed, healthcare providers restore your heartbeat in the operating room and discontinue the heart-lung machine. The surgeon employs wires to secure the chest bone, and these wires remain in your body once the bone has healed.

Potential complications associated with Coronary Artery Bypass Graft Surgery (CABG) encompass:

• Haemorrhage (bleeding) during or following the surgery.
• Formation of blood clots, which could lead to heart attack, stroke, or lung issues
• Infection at the site of the surgical incision
• Development of pneumonia
• Respiratory difficulties
• Onset of pancreatitis
• Kidney dysfunction
• Irregular heart rhythms
• Graft failure
• Fatality

Your specific medical condition may entail additional risks. It's important to address any concerns with your physician before undergoing the procedure.

During Hospitalization:

Following the Coronary Artery Bypass Graft Surgery, you'll be transferred to the Intensive Care Unit (ICU) for vigilant monitoring. Monitoring devices will continuously display your Electrocardiogram (ECG) pattern, blood pressure, pressure readings, breathing rate, and oxygen levels. The recovery process for Coronary Artery Bypass Surgery (CABG) usually necessitates a hospital stay of several days.

A tube in your throat, connected to a ventilator (breathing machine), will assist your breathing until your condition stabilizes. As you gradually awaken from anesthesia and your natural breathing resumes, your doctor can adjust the ventilator to let you gradually take over breathing. When you're sufficiently conscious and able to cough, the breathing tube will be removed by your doctor.

Subsequent to tube removal, a nurse will guide you to cough and take deep breaths every few hours. Although this might cause discomfort due to soreness, it's crucial to prevent mucus accumulation in the lungs, which could lead to pneumonia. Your nurse will demonstrate how hugging a pillow tightly against your chest while coughing can alleviate the discomfort.

The surgical incision site might be tender or sore for several days post-CABG. Follow your doctor's recommendations for using pain relievers. Note that aspirin or specific pain medications might heighten bleeding risk, so adhere to prescribed medications only.

Your doctor could administer medications through an IV to manage Blood Pressure, Heart function, and any bleeding concerns. As your condition stabilizes, these medications will be gradually reduced and then stopped.

Once the breathing and stomach tubes are removed, and your stability is confirmed, you'll begin consuming liquids. Gradually, solid foods can be reintroduced based on your tolerance.

When your doctor deems you ready, you'll be transitioned from the ICU to a post-surgical nursing unit, continuing your recovery. Your activity level will gradually increase as you start getting out of bed and walking for longer durations. Solid foods can be resumed once your tolerance allows.

After Returning Home:

Once home, it's important to maintain cleanliness and dryness around the surgical area after Coronary Artery Bypass Graft Surgery. Your doctor will provide specific bathing instructions. If not removed before leaving the hospital, your doctor will take out sutures or surgical staples during a subsequent hospital visit. Refrain from driving until your doctor confirms it's safe. You might also have additional activity restrictions.

Inform your doctor if you experience:

• Fever or chills
• Redness, swelling, bleeding, or any drainage from incision sites
• Increased pain around incision sites
• Breathing difficulties
• Rapid or irregular pulse
• Leg swelling
• Numbness in arms and legs
• Persistent nausea or vomiting

Your doctor may offer further instructions post-procedure, according  to your situation.

The process of recuperation following a Coronary Artery Bypass Graft Surgery is a gradual one, with individuals recovering at varying paces. Typically, you should be capable of sitting in a chair within the first day, walking within three days, and manoeuvring stairs around five to six days. The majority of individuals achieve complete recovery within a span of 12 weeks from the surgery. However, if complications arise during or post-surgery, the duration of your recovery is likely to extend.

A subsequent appointment for follow-up is recommended, usually scheduled around 6 to 8 weeks after the surgical procedure.

Adhering to the discharge plan and engaging in a cardiac rehabilitation scheme constitute the most effective strategies for recuperating from bypass surgery. The significance of post-operative care cannot be overstated, as individuals who have undergone bypass surgery face a notably heightened susceptibility to further cardiac incidents. These may encompass recurring chest discomfort, heart attacks, heart failure, and an elevated risk of mortality.

Coronary Artery Bypass Graft Surgery continues to be a recognized treatment option for Coronary Heart Disease, with most procedures addressing cases of disease in multiple vessels. On the whole, there is low mortality rate associated with this surgery, approximately ranging from 2% to 3%. Nonetheless, this advantage is counterbalanced by a complication rate of roughly 20% to 30%.

The survival rates post CABG surgery over a span of twenty years varied by age: 55% for those under 50 years old, 38% for individuals aged 50 to 59, 22% for those aged 60 to 69, and 11% for those over 70 at the commencement of the initial surgical procedure. The survival rates at the 20-year mark after surgery, considering the presence or absence of hypertension, stood at 27% and 41% respectively. Likewise, the twenty-year survival rates were 37% for men and 29% for women.

India's healthcare system capitalizes on decreased labour and infrastructure costs, enabling healthcare establishments to furnish services at more affordable prices. Moreover, the presence of proficient medical experts combined with a competitive market cultivates economically efficient approaches. Additionally, India's thriving pharmaceutical sector frequently manufactures generic drugs, which contributes to a decrease in the overall cost of treatment. This is the reason for the relatively reduced cost of Coronary Artery Bypass Graft Surgery in India in comparison to other nations. 

Nonetheless, the cost of Coronary Artery Bypass Graft Surgery in India might fluctuate contingent on the subsequent key aspects:

• Health insurance coverage
• Out of pocket expense
• Admission charges
• Cardiologist remuneration
• Patient's age
• Severity of artery blockage
• Patient's medical state
• Diagnostic procedure charges
• Medication cost
• Complications encountered post-procedure
• Hospital category
• Chosen room category for admission
• Additional laboratory or diagnostic assessments like X-rays, ECGs, Echo, and others

The expenses associated with the preliminary assessments and examinations conducted prior to the Coronary Artery Bypass Graft Surgery might cover various diagnostic procedures. These additional charges encompass tests such as X-Rays, CT Scans (Computed Tomography), MRI scans (magnetic resonance imaging), Pulmonary Function Tests (PFTs), Carotid Doppler/Ultrasound Studies (Carotids), Ankle-Brachial Index (ABIs), Surface Echocardiograms (Echo), Vein Mapping, Trans-Esophageal Echocardiograms (TEE), ECG-gated SPECT myocardial perfusion imaging (stress test), heart catheterization (Cath), cardiac magnetic resonance imaging (MRI), and other diagnostic evaluations. The total expenses for these tests can vary between INR 1,00,000 and INR 1,50,000.

MedFlick, your trusted healthcare companion, is dedicated to ensuring that your medical journey goes as smoothly and successfully as possible.

• Individualized Guidance: Personalized guidance throughout your medical journey.
• Access to a broad network of prominent hospitals, top doctors, and skilled surgeons.
• Transparent and Competitive Pricing: A full breakdown of treatment costs that eliminates surprises and offers you cost-effective solutions.
• MedFlick provides everything from travel arrangements to hotel and visa help to lodging.
• Multilingual Support: Breaking down language barriers to allow patients and medical professionals to communicate more effectively.
• The road to a successful Coronary Artery Bypass Graft Surgery is long and winding, full of hope, resilience, and the promise of a brighter future. With MedFlick as your guide, navigating this life-changing adventure becomes simple and liberating.