Coronary artery bypass graft surgery: what is it and who needs it?

Coronary artery bypass graft (CABG) surgery is a potential lifesaver for people with coronary artery disease.

Dr Andile Xana, a cardiologist at Mediclinic Heart, explains why.

Coronary artery bypass graft (CABG) surgery is a major, potentially life-saving intervention for patients with coronary artery disease. This type of surgery addresses narrow or blocked heart arteries caused by atherosclerotic plaque (hardening of the arteries).

How CABG surgery helps in coronary artery disease

Coronary artery disease happens when the walls of the arteries in the heart build up plaque, which can block the normal flow of blood. CABG is a surgery that makes a new pathway or bypass around these blocked arteries. This helps in delivering oxygen and nutrients to the heart more effectively. The surgery can be classified as triple, quadruple, or quintuple bypass based on how many new pathways are created, depending on the seriousness and extent of the blockages in the arteries.

Who needs CABG surgery?

Your doctor might recommend CABG surgery if you’re experiencing angina that hasn’t responded to medications. It’s also used to treat cases of angina after myocardial infarction, heart valve disorders, and significant coronary artery narrowing, especially in diabetes patients.

The procedure

CABG is a medical procedure where graft vessels are connected to coronary arteries to create a detour around narrowed or blocked areas. This procedure is typically performed using a heart-lung bypass machine. The machine temporarily stops the heart's function, takes over by adding oxygen to the blood, and circulates it throughout the body. During the surgery, which lasts about four hours, the bypass machine is actively used for ±90 minutes. The heart is cooled, and a preservative solution is injected to minimise damage.

Evolving techniques

Modern advancements have introduced less invasive alternatives to traditional open-chest surgery. Techniques like off-pump coronary artery bypass (OPCAB), minimally invasive surgery with a small incision, and robotic technology, provide options with reduced complications, ensuring a smoother recovery for the patient.

Risks associated with CABG surgery

CABG surgery is effective in most cases, and although it’s a major operation, it’s become a routine one. However, like any surgery, it does present a margin of risk. That’s why it’s important to consult an experienced heart surgeon who will formulate a comprehensive, individual treatment plan for you. Your surgeon will discuss the risks with you and how to mitigate them.

Potential complications include blood clot-related graft blockages, narrowing of grafts due to scar tissue formation, and atherosclerosis. Other risks are problems with anaesthesia, heart attack, stroke, bleeding, infections, abnormal heart rhythms, and, in some cases, memory loss and cognitive issues.

Post-surgery management

Coronary artery bypass surgery plays a key role in treating coronary artery disease. Understanding its intricacies, potential risks, and being proactive about post-surgery management are crucial for a healthier cardiovascular future. To boost the probability of prolonged graft survival and to reduce your heart attack risk, you’ll be advised to:

• Have regular specialist check-ups
• Adhere to prescribed medications, such as statins
• Make heart-healthy lifestyle changes, such as quitting smoking; maintaining a healthy weight; controlling conditions like diabetes and high blood pressure; and exercising regularly.

Remember, CABG surgery isn't a cure for coronary artery disease; ongoing efforts to reduce risk factors and slow atherosclerosis through lifestyle changes and medication are essential.

To find a cardiologist near you, click here.