Coronary artery bypass grafting (CABG) is a type of an open heart surgery that intends to improve the flow of blood to the heart. It involves the placement of a coronary artery bypass graft, which is retrieved from a healthy artery in the body, and placed in the position of the blocked portion of the artery that supplies blood to the heart. CABG surgery is a complex, yet common procedure.
A waxy substance called plaque may deposit in good amount in the coronary arteries of the heart over a period of time. As time advances, the plaque starts hardening and eventually ruptures and breaks open. The plaque interferes with blood flow as arteries grow narrow at the affected region. A blood clot develops when the plaque ruptures. The artery may get blocked completely is the size of the clot is big enough to stop the flow of blood to the heart. This may eventually lead to serious events such as heart attack and also put the individual at the risk of death.
The person may experience chest pain and discomfort when the heart is deprived of rich oxygenated blood This pain is referred to as angina. Breathlessness and fatigue are some of the other problems associated with coronary heart disease.
Coronary artery bypass surgery aims at improving the overall blood circulation to the heart. A part of healthy artery or vein from another part of the body is taken and is grafted or connected to the blocked coronary artery for bypass. This artery or vein goes around the blocked portion of the coronary artery and establishes a new path for the blood to flow to the heart, thus reducing the chance of a heart attack. In a single surgery, surgeons can bypass multiple coronary arteries. Severe blockages can be treated with this procedure.
CABG is conducted when there are one or two blockages in the artery. High risk CABG is conducted when there are multiple blockages in the artery and the blood flow to the heart is severely restricted.
Before the actual procedure you may be required to visit the surgeon multiple times as they perform a number of tests. The surgical team may perform several tests to check for the overall functioning of the heart and other vital organs. The purpose of these tests is to assess you overall capacity to tolerate the surgery. Additionally, it also helps the surgeons decide a surgical approach and the things that they need to take care of during the procedure.
Days before the procedure, you must make your lifestyle as simple as possible and you must avoid exerting yourself. Blood count, clotting time, and catheterization tests are conducted to check the severity of the blocked coronary arteries and to anticipate the complications that may arise as a result of the coronary artery bypass surgery.
There are two approaches to conduct CABG – open heart surgery and laparoscopic bypass heart surgery. The latter is a type of minimally invasive heart bypass surgery, which involves the creation of smaller incisions. This results in minimum discomfort and complications and allows for faster recovery and healing.
Laparoscopic bypass heart surgery is mostly preferred when there is not much blockage in the coronary artery. Open heart surgery, on the other hand, is conducted in complicated cases. High-risk CABG is mostly conducted as an open heart surgical procedure.
The selection of a particular approach, however, depends on a number of factors, including the overall health of the patient and the experience of the surgeon. CABG involves the use of general anesthesia. Typically, an incision down the middle of the chest is made by the cardiac surgeon. He then uses a saw like instrument to access the breastbone or the sternum. This cutting of the middle of the sternum is referred to as median sternonomy. During CABG, the heart has to be first cooled with iced salt water. Along with this, a preservative solution has to be injected in the arteries of the heart. This procedure is referred to as cardioplegia, where damage is minimized due to reduced blood flow to the heart during the surgery.
A cardiopulmonary bypass must be established before a bypass surgery can take place. To channelize venous blood out of the body, plastic tubes must be placed in the right atrium. A membrane oxygenator, which is like a plastic sheeting, is employed to channelize it to the heart lung machine.
The oxygenated blood is then returned to the body. To allow the bypass to connect with the aorta, the main aorta is cross clamped during the surgery. This maintains a bloodless field. Saphenous vein from the leg is the commonly used as coronary artery bypass graft.
Beyond the narrowing of the vessel or the coronary artery, the graft vessel is sewed to the coronary arteries. The other end of the grafted vein or vessel is made to attach with the aorta. Nowadays, chest wall arteries or more specifically, the internal mammary artery is used as a coronary artery bypass graft.
The artery is then separated from the wall of the chest to connect to the left anterior descending artery. It can also be connected to one of the major branches which is beyond the blockage.
Internal mammary arteries have an advantage over venous grafts. The former remains open for a longer period of time. The percentage of being open in the case of venous grafts is around 66 percent, while for internal mammary arteries it is 90 percent.
The aorta must be clamped off for 60 minutes while the body is supported by cardiopulmonary bypass. The use of 3, 4 or 5 bypasses has grown very common. At the end of the surgery, the sternum is wired together with the help of stainless steel while the incision made in the chest is sewn. Plastic tubes are kept undisturbed to allow any blood drainage from the region around the heart. The chest tubes are removed right after surgery along with the breathing tube.
Patients are transferred to the ICU right after the surgery and shifted to the patient ward a day later. Heart rhythm disturbances are discovered in 25 percent of the patients within a period of 3 or 4 days after the surgery. They are temporary atrial fibrillations associated with surgical trauma. Such patients respond well to standard medical therapies.
They can be weaned within a period of a month after the surgery. From one week to one day, the range of stay in the hospital may vary from one patient to the other. Young patients are usually discharged within two days. The recovery time can be very long and the range of physical activities must be kept to a minimum.
The bypass surgery cost is much affordable and significantly lower than what it costs in the Western country, especially in the US. It is estimated that a patient from abroad saves thousands of dollar by choosing to undergo CABG and high risk CABG in India instead of any other Western country.
The coronary artery bypass graft cost varies among different countries. The total cardiac bypass surgery cost in India and abroad varies on a number of factors. Some of these factors include the following:
The following tables highlight the approximate high risk coronary artery bypass surgery cost in India and abroad:
|Cost of High Risk CABG surgery in India||$8000|
|Cost of High Risk CABG surgery in Thailand||$12000|
|Cost of High Risk CABG surgery in South Korea||$33500|
|Cost of High Risk CABG surgery in Hungary||$34500|
|Cost of High Risk CABG surgery in UAE||$21251|
|Cost of High Risk CABG surgery in Poland||$22100|
The cost of triple bypass surgery in India is also reasonable price in comparison to other country. The following tables highlight the approximate coronary artery bypass surgery cost in India and abroad:
|Treatment cost in India:||4000|
|Treatment cost in Turkey:||6000|
|Treatment cost in United Arab Emirates:||21251|
|Treatment cost in Singapore:||19164|
|Treatment cost in Thailand:||9063|
|Treatment cost in Hungary:||34500|
Q. What is the average cost of heart bypass surgery?
A. Average heart bypass surgery cost varies from one country to the other and depends on several factors, including the number of blockages cleared and the total duration of hospital stay.
Q. Is heart bypass surgery cost covered under health insurance?
A. Yes, a majority of health insurances cover CABG surgery. The best is to check with your insurance provider about the claim.
Q. Is it possible to develop another blockage after having CABG?
A. Blockage can return back after a long period of time. Chances cannot be ruled out.
Q. How much should I rest after CABG surgery?
A. It is important to abstain from sexual intercourse for at least four to six week after the surgery. In addition, you can begin with light physical exercises and normal work routine after six weeks. Make sure to consult your doctor before you begin doing anything that may strain you.
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