The first human coronary artery bypass surgery (CABG) was performed in the United States in 1960, by Drs Goetz and Rohman. In the last half a century this procedure (with some improvements and variations) has been performed on millions of patients worldwide. The term coronary artery bypass surgery implies ‘bypassing’ the narrowed segments of coronary arteries (Figure 1).
What does this procedure entail?
This procedure requires the administration of a general anaesthetic. Following that the cardiac surgeon makes an incision along the middle of the breast bone and skillfully dissects down to expose the heart. Prior to the heart surgery, the surgeon would have studied the coronary angiogram images and would have identified the diseased arteries requiring ‘bypassing’. In addition, the arteries or veins to be used as grafts (internal mammary artery-present in the chest, radial artery-present in the wrist or saphenous vein-present in the legs) would be harvested and prepared during the procedure.
Most surgeons operate using a heart-lung bypass machine (on-pump surgery) while some may perform surgery without using the heart-lung machine (off-pump or beating-heart surgery).
This procedure is routinely being performed at Omar Hospital & Cardiac Centre, Jail Road Lahore.
The conventional on-pump operation would entail stopping the heart (for example by infusing potassium) and then allowing blood to be circulated through the heart-lung machine. The beating heart surgery would avoid this process. However, as this process is being refined and evolved, the heart-lung machine is always kept standby for any unavoidable complication.
What are the major complications involved?
These include death, stroke, heart attack, graft failure or wound infection. The risks of major complications vary from person to person however, in low-risk cohorts this may be up to 2 in 100 patients. This includes death or stroke during or following the operation. When assessing an individual’s risk the surgeon may consider the age, sex, co-morbidities (diabetes, kidney disease, hypertension, heart failure, history of stroke, lung problems or poor circulation to the legs). There are international scoring systems for example, EuroSCORE to estimate peri-operative risk. More information is available on www.euroscore.org where an interactive scoring system is available for the benefit of doctors and patients.
Coronary angioplasty or CABG?
This is a never ending debate between the aficionados of the both sides. Generally, in most patients the choice will be clear. For example, a patient with narrowing s in multiple blood vessels will derive most benefit from CABG especially with coexistent diabetes. In contrast, a patient with discrete narrowing in one or two blood vessels, coronary angioplasty and stent insertion may be attractive alternative. If the management option is not clear then your cardiologist may have a chat with you and explain to the pros and cons of both procedures.