Coronary Artery Bypass Graft (CABG) - Triple Bypass Surgery
In the 1960s, Dr. Frank C. Spencer of New York University (NYU), developed the technique of coronary artery bypass grafting (CABG), creating a foundation for modern cardiac surgery. Following this breakthrough, Dr. George Green (NYU) utilized an internal mammary artery (blood vessel) for grafting, instead of a leg vein. It was found that the mammary artery improved durability, and enhanced the sustainability of the CABG procedure.
What is Triple Bypass Surgery?
A coronary artery bypass graft is an open heart surgical procedure for treating blocked coronary arteries that supply blood to the heart. Following CABG, there is an improvement in blood flow and increased oxygen to the heart. The aorta, which supplies blood to the heart, is divided into 2 arteries, left and right. The left artery is further divided into 2 additional blood vessels. Triple bypass surgery, a form of CABG, circumvents blocks in the 3 arteries, with grafts of blood vessels obtained from either the chest or the leg. This improves blood flow to the heart.
Robot-assisted Triple Bypass Surgery
In 2010, surgeons, at the University of Maryland School of Medicine (UMMC), were successful in performing a robot-assisted endoscopic triple bypass surgery using the arrested heart approach. Surgeons at NYU, first performed this procedure in 1996. The arrested heart approach was performed with the help of a heart-lung machine. Generally, the chest needs to be opened to use the heart-lung machine. However, in the above procedure, the heart-lung machine was connected to a blood vessel in the groin and the heartbeat was stopped. Being minimally invasive, the surgeons were able to perform tight sutures, which improved the overall outcome. The mammary blood vessels, used for the graft, are durable for nearly 20-30 years.
Cost of Triple Bypass Surgery
The cost of CABG ranges between ~$10 000 to $33 000 in Canada. The increase in cost is based on the number of blood vessels grafted. On the other hand, the cost of CABG in India is ~$8000.
Risk Factors of Triple Bypass Surgery
Causes of plaques or fatty deposits developing in blood vessels are advanced age, obesity, high-fat diet, and smoking among others. A study in 2012 has observed that the risk of stroke is greater in patients undergoing CABG, irrespective of the number of blood vessels grafted.
Effect on Lifespan
Triple bypass surgery may improve the lifespan of individuals only if there is a simultaneous change in lifestyle. The number of blood vessels grafted is not an indication of the gravity of coronary heart disease. A single bypass individual may have a more serious heart condition than the individual with triple bypass.