Coronary Artery Bypass Surgery
CABGS; Inside the Operating Room for Open Heart Surgery
Open heart surgery revealed. Go inside the operating room for coronary artery bypass surgery which is used to treat coronary artery disease due to cholesterol and fat.
Open Heart Surgery – inside the OR for coronary artery bypass surgery
Facing open heart surgery is a daunting prospect, but information can be the best defense against fear of the unknown. The commonest heart surgery performed worldwide is coronary artery bypass surgery, also known as CAGS, CABGS or even ‘cabbages’.
Why do I need CAGS?
There are three main coronary arteries which supply blood to the heart muscle. These can become diseased over time from the build-up of fat and cholesterol, which restricts blood flow to the heart muscle and leads to chest pain or tightness (angina), shortness of breath and fatigue. The extreme form of this process is a heart attack, where the heart muscle is so starved of blood that a part of it dies.
Coronary artery bypass surgery is performed to bypass blocked or narrowed coronary arteries. These blockages are left in place and new arteries or veins are used to bypass around the blockage, much like a bypass road circumvents a town. This bypass graft creates a new path for blood to reach the heart muscle and minimizes the risk of angina or heart attack.
Some people need 1 bypass graft, some people need 6 bypass grafts; the number of grafts required is reflective of both the extent of disease and the anatomy of the patient’s coronary arteries, which is as individual as a thumbprint.
What happens in the operating room?
Once on the operating table, the arteries and veins which will be used as bypass grafts are removed. The commonest artery used is call the left internal mammary artery (LIMA) or internal thoracic artery (LITA). It is used in >90% of cases and is taken through the same midline chest incision through the breastbone used to access the heart.
Other vessels commonly used are the radial artery from the forearm or the saphenous vein from the legs. Both can be removed safely without compromising the circulation of the hands or legs.
In most CABGS, the patient is placed on the heart – lung bypass machine which enables the heart to be paralysed with a high potassium solution. The bypass grafts are the sewn onto the coronary arteries beyond the blockages.
With the bypass grafts in place, the heart is slowly weaned from the heart-lung bypass machine and the breastbone is reunited using fine stainless steel wires.
The patient returns to the intensive care unit for 24-48 hours where recovery begins. Most patients will leave hospital 5 – 7 days after surgery and will be walking, showering and dressing themselves by then.
What now? The path beyond open heart surgery.
Undergoing open heart surgery is like asking your body to run a marathon - without training. During the first six weeks of recovery the body is playing catch-up, and this manifests as extreme tiredness (including needing a midday nap), decreased appetite and concentration as well as disturbed sleep patterns.
Most patients do not complain of much wound pain and by the end of the first week are usually on paracetamol or acetaminophen.
After six weeks, the breastbone is usually healed and activity levels can increase. It is important to keep moving after any surgery to help stave off complications such as pneumonia and blood clots, but the real key is to listen to your body; if it hurts or if you are tired – stop. Pushing through any pain or fatigue will only slow your recovery and can even do you harm.
Recovery should be about steady improvements in pain, energy levels and stamina. If there is a sudden deterioration in your condition you should always consult your surgeon. Lifestyle changes should help prevent disease progression.
