In angina or after a heart attack (myocardial infarction) certain areas of the heart do not receive adequate blood supply and these areas are starved of oxygen and nutrients and this result in areas of the heart that are ischemic.
By performing a surgical operation like Coronary artery bypass grafting or CABG these areas are re-perfused using 'free vein or arterial bypass' that connect the normal areas of the arteries to less perfused areas and 'bypass' the blocked arteries. The bypass sections of the arteries or veins are harvested from elsewhere from the body like the leg or the arm or from within the chest itself.
Lifestyle modifications and rapid urbanization has led to an epidemic of cardiac disease in India. The incidence of coronary artery disease ranges from 14.8 to 65.4 per 1000 population. Cardiac surgeries and are now spanning into sophisticated technologies, where innovative methods are introduced to provide distinctive care even for high-risk surgeries.
Report from 2005 shows that out of 60,000 open heart surgeries done every year majority are CABGs and Valve replacements.
Success of every surgery is teamwork and cardiac surgery is no exception. A team of surgeons, anesthesiologist, perfusionist, nurses and technicians are involved during the procedure. Bypass surgery is done under general anesthesia. To access the heart the chest has to be cut wide open. A special heart-lung machine is used to bypass the blood when the heart is stopped to perform the surgery. The heart lung machine oxidizes the impure blood and sends it back to the body. Vein from legs or arteries from the chest wall or forearm are harvested depending on the number of blocks and the age of the patient. They are then cleaned and sutured to the arteries above and below the plaque creating a bypass for the blood flow, reinstating oxygen supply to the myocardium (heart muscle). The chest layers are then sutured and patient is transported to the Intensive care unit or Post surgical care unit.
Surgery on the heart can also be performed when it is still beating or pumping blood and this is called Off-pump Coronary Bypass (OPCAB) Surgery. This procedure can be done in a majority of the patients, however patients with certain unfavorable conditions such as unstable hemodynamics or blockage in the vessels that is less accessible when the heart's beating, require the use of the heart-lung machine.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is done without the use of the perfusion pump. As the name suggest, the incision is made relatively smaller and on the left side of the chest, closer to the heart. A small portion of the rib is removed to access the heart. This can be performed only on patients who need just one or two grafts on the arteries that are in close proximity to the incision.
The surgery lasts about 3 to 6 hours.
The total hospital stay depends on individual progress and may vary any where between 7 days or more in case of complications.
The cost of CABG is about Rs.150,000-200,000 (US$4000-5000).