Coronary Artery Bypass Grafting: Safe and effective
Published on: Tuesday, October 03, 2023
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Inset: Dr Talal Reda Mahmoud
Most ancient people did not need a guy like me, a doctor/surgeon, but those times no longer exist as we, humans are living increasingly in stressful, unhealthy ways.
Most of us now love to eat processed and fast food, which is very unhealthy. We are even so lazy as to use our car, motorcycle, or e scooter to go to a nearby place instead of walking.
Exercise becomes a chore we do not have time for. Furthermore, those who smoke, have chronic diseases like diabetes, hypertension, and family history of coronary artery disease (CAD) will eventually need to come to visit us, your doctor or surgeon.
Our hearts are like an engine that drives the whole body. For this engine to work continuously and properly, it must have enough fuel which is supplied by our blood.
Blood reaches our heart through tubes which we called coronary arteries.
These arteries are the victim of our modern way of life as they get blocked with time, leading to a condition we called CAD.
When the blockade inside these arteries become critical, the heart will not function adequately anymore, and something needs to be done.
Most people tend to go for easier way out to solve their problems. Easy choices are always on the table but most of the time these choices are NOT as good as the tougher ones.
The easy choices we talk about here for people who suffer blockade of his coronary arteries are to take medicine or to do stenting to open the artery from inside.
The hard choice, however, will be to do a surgery called coronary artery bypass grafting (CABG).
I still remember when I started my career in 1995 as a cardiothoracic surgeon, CABG was risky, and many patients had complications.
With the advancement of modern technology, CABG is now an everyday practice for a cardiac surgeon like me with a success rate of up to 98 per cent.
According to recent research, CABG, which is always considered to be a tougher decision of treatment, has proven to be most effective, long-lasting solution to CAD with lesser side effects and complications.
CABG involves taking a blood vessel from another part of the body such as chest, leg or arm and connecting it to the coronary artery to bypass the blocked area so that the supply of oxygen-rich blood to the heart muscle can be restored.
There are now many variations of coronary artery bypass surgery which include the conventional on-pump CABG, Off-pump, or beating-heart CABG and the minimal invasive (small incisions) CABG.
On-pump CABG is a long-established procedure that is performed while the heart is stopped.
A heart-lung machine is then used to provide artificial circulation system which temporary took over the work of the heart and lungs.
Tubes are placed in the heart to drain blood back and forth from the heart-lung machine and the patient.
At the end of the surgery, the heart is restarted. When the heart start to pump on its own adequately, the heart-lung machine can be disconnected after the tubes are withdrawn from the heart.
Although on-pump CABG nowadays is a safe procedure with minimal risk of complications, patients with other health conditions such as stroke, kidney impairment, liver failure, bleeding tendencies have increase risks of complication post-surgery.
This is mainly due to the use of the pump and tubes during surgery.
Therefore, an alternative technique called the Off-pump CABG is developed to minimise the risks stated earlier.
Off-pump CABG is a method of performing CABG without the use of heart-lung machine and tubes. As the heart is still beating during the procedure, special tools called the heart positioner and stabiliser are used to immobilise and hold portions of the heart that need to be worked on.
Due to the complexity of attaching grafts to the heart while it is continuously beating, experience of the surgeon in performing such procedure is utmost important in achieving good results.
With in-depth experience, heart surgeons have become more confident and talented so much so that CABG has been developed into a minimally invasive surgery.
In minimal invasive CABG, the heart is approached through the left side of the chest (under the left nipple) via a small incision of 6-10 cm between the ribs.
The breastbone (sternum) is therefore preserved unlike the conventional CABG which required the breastbone to be cut to access the heart. By avoiding the cutting of sternum, there is no bone to heal, and patient can return quickly to their routine activity.
On top of that, the patient experiences less pain, lower risk of infection and have a better aesthetic result.
To minimise postoperative pain, risk of infection and delayed wound healing, the grafts that are used during CABG have been harvested through a minimally invasive technique as well.
These techniques are called Endoscopic vein harvesting (EVH) for the harvesting of long saphenous vein in the leg and Endoscopic Radial Harvesting (ERH) for the harvesting of radial artery in the arm respectively.
Hence, CABG is no longer a scary surgery, it can be a safe and effectively way to treat CAD with proven excellent long-term outcomes.
Before I sign off, let me give you a simple advice. If you are a man above 40 years old or a woman after menopause, and have a family history of CAD, please go for heart check-up annually to detect, and solve heart problems before it is too late!
A minimal scar is evident after the Endoscopic Radial Harvesting (ERH) procedure as seen in the photos above.
# This article was contributed by Dr Talal Reda Mahmoud who is a Cardiothoracic Surgeon at Gleneagles Hospital Kota Kinabalu.
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