A Comprehensive Guide on Coronary Artery Bypass Graft (CABG)

Procedure of Coronary Artery Bypass Graft (CABG) surgery

Preoperative Preparation:

1. Medical Evaluation: Before surgery, the patient undergoes a comprehensive medical evaluation. This includes reviewing medical history, conducting a physical examination, and performing various diagnostic tests such as electrocardiogram (ECG), echocardiogram, stress tests, and coronary angiography. These tests help determine the location and severity of coronary artery disease (CAD) and assess the overall heart function.

2. Medication Adjustment: Depending on the patient's condition, medications may be adjusted. For example, blood thinners (anticoagulants) might be stopped temporarily before surgery to reduce the risk of bleeding during and after the procedure.

3. Patient Education: Patients receive detailed information about the surgery, including its purpose, potential risks and complications, expected outcomes, and postoperative care. They may also meet with an anesthesiologist to discuss anaesthesia options and their preferences.

Surgical Procedure:

1. Anesthesia: CABG surgery begins with the administration of general anaesthesia. This ensures that the patient is unconscious and pain-free throughout the procedure.

2. Incision: A long incision is made in the chest, typically down the centre of the sternum (breastbone). This approach is known as a median sternotomy. Alternatively, in some cases, a minimally invasive approach may be used, involving smaller incisions between the ribs (thoracotomy).

3. Accessing the Heart: Once the chest cavity is opened, the surgeon gains access to the heart and its blood vessels.

4. Harvesting of Grafts: The surgeon identifies suitable blood vessels to use as grafts. Commonly used grafts include:

• Internal Mammary Artery (IMA): This artery, located inside the chest wall, is often used due to its durability and long-term success in bypassing coronary blockages.
• Saphenous Vein: This vein, harvested from the leg, is another option for grafting.
• Radial Artery: Occasionally, the radial artery from the arm may be used as a graft.

The chosen graft(s) are carefully dissected and prepared for attachment to the coronary arteries.

5. Cardiopulmonary Bypass (CPB): To temporarily take over the heart's pumping function and allow the surgeon to work on the coronary arteries without blood flow interfering, a heart-lung bypass machine is connected to the patient. This machine oxygenates the blood and circulates it through the body, maintaining vital organ perfusion while the heart is temporarily stopped.

6. Graft Placement: Using delicate surgical instruments and techniques, the surgeon begins bypassing the diseased coronary arteries. This involves:

• Anastomosis: Attaching one end of the graft to the aorta (the main artery leaving the heart) or another suitable site.
• Distal Anastomosis: Attaching the other end of the graft to the coronary artery beyond the blockage, creating a new pathway for blood to flow around the narrowed or blocked segment.
• Proximal Anastomosis: If multiple grafts are used, additional connections may be made to bypass other affected coronary arteries.

7. Assessment and Completion: Once all grafts are in place and blood flow is restored to the heart muscle, the surgeon carefully assesses the function of each graft and the overall surgical outcome.

8. Closure: After completing the bypass grafting, the heart-lung bypass machine is gradually weaned off as the heart resumes its normal pumping function. Chest tubes are placed to drain any accumulated fluid from around the heart and lungs. The sternum and skin incisions are then closed with sutures or staples.

Postoperative Care:

1. Intensive Care Unit (ICU) Monitoring: After surgery, the patient is transferred to the ICU for close monitoring of heart function, vital signs, fluid balance, and overall recovery. Continuous monitoring helps detect and manage any potential complications early on.

2. Pain Management: Adequate pain relief is provided through medications to ensure patient comfort and facilitate early mobility and recovery.

3. Rehabilitation and Recovery: Physical therapy begins soon after surgery to promote chest wall mobility, breathing exercises, and a gradual increase in physical activity. This helps prevent complications such as pneumonia and blood clots.

4. Long-term Management: Following discharge from the hospital, patients are advised on long-term management strategies. This includes adhering to prescribed medications (such as antiplatelet agents, statins, and blood pressure medications), adopting heart-healthy lifestyle changes (including diet modifications, regular exercise, and smoking cessation), and attending regular follow-up appointments with their cardiologist.

CABG surgery aims to relieve angina (chest pain), improve quality of life, and reduce the risk of heart attack in patients with severe coronary artery disease. The success of the procedure depends on various factors including the patient's overall health, extent of coronary artery disease, and the skill and experience of the surgical team.

