Symptoms of chest tightness, unexplained easy fatigue, or shortness of breath during exertion may be warning signs of ‘Coronary Artery Disease’. If not diagnosed and treated promptly, it can lead to acute myocardial ischemia or acute heart failure, especially in patients with multiple coronary artery stenoses or those with underlying conditions such as diabetes, hypