Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting (CABG) - What it is

Coronary artery bypass grafting (CABG), also known as heart bypass surgery, is an open heart surgery. It is also a known treatment procedure for coronary artery disease (CAD). In this procedure, the surgeon removes a vein from the leg and/or an artery from the non-dominant arm and/or an artery from within the chest and sews it beyond the blockage so that blood can flow through the newly grafted vessel, bypassing the blocked coronary artery.

Coronary Artery Bypass Grafting (CABG) - 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.

Coronary Artery Bypass Grafting (CABG) - How to prevent?

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.

Coronary Artery Bypass Grafting (CABG) - Causes and Risk Factors

Causes

‘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. CABG surgery performed for this condition, is the most common open heart operation.

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

Risks

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.

CABG results are more durable as they last an average of 10 years. However, it has a slightly higher risk for complications than coronary angioplasty (also known as percutaneous coronary intervention, or PCI). It also requires a longer hospital stay (one week) and longer recovery (one to two months).

Coronary Artery Bypass Grafting (CABG) - Treatments

The mainstay of treatment for coronary artery disease is 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 patient’s 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 symptoms, reduces the need for medications, 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 an excellent track record of over 50 years.

Coronary Artery Bypass Grafting (CABG) - Preparing for surgery

Before the Procedure

If you are smoking, you are advised to stop smoking before your operation.

Day Before Procedure

You will not be allowed to consume any food or drink at least six hours before the operation.

A laxative will be given to you to clear your bowels the night before your operation.

Coronary Artery Bypass Grafting (CABG) - Post-surgery care

Bypass surgery aims to return 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.

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 six weeks to two 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 are available for selected patients.

How long will I be off work?

It depends on the nature of your work. A sedentary worker can return to his/her desk-job by four to six weeks. Those performing manual labour, especially requiring upper body strength could return after three 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.