This operation is sophisticated plumbing. The narrowed areas of the Coronary arteries are by passed with a graft to provide blood supply to the artery below the blockage. The bypass is created using either an artery from inside the chest (internal mammary artery), an artery from the forearm (radial artery) or vein from legs or a combination of three. The patency of arterial graft is longer and it prolongs the benefit and survival of the patient. Hence we prefer to use more of arterial conduits especially in young patients (Total Arterial Revascularization).

Coronary artery a bypass grafting can be done through midline sternotomy with or without heart lung machine. When the heart lung machine is used, the heart is stopped and suturing is done. But  in most of the cases this operation can be done on beating heart. This is called Off Pump Coronary Artery Bypass (OPCAB). This procedure has the advantage of lesser post operative complication rate and faster recovery with good long term result. In our hospital most of the bypass surgeries are done in this method. In selected cases CABG can be through a small incision in the thorax (minimally invasive surgery) in selected group of patients.

Patients who are symptomatic with: 

• Significant left main Stenosis of > 50%

• Triple vessel Disease

• Two vessel disease including a significant proximal left anterior descending (LAD) artery Stenosis

• Single vessel disease with proximal lesion and poor heart function

• Patients with poor heart function and diabetes benefits maximum from CABG operation

• CABG significantly improves symptoms of angina, exercise capacity and reduce the need for medications. Overall quality of life improves significantly.

• It reduces chance of further heart attack.

• It significantly improves long term survival (10 yrs). Those with the most severe Coronary Artery Disease gain maximum from CABG operation.

It is not appropriate or feasible in all patients. Patients with single vessel disease without much symptoms can be managed medically. Patients with diffuse coronary atheroma with poor target arteries and those with occluded coronary vessels without lumen, are not suitable for CABG. In some patients with significant co- morbid conditions CABG may be prohibitive.

What are the risks of CABG?

Coronary Artery Bypass Grafting is a safe operation with elective surgical mortality of around 1-2% in good LV function. Various factors influence surgical mortality including age, sex, degree of cardiac dysfunction and other co-morbid conditions including obesity, renal impairment, carotid artery disease etc. Post operatively myocardial infarction (heart attack), stroke infection, hemorrhage and renal failure are the major complications.

How long revascularization lasts?

Angioplasty re-stenosis at the site of PCI remains a problem but less likely with drug eluting stents. The current rate of re-stenosis is to the tune of 10-20%.

For CABG early failure rate is about 10-15% (some venous grafts may be blocked). Thereafter about 2% a year upto 10 yrs. Majority of the patients enjoys long-term benefits after CABG rather than Angioplasty. The commonest cause of graft blockage is development of atheromatus disease in the grafts. Aggressive lifestyle modification and control of serum lipids prolongs graft patency.

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