Top Doctors for Coronary Artery Bypass Graft (CABG) in India

Designation: Chairman and Managing Director - Medanta Heart Institute

Country: India

Surgeon's Rating: 4.5

Experience Years: 43

Number of Surgeries: 48,000

About Dr. Naresh Trehan

Dr. Naresh Trehan is a world-renowned cardiovascular and cardiothoracic surgeon serving as the Chairman and Managing Director of Medanta - The Medicity, Gurugram. He has been awarded the prestigious Padma Bhushan and Padma Shri by the Government of India. With over 48,000 successful open heart surgeries to his credit, Dr Trehan is celebrated for his significant contributions to the field.

Specializations:

• Cardiothoracic Surgery
• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Heart Transplant

Professional Experience

• Chairman and Managing Director, Medanta - The Medicity: 2009 - Present
• Senior Consultant, Cardio Vascular Surgery, Apollo Hospitals, Sarita Vihar: 2007 - 2009
• Executive Director and Chief Cardiothoracic and Vascular Surgeon, Escorts Heart Institute and Research Institute: 1988 - 2007
• Personal Surgeon to The President of India: 1991 - Present
• Honorary Consultant, Cromwell Hospital, London, UK: 1994 - Present

Education

• Diplomate, The American Board of Cardiothoracic Surgery, USA: 1979
• Diplomate, The American Board of Surgery, USA: 1977
• M.B.B.S., K.G. Medical College, Lucknow: 1968

Awards and Honors

• Padma Bhushan Award: 2001, by the President of India for distinguished service in Cardiology Medicine
• Padma Shri Award: 1991, by the President of India for distinguished service in Surgery
• Dr. B. C. Roy Award: 2002, from the Medical Council of India
• India Today Ranking: 35th in India's 50 Most Powerful People of 2017 list

Memberships and Certifications

• Ex-President of the International Society for Minimally Invasive Cardiac Surgery
• Member of the Society of Thoracic Surgeons of the U.S.A.
• Vice Chairman of Services Export Promotion Council
• Chairman of the Confederation of Indian Industries-Healthcare Industry Committee
• Contributor to the Ministry of Health and Family Welfare, Government of India, among other advisory roles

Top Hospitals for Coronary Artery Bypass Graft (CABG) in India

India is home to several world-class hospitals equipped with state-of-the-art facilities for treating fatty liver disease. Top hospitals include:

                                                                                                                                        
Address: Jaslok Hospital & Research Centre, 15 - Dr. Deshmukh Marg, Pedder Road, Mumbai - 400 026
Country: India
Treatment Availability: International
Hospital Category: Medical
Established Year: 1973
City: Mumbai
Status: Active
Visibility on Website: Yes

About Hospital

Jaslok Hospital and Research Centre, founded by philanthropist Seth Lokoomal Chanrai along with surgeon Shantilal Jamnadas Mehta, was formally inaugurated on 6 July 1973 by the then Prime Minister, Indira Gandhi. The hospital is accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of the Qu

Specialities and Services

Jaslok Hospital Mumbai offers comprehensive medical services across various specialities including IVF, cardiology, neurology, oncology, surgery (general, laparoscopic, and robotic), critical care, and specialized departments like hepatology, nephrology, and geriatric medicine. The hospital also provides advanced diagnostic and therapeutic services in radiology, pathology, and laboratory medicine.

Infrastructure

• Total No of Beds: 343
• Non ICU Beds: 255
• ICU Beds: 58

2. Max Healthcare Saket

Name: Max Healthcare Saket
Address: New Delhi, Saket
Country: India
Treatment Availability: International
Hospital Category: Medical
Established Year: 2006
City: New Delhi

About Hospital

• Max Super Speciality Hospital is one of the top multi-specialty hospitals in Delhi.
• The hospital has a 500+ bedded facility offering treatment across all medical disciplines.
• Expert doctors at Max Hospital have treated over 34 lakh patients across all major specialities.
• The hospital is equipped with a state-of-the-art 1.5 Tesla MRI machine and a 64 Slice CT Angio.
• It houses Asia's first Brain SUITE, an advanced neurosurgical operation theatre that allows MRIs to be taken during surgery.
• The hospital has won prestigious awards from the Association of Healthcare Providers of India (AHPI) and FICCI.
• FICCI awarded Max Super Specialty Hospital, Saket, the Award for Operational Excellence in Healthcare Delivery on 7 September 2010.

Key Highlights

• Specialized Dialysis Unit conforming to international standards.
• Haemodialysis for patients with end-stage kidney disease requiring renal replacement therapy.

Infrastructure

• Number of Beds: 530
• Operation Theaters: 12

3. Apollo Hospitals, Chennai

Apollo Hospitals on Greams Road in Chennai was established in 1983 by Dr Prathap C Reddy. It was India's first corporate hospital and is acclaimed for pioneering the private healthcare revolution in the country. Over the years, Apollo Hospitals has risen to a position of leadership, emerging as Asia's foremost integrated healthcare services provider.

Location

• Address: 21 Greams Lane, Off Greams Road, Thousand Lights, Chennai, Tamil Nadu 600006, India
• City: Chennai
• Country: India

Hospital Features

• Established Year: 1983
• Treatment Availability: International
• Hospital Category: Medical
• Status: Active
• Visibility on Website: Yes

About Apollo Hospitals

Apollo Hospitals has a robust presence across the healthcare ecosystem, including hospitals, pharmacies, primary care, and diagnostic clinics. The Group also has telemedicine units across 10 countries, health insurance services, global projects consultancy, medical colleges, Med-varsity for e-learning, colleges of nursing, and hospital management.

Team and Specialties

• Cardiology and Cardiothoracic Surgery: Apollo Hospitals hosts one of the largest cardiovascular groups globally, with around 14 world-class institutes, over 400 cardiologists & cardiac surgeons, and 200 heart stations.
• Robotic Spinal Surgery: Among the few centres in Asia to perform this advanced procedure, Apollo is at the forefront of spinal disorder management.
• Cancer Care: A 300-bedded, NABH-accredited hospital providing advanced technology in diagnosis and radiation, supported by an oncology team of renowned specialists and well-trained medical and paramedical professionals.
• Gastroenterology: Offers the latest endoscopic procedures for gastrointestinal bleeding, cancers, foreign body removal, etc.
• Transplant Institutes: The Apollo Transplant Institutes (ATI) is one of the largest, most comprehensive, and busiest solid transplant programs globally.
• Liver Surgery: Equipped with a 320-slice CT scanner, a state-of-the-art Liver Intensive Care Unit & Operation Theatre, and various surgical tools to enable safe & bloodless liver surgery.
• Neurosurgery: Recognized as a leader in acute neurosurgery, Apollo Hospitals, Chennai, is among the top hospitals specializing in neuro care worldwide.

Infrastructure

With the experience of over one million health checks, Apollo Hospitals has emerged as a key player in the corporate healthcare sector. Over 500 leading corporates, across all industry segments, have tied up with Apollo Hospitals, providing their employees ready access to sophisticated medical facilities at over 64 locations in India. The corporate services initiative of Apollo Hospitals, Chennai, aims to provide world-standard healthcare within the reach of every individual.

4. Fortis Memorial Research Institute (FMRI), Gurugram

Fortis Memorial Research Institute (FMRI) in Gurgaon is a premier multi-super specialty, quaternary care hospital. Known for its international faculty and reputed clinicians, including super-sub-specialists and speciality nurses, FMRI is supported by cutting-edge technology. The hospital aims to be the 'Mecca of Healthcare' for the Asia Pacific region and beyond.

Location

• Address: Sector - 44, Opposite HUDA City Centre, Gurgaon, Haryana - 122002, India
• City: Gurgaon
• Country: India

Hospital Features

• Established Year: 2001
• Number of Beds: 1000
• Number of ICU Beds: 81
• Operation Theaters: 15
• Hospital Category: Medical
• Treatment Availability: International
• Status: Active
• Visibility on Website: Yes

Specialties

FMRI excels in several medical specialities, including:

• Neurosciences
• Oncology
• Renal Sciences
• Orthopedics
• Cardiac Sciences
• Obstetrics and Gynecology

These specialities leverage advanced technology and top clinicians to deliver exceptional healthcare services.

Team and Expertise

• International Recognition: FMRI has been ranked No.2 of the 30 most technologically advanced hospitals in the world by ‘topmastersinhealthcare.com,’ surpassing many other outstanding medical institutions globally.
• Patient Care: Fortis hospitals treat over 3.5 lakh patients annually, relying on reputed clinicians, state-of-the-art infrastructure, and world-class technology such as the Da Vinci robot, ensuring patients go home healthy.
• Innovative Initiatives: FMRI's initiatives range from customized preventive health checks to quaternary care provided by super-specialized clinicians conducting rare and complex surgeries.

About Fortis Healthcare

FMRI is a flagship hospital of Fortis Healthcare, one of the top healthcare providers in India. Fortis Healthcare is known for its commitment to quality healthcare and patient safety, making FMRI one of the most sought-after medical destinations in the region.