Coronary artery bypass graft (CABG) surgery is a procedure used to treat CAD in certain circumstances. CAD is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a build-up of fatty material within the walls of the arteries. This build-up causes the inside of the arteries to become narrowed, limiting the supply of oxygen-rich blood to the heart muscle.
One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with another piece of blood vessel. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein taken from the legs or an artery in the chest. At times, an artery from the wrist may also be used. One end of the graft is attached above the blockage and the other end is attached below the blockage. Thus, the blood is rerouted around, or bypasses, the blockage through the new graft to reach the heart muscle. This bypass of the blocked coronary artery can be done by performing CABG.
Traditionally, in order to bypass the blocked coronary artery in this manner, the chest is opened in the operating room and the heart is stopped for a time so that the surgeon can perform the bypass. In order to open the chest, the breastbone (sternum) is cut in half and spread apart. Once the heart is exposed, tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine (heart–lung machine). The bypass machine is necessary to pump blood while the heart is stopped and kept still in order for the surgeon to perform the bypass operation.
While the traditional “open heart” procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries. “Off-pump” procedures, in which the heart does not have to be stopped, were developed in the 1990s. Other minimally-invasive procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), are being used increasingly.
Two other surgical improvements for persons undergoing CABG are endoscopic vein harvesting and endoscopic radial artery harvesting. In both these procedures, surgeons use an endoscope (thin surgical tube with a light and camera at the end) to locate blood vessels that will be used for bypassing the blocked coronary arteries. Veins are generally harvested from the inner thigh and calf areas of the legs, while the radial artery is harvested from the wrist.
Traditional (open) approaches involve making long surgical incisions down the inner thigh and/or calf. Research comparing traditional approaches with endoscopic methods indicates that patients generally have fewer complications, less leg pain, and shorter hospital stays with the endoscopic harvesting methods. Some persons, however, may not be eligible for these methods because of other health conditions.
In order to sew the grafts onto the very small coronary arteries, the heart must be stopped to allow the doctor to perform the very delicate procedure. Tubes will be inserted into the heart so that the blood can be pumped through your body by a cardiopulmonary bypass machine.
Once the blood has been diverted into the bypass machine for pumping, the heart will be stopped by injecting it with a cold solution.
When the heart has been stopped, the doctor will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. If the internal mammary artery inside your chest is being used as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage.
You may have more than one bypass graft performed, depending on how many blockages you have and where they are located. After all the grafts have been completed, the doctor will examine them to make sure they are working.
Once the bypass grafts have been completed, the blood circulating through the bypass machine will be allowed back into your heart and the tubes to the machine will be removed. Your heart will be restarted.
Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
Once the chest has been opened, the area around the artery to be bypassed will be stabilized with a special type of instrument.
The rest of the heart will continue to function and pump blood through the body.
The cardiopulmonary bypass machine and the perfusionist who runs it may be kept on stand-by should the procedure need to be completed on bypass.
The doctor will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery or internal mammary artery just below the blockage.
You may have more than one bypass graft performed, depending on how many blockages you have and where they are located.
Before the chest is closed, the doctor will examine the grafts to make sure they are working.
The Estimate Includes:
1. Bed charges
2. Clinical Lab Charges
3. Professional Charges
4. Nursing Charges
5. Dietary Charges for the patient and an attendant
6. Operation Theatre charges
7. Anesthetist charges
8. Procedure charges
9. Meet & Greet at the Airport.
The Estimate Excludes:
1. Stay outside the hospital, cost of the same is not included in the above estimate and is payable on actual.
2. Any outpatient consultations and medicines which are required during the follow-up will not be a part of the estimate.
3. The estimate cost is for the number of days indicated above, if situation demands to extend stay in hospital, the additional days stay would be charged accordingly.
4. Cost for additional or multiple implants will be charged at actual.
5. Special Investigations referred by other departments or if situation demands any additional investigation would be charged accordingly.