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CABG is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart.
The goals of the procedure are to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle and lower the risk of a heart attack or other heart problems. Diagnostic tests have helped your heart doctor identify the location, type and extent of your coronary artery disease. At CIMS Hospital, CABG surgery may be combined with other heart surgeries, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an irregular heartbeat).
After general anesthesia is administered, the surgeon removes the veins or prepares the arteries for grafting. Internal mammary arteries [also called IMA grafts or internal thoracic arteries (ITA)] are the most common bypass grafts used, as they have shown the long-term results.
To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. Before the patient leaves the hospital, the doctor or nurse will explain the specific bypass procedure that was performed.
During surgery, the heart-lung bypass machine (called “on-pump” surgery) is used to take over for the heart and lungs, allowing the circulation of blood throughout the rest of the body.
Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. Minimally invasive coronary artery bypass (MIDCAB) surgery is an option for some patients who require a left internal mammary artery (LIMA) bypass graft to the left anterior descending (LAD) artery. Other minimally invasive surgery techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery.
The surgical team will carefully compare the advantages and disadvantages of minimally invasive CABG surgery versus traditional CABG surgery. The surgery generally lasts from 3 to 5 hours, depending on the number of arteries being bypassed. A blood and urine test will be done to ascertain that everything is in proper balance and to ascertain baseline values. The anesthesiologist will meet you before surgery and pre-operative medications for the day of the surgery. The physiotherapist (your case co-ordinator) will visit and explain about exercise to be performed during and after hospitalization. A member of the surgical team, will visit the patient and family to explain what the surgery is all about and what will happen in the Intensive Care Unit (ICU) when one awakes after surgery.
An hour before you wheeled into the operation theater, you will be called into the ICU & will receive a preoperative antibiotic injection to prevent infection and an injection which will help you relax and make a little drowsy. Another line, Swan Ganz catheter or Triple lumen catheter will be inserted into large vein in the neck after anaesthetisation which monitors the heart pressures during the operation. Once all lines are inserted, you will be anesthetized through medication given into the IV lines. After anaesthesia, a breathing tube is inserted through mouth or nose, and the operation begins.
Nasogastric tube (Stomach tube): It will be put in the nose, going down into the stomach to prevent gastric distention and nausea. When you awaken, you will not be able to talk because the breathing tube goes down between the vocal cords.
Suctioning of the breathing tube will be done, as needed, to remove secretions and prevent pulmonary problems. Foley catheter: It will be inserted into your bladder while you are asleep to accurately measure and record urine output. An arterial line is a soft plastic needle that is inserted into the radial artery in the wrist to monitor the blood pressure.
When you are awaken, you will be taken off the ventilator and allowed to breath on your own.
You will be taught how to perform coughing and deep breathing exercise.It may seem uncomfortable but is beneficial and will not cause any damage to the heart, grafts or incisions. Clear liquids will be given several hours after the breathing tubes have been removed and then there will be a gradual process to a regular diet. Depending on the medical condition, the following protocol will be observed on the second day.
After the chest tube(s) have been removed, you will be assisted out of bed and into the chair.
Normally, there is a small amount of fluid in the pericardial sac, and the heart moves easily within it. The sac may become inflamed and irritated as a result of the surgery, and this will cause discomfort in the chest, shoulder and neck. Dysrhythmias, or irregular heartbeats, can occur after surgery in 30% of patients & in particular old age patients. This is a most common post-operative syndrome and can last for several days, or even months, after the operation. After surgery, coughing and taking deep breaths might be painful, but coughing is extremely important. Deep breathing is essential so that secretions do not build up in the lungs which could lead to a partial collapse of lungs, or even pneumonia. The day you are transferred to the regular unit, you should walk in your room and sit in a chair two or three times. The next day, you should walk in the hallway; at first, walk with assistance until you are more steady on your feet.

For the remainder of your hospital stay you should start walking more and more in the hallway. It is extremely normal to feel anxious or depressed about leaving the hospital which has provided you with a sense of security. You should contact the surgeon’s office, if any problems arise before the next appointment. Increased redness, tenderness, swelling or a pus-like drainage from the incisions may indicate infection. The average demand on the heart during intercourse is equivalent to walking briskly for several minutes along with climbing two flights of stairs.
Smoking increases the heart rate, narrows the blood vessels, raises blood pressure and affects the lungs.
Physical activities (tennis, swimming, bowling, golf) other than walking should be postponed for 10-12 weeks.
Physical activities which do not involve exertion can be indulged in such as playing cards, going out for dinner, movies or theatre, or social visits can be indulged in.
If such symptoms occur, the physician should be contracted so that treatment can be commenced. Cola drinks, chocolate, tea and some pain medications contain caffeine or caffeine-like substances- so include them in calculating the intake of two cups a day. Stay away from non-dairy creamer and cream in coffee, as these contain considerable amounts of saturated fats. It is important to maintain an adequate and nutritious diet after surgery to quicken the process of healing, and gaining strength and good health. Some saturated fats can be made from unsaturated fats through a chemical process called hydrogenation which should be avoided.
The diet should be rich in fiber including foods like raw salads, fruits, green leafy vegetables and whole grains. Five servings of fruits and vegetables should be included in the diet not only to meet the nutritional requirement but also to meet antioxidants and fibre.
Consumption of two or more oils help in obtaining the optimal ratio of different fatty acids.
Concentrated foods like sweets, chocolates, cakes, pastries, ice creams and fried foods should be restricted. Foods giving only empty calories like carbohydrated beverages, alcohol, sugar and sago are to be totally avoided. Coconut should be avoided in the diet as it contains high amount of saturated fatty acids and it is a concentrated source of energy.
Animal foods like meat and pork which contain high amount of saturated fat should be avoided. Foods that have hypercholesterolamic effects like soyabean, fenugreek, garlic, onion and turmeric should be included in the diet.
For stir frying and salad dressing: Any oil low in saturated fat like canola oil, corn oil, or flaxseed oil, olive oil, peanut oil, walnut oil, sunflower oil and safflower oil. After the surgeon gives his consent after the 4-week check up, most patients can return to work in 6-10 weeks, depending on the occupation. We are a team of cardiac thoracic & vascular surgeons and cardiac anaesthestists and intensivists providing world class surgical services in the heart of Ahmedabad. Heart failure surgery: It includes LV Volume Reduction surgeries like Dor’s procedure, SVR, geoform Functional Mitral Valve Repair. Specialization in Adult Cardiac Surgery (Total arterial CABG also), Heart Failure Surgery, Valve Repairs, Paediatric Cardiac Surgery, Minimally invasive surgery. Fellowship Course in Minimally Invasive at Leipzig Heart Institute, Germany under Dr.Friedrich Mohr. A part of the Pioneering team in India in developing Surgical Ventricular Restoration and Heart Failure surgery. Timeless health, weight loss and wellness tips for everyday living - with a few fun facts tossed in.
Quick Cooking Tips to help you speed up the cooking process in your kitchen when time is short. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The results of these tests, the structure of your heart, your age, the severity of your symptoms, the presence of other medical conditions, and your lifestyle will help your cardiologist, surgeon and you determine what type of treatment is best. The surgeon decides which graft(s) to use, depending on the location of the blockage, the amount of the blockage and the size of the coronary arteries. In most cases, these arteries can be kept intact at their origin because they have their own oxygen-rich blood supply, and then sewn to the coronary artery below the site of the blockage. Your surgical risks are related to your age, the presence of other medical conditions and the number of procedures you undergo during a single operation.
If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. The heart’s beating is stopped so the surgeon can perform the bypass procedure on a “still” heart. The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Your surgeon will review the results of your diagnostic tests before your surgery to determine if you are a candidate for any of these minimally invasive techniques. It is strongly advised that the patient visit the ICU before surgery, he does not find himself in an unknown area.

You will feel drowsy and be sedated for 4-6 hrs after the operation due to effects of anesthesia. You may still feel the urge to urinate even with the catheter.It will be removed on the 2nd postoperative day. For the first day any blood sample that are necessary for tests can be drawn from the arterial line.
The discomfort subsides within a few days and the medication can be discontinued within a few weeks.
The drainage from the chest tube(s) is observed closely for any signs of excessive bleeding. By the time you leave the hospital you may be able to walk up to one mile a day (not all at one time) and climb 7-8 steps.
Do not forget, that you will not be discharged until the doctors are confident of your fitness to go home. After suture removal take regular bath twice a day with thorough cleaning of suture lines with soap and water. It is a common fear that one may experience difficulty in getting or maintaining an erection, lack of stamina or trouble having an orgasm. It should be indulged only after the partner is well rested, not eaten a heavy meal and is relaxed. Being depressed is different from clinical depression which is a condition wherein a patient is depressed, but also is prone to other symptoms such as insomnia, appetite disturbances, fatigue, lethargy, lack of interest in pleasure-giving things including sexual intercourse and feelings of hopelessness and despair.
After a one month follow-up with surgeon and the cardiologists opinion, one can resume work slowly with light duty initially. Totally committed to provide our best with no compromises on patient management and ethics. Dhiren Shah has been rated the best cardiac surgeon in Gujarat by independent reviewers with actual feedback recorded on the internet. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.
If the surgeon removes the mammary artery from its origin, it is called a “free” mammary artery.
Most people receive blood to their arm from the ulnar artery and will not have any side effects if the radial artery is used. Your cardiologist will discuss these risks with you before surgery; please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Other possible benefits may include a reduced risk of infection, less bleeding, less pain and trauma, decreased length of stay in the hospital (3 to 5 days) and decreased recovery time. The breathing will be mechanically assisted by a ventilator with oxygen going in through the tube. There may be a burning sensation the first time you urinate after the Foley catheter is removed. The nurses will ask you if you have pain in either chest or leg incision, but it is your responsibility to ask the nurse for pain medication.
You may not feel like eating for a few days which is normal because of antibiotics & medicines. One should be in a more passive position and not place weight on the arms for the first six weeks. Over the last decade, more than 90% of all patients received at least one internal artery graft. Normally, one person of the family can visit the patient in the ICU one to two hours after the operation. When the family comes in to visit they will see drainage container at the foot of the bed with some bloody drainage in it. If the comfort level is satisfactory it will be easier to do breathing and coughing exercise and to get out of bed and walk. A good time to request the pain medication is 15-20 minutes before beginning your breathing exercises. The breastbone requires approximately 6-8 weeks to heal and strain should be avoided during this period. Initially after surgery, one may not have much of an appetite, which will improve over time.
Dhiren Shah is the only cardiac surgeon in India to have launched healthcare mobile applications to help patients on Android, iOS, and Windows Mobile Platforms. If the radial artery is used as the graft, the patient may be required to take a calcium channel blocker medication for several months after surgery. As one catches up on sleep after being shifted into the room, and the time of discharge approaches, the depression usually lessens or disappear.

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