Name of the Procedure:

Coronary Artery Bypass Graft (CABG) Surgery using arterial grafts for three coronary arterial grafts

Summary

Coronary artery bypass graft (CABG) surgery involves creating new pathways for blood flow to the heart by using arterial grafts to bypass blocked coronary arteries. In this procedure, three arterial grafts are specifically used to reroute the blood flow around three blocked arteries.

Purpose

Medical Condition:

• Coronary Artery Disease (CAD)
• Severe blockages in the coronary arteries that restrict blood flow to the heart

Goals:

• To improve blood flow to the heart muscle
• To reduce symptoms such as chest pain (angina) and shortness of breath
• To improve overall heart function
• To lower the risk of heart attacks

Indications

• Severe coronary artery disease not adequately managed by medication or lifestyle changes
• Significant blockages in multiple coronary arteries
• Symptoms like chest pain, shortness of breath, or fatigue
• Poor response to other treatments such as angioplasty or stenting
• High-risk of heart attack based on diagnostic imaging results

Preparation

• Fasting for 8-12 hours before the procedure
• Adjustments or temporary discontinuation of certain medications like blood thinners
• Pre-operative tests including blood work, chest X-rays, EKG, and possibly cardiac catheterization
• Discussion with your healthcare provider about medical history and current health status

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Incision: A surgical incision is made in the chest, and the breastbone is separated to access the heart.
3. Harvesting Grafts: Arteries (often the internal mammary arteries and/or radial arteries) are harvested to be used as grafts.
4. Bypass Creation: The surgeon attaches one end of each graft to the aorta and the other end to the blocked artery past the blockage.
5. Restarting the Heart: The heart is often temporarily stopped and then restarted with the help of a heart-lung machine during the procedure.
6. Closure: The breastbone is wired back together, and the incision is closed with sutures or staples.

Tools and Technology:

• Surgical instruments for incision and grafting
• Heart-lung bypass machine
• Anesthesia equipment

Duration

The procedure typically takes between 3 to 6 hours.

Setting

Performed in a hospital operating room, usually in a specialized cardiac surgery unit.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (who operates the heart-lung machine)
• Surgical assistants

Risks and Complications

Common Risks:

• Infection at the incision site
• Bleeding
• Reaction to anesthesia

Rare Complications:

• Stroke
• Heart attack
• Blood clots
• Kidney failure
• Arrhythmias (irregular heartbeats)

Management:

• Close postoperative monitoring
• Medications to manage pain, blood pressure, or prevent infection
• Prompt treatment of any arising complications

Benefits

• Relief from chest pain and other symptoms
• Improved heart function and overall cardiovascular health
• Reduced risk of future heart attacks
• Potentially longer lifespan and improved quality of life

Recovery

• Initial hospital stay of about 5 to 7 days
• Gradual increase in physical activity with cardiac rehabilitation
• Follow-up appointments with the cardiac surgeon and cardiologist
• Medication adjustments and regular monitoring
• Full recovery usually takes 6 to 12 weeks, with restrictions on heavy lifting and certain activities

Alternatives

Other Treatment Options:

• Medication management for coronary artery disease
• Percutaneous coronary intervention (PCI), such as angioplasty and stenting

Pros and Cons:

• Medications: Non-invasive but may not be sufficient for severe blockages
• PCI: Less invasive, shorter recovery time but may not be suitable for complex or multiple blockages

Patient Experience

During the Procedure:

• Under general anesthesia, so completely unaware of the procedure

After the Procedure:

• Initial pain and discomfort managed with pain medications
• Feeling of fatigue, soreness at incision sites
• Gradual improvement in energy levels and reduction in symptoms over the recovery period
• Emotional and psychological support may be beneficial during recovery