CABG

Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting (CABG) is a surgical procedure used to treat coronary artery disease (CAD). CAD is the narrowing or blockage of the coronary arteries due to the buildup of atherosclerotic plaques, which can lead to myocardial infarction (heart attack) and other cardiovascular complications.

Indications

CABG is typically indicated for patients with severe coronary artery disease, particularly when:

• There is significant left main coronary artery stenosis.
• There is triple-vessel disease, especially with reduced left ventricular function.
• There is ongoing angina despite optimal medical therapy.
• There is a high risk of heart attack or death based on non-invasive testing.

Procedure

The CABG procedure involves creating a bypass around the blocked or narrowed coronary arteries using a graft. The grafts are typically harvested from the patient's own body and can include:

• The internal thoracic artery (ITA), often the left ITA, which is preferred due to its superior long-term patency.
• The saphenous vein from the leg.
• The radial artery from the arm.

Steps of the Procedure

1. Anesthesia and Incision: The patient is placed under general anesthesia. A median sternotomy is performed to access the heart. 2. Harvesting Grafts: The surgeon harvests the grafts from the donor sites. 3. Cardiopulmonary Bypass: The patient is connected to a heart-lung machine, which takes over the function of the heart and lungs during the procedure. 4. Grafting: The surgeon sews the grafts to the coronary arteries beyond the blockages and to the aorta or another major artery. 5. Weaning from Bypass: The heart is restarted, and the patient is gradually weaned off the heart-lung machine. 6. Closure: The sternum is closed with wires, and the incision is sutured.

Postoperative Care

After CABG, patients are monitored in the intensive care unit (ICU) for hemodynamic stability and potential complications. Postoperative care includes:

• Pain management.
• Monitoring for arrhythmias, bleeding, and infection.
• Respiratory therapy to prevent pneumonia.
• Gradual mobilization and cardiac rehabilitation.

Risks and Complications

While CABG is a common and generally safe procedure, it carries risks such as:

• Infection
• Bleeding
• Stroke
• Myocardial infarction
• Graft occlusion
• Arrhythmias

Outcomes

CABG can significantly improve symptoms of angina, quality of life, and survival in patients with severe coronary artery disease. Long-term outcomes depend on factors such as the patient's age, comorbidities, and adherence to lifestyle changes and medications.

Alternatives

Alternatives to CABG include:

• Percutaneous coronary intervention (PCI), which involves balloon angioplasty and stenting.
• Medical management with anti-anginal medications, statins, and lifestyle modifications.

See Also

• Coronary artery disease
• Myocardial infarction
• Cardiac surgery

References

• Smith, S. C., et al. (2011). "AHA/ACC Guidelines for Coronary Artery Bypass Graft Surgery." Journal of the American College of Cardiology.
• Fihn, S. D., et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." Circulation.