Coronary Artery Bypass Grafting (CABG) is a core surgical procedure used to treat coronary artery disease, primarily by establishing new blood vessel pathways that bypass obstructed coronary arteries to restore blood supply to the heart muscle. This surgery is suitable for patients with severe narrowing or blockage of the coronary arteries, leading to angina, myocardial infarction, or impaired cardiac function.
The procedure involves harvesting the patient's own veins or internal thoracic arteries and connecting the upstream and downstream of the blocked segment, allowing blood to bypass the obstruction and improve myocardial oxygen deficiency. This open-heart surgery can significantly reduce the risk of cardiac events and enhance long-term quality of life for patients.
Coronary artery bypass surgery mainly divides into “traditional open-chest surgery” and “minimally invasive small-incision surgery.” The traditional approach requires cutting the sternum and using a heart-lung machine, while minimally invasive surgery uses small incisions and heart arrest techniques to reduce trauma and recovery time.
The mechanism involves using autologous blood vessels (such as great saphenous vein, internal mammary artery) as “bypass grafts” to circumvent the obstructed coronary artery segments. The internal mammary artery is preferred for its superior resistance to occlusion, often used for grafting important vessels like the left anterior descending artery.
This treatment is mainly suitable for patients with multi-vessel severe stenosis (such as three-vessel disease), left main coronary artery obstruction, or those whose symptoms cannot be effectively controlled with medication or angioplasty. Additionally, patients with diabetes or left ventricular dysfunction are often recommended for this surgery.
It is not suitable for patients with mild single-vessel obstruction or those in poor overall health unfit for open-heart surgery. Physicians will evaluate the indications based on the location of vascular blockages, patient age, and overall health status.
The surgery generally requires general anesthesia, with duration depending on the number of blocked vessels, typically 4 to 6 hours. The surgeon will select the number of bypass grafts based on the blockage sites, commonly 1 to 4 grafts. Postoperative hospitalization lasts 7 to 10 days, followed by cardiac rehabilitation.
The concept of “dosage” does not apply to this surgery, but the surgeon will choose appropriate vessel lengths and anastomosis sites based on the severity of blockage and patient body size. The success of the surgery depends on vessel selection, suturing techniques, and postoperative management.
Compared to angioplasty, this surgery offers more durable results for patients with multi-vessel disease, especially for diabetic patients, with a more significant reduction in long-term cardiac event risks.
Main risks include:
Older patients or those with diabetes may face higher infection risks. Postoperative monitoring for thrombosis and vascular function is essential.
Contraindications include severe liver or kidney failure, uncontrolled infections, or inability to tolerate cardiopulmonary bypass. Preoperative assessment of coagulation and lung function, as well as blood sugar and blood pressure control, are necessary.
Postoperative strict adherence to anticoagulant therapy and avoiding strenuous activity for at least 6 weeks are recommended. Immediate medical attention should be sought if symptoms like chest pain or fever occur.
This surgery is often combined with antiplatelet medications (such as aspirin) to prevent thrombosis. Care must be taken to avoid conflicts with anticoagulants (such as warfarin), which require dose adjustments by the physician.
Combination with angioplasty should be approached cautiously, usually favoring one treatment. Postoperative management includes lipid-lowering and antihypertensive medications to prolong graft patency.
Most studies show that patients receiving grafts of three or more vessels have a 40% higher five-year survival rate than those on medication alone. A 2016 comparison of CABG and PCI indicated that patients with complex lesions had a 35% reduction in cardiac events after surgery.
Internal mammary artery grafts have an 85% patency rate at five years, compared to about 60% for saphenous vein grafts. Regular postoperative echocardiography and electrocardiograms help detect complications early.
Alternatives include Percutaneous Coronary Intervention (PCI) with stent placement or medication management with beta-blockers and nitrates. PCI is suitable for single-vessel occlusion but has a higher long-term restenosis rate.
High-risk or elderly patients may opt for medication and lifestyle modifications, but for multi-vessel occlusions, surgery remains the first choice. Treatment should be selected based on lesion location and patient condition.
Preoperative comprehensive cardiac assessment, including angiography and vascular imaging, is recommended to determine the optimal bypass routes. Patients should adjust anticoagulant use and control blood sugar and blood pressure within target ranges. Quitting smoking and improving nutritional status can also reduce complication risks.
How to manage pain and activity restrictions during sternal healing?Postoperative pain is managed with pumps or medications initially. Patients should avoid bending and lifting heavy objects to protect the sternum. Typically, strenuous activities are restricted for 6-8 weeks, but deep breathing exercises and light walking are encouraged to promote lung recovery.
Does the risk of vessel blockage completely disappear after coronary artery bypass surgery?The surgery improves existing blockages, but new plaques can form in other vessels. Patients should continue lipid-lowering therapy, control triglycerides, and undergo regular vascular imaging. Healthy diet and regular exercise help delay new obstructions.
Is bloating or indigestion common after surgery? How to relieve it?Open-heart surgery may affect diaphragm function, leading to temporary slowed gastrointestinal motility. Small, frequent meals, avoiding high-fat foods, and using prokinetic drugs as prescribed can help. Gentle abdominal massage and moderate activity promote digestion, but vigorous movements should be avoided.
How long after surgery can one resume normal work and exercise?Generally, light work can be resumed in 4-6 weeks, with strenuous activities delayed for 3-6 months. Recovery speed varies based on age and preoperative cardiac function. The medical team will develop a personalized rehabilitation plan based on echocardiography results and symptoms.
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