Heart Bypass Surgery Coronary Artery Bypass Grafting (CABG)

Introduction Causes Symptoms Risk Factors Treatment Frequently Asked Questions

Contributed by Dept of Cardiothoracic Surgery

Introduction
Heart attack is the second commonest cause of death after cancer in Singapore. It is also the third commonest reason for patients to be admitted into hospital. Coronary artery bypass grafting (CABG) surgery performed for this condition, is the most common open heart operation.

Causes
Heart attack occurs when the coronary arteries supplying blood to the heart becomes hardened and subsequent blocks (coronary artery disease). Coronary artery bypass grafting is an established operation to restore the blood supply to the heart.

Symptoms
Coronary artery blockages result in chest discomfort (called angina pectoris), often described as tight sometimes involving the jaw, left shoulder or arm. During a heart attack you may even be breathless, sweaty with cold and clammy peripheries. Nevertheless some patients (especially diabetics) may have absolutely no pain. When heart muscles die and become scarred, the heart subsequently fails as an efficient pump.

Risk Factors
The risk factors for heart disease include diabetes, high blood pressure, excessive blood cholesterol, obesity and smoking. Although increasing age and male gender increases the risks as well, these are non-modifiable risks. A strong family history of coronary artery disease however (especially first degree relatives younger than 50 years old) should prompt early consultation when symptoms arise.

Prevention
A healthy lifestyle is a lifelong investment: regular 30-minute walk, smoking cessation, a balanced natural diet, maintaining a healthy weight, together with appropriately treated diabetes and high blood pressure is a good start. Be aware of your body. Seek medical advice when symptoms occur.

Treatment
The mainstay of treatment for coronary artery disease remains medication. Some patients will require invasive intervention

such as coronary artery bypass grafting (CABG).

During CABG, a new graft vessel which is a healthy artery or vein taken from the patients leg, arm or chest, is surgically removed and sewn around the areas of the blockage. The graft vessel supplies oxygenated

blood to the part of the heart that needs it, thereby bypassing the blocked arteries and

restoring blood flow to the heart muscle. Augmented blood flow improves symptom, reduce the need for medication, and

prolongs life in well-selected patients. This operation is well established in Singapore and worldwide. It is undoubtedly the most well studied operation in the realm of surgery, and has over 40 years of excellent track record.

Frequently Asked Questions

Before the Procedure If you are smoking, you are advised to stop smoking before your operation. Your will require blood for the surgery. Please arrange for 3 4 blood donors to replace the amount of blood to be used during surgery.

 Day Before Procedure You will not be allowed to consume any food or drink at least 6 hours before the operation. A laxative will be given to you to clear your bowels the night before your operation. What Happens After the Procedure? Bypass surgery aims to return patients to gainful employment, or active retirement with a restored sense of wellbeing. You will have to continue to invest in changes that maintain this gain. You must comply with prescribed medication, smoking cessation, weight control, and adhere to a diet low in salt, fat and cholesterol. Cardiovascular Rehabilitation Preventive Cardiology (CVR & PC) Programme You are encouraged to attend the Cardiovascular Rehabilitation & Preventive Cardiology Programme that will enable, encourage and assist you on the road to recovery. How long is the period of convalescence? An uncomplicated hospital stay may last a week, whilst your surgical wounds will completely heal between 6 weeks to 2 months. How many incisions will I have? A midline incision on the chest, with a forearm and leg incisions depending on the extent of surgery is the norm. Newer techniques using key hole surgery is available for selected patients. How long will I be off work? It depends on your work. A sedentary worker can return to his/her desk-job by 4-6 weeks. Those performing manual labour, especially requiring upper body strength could return after 3 months. Some may not be able to return to their former jobs. Must I change my lifestyle? Coronary bypass surgery aims to enable patients to gainful employment, or active retirement with a restored sense of well-being. You will have to continue to invest in changes that maintain this gain. You must comply with prescribed medication, smoking cessation, weight control, and adhere to a diet low in salt, fat and cholesterol.

PTCA Percutaneous transluminal coronary angioplasty. A procedure with a balloon-tipped catheter to enlarge a narrowing in a coronary artery. Often just called angioplasty. Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then

inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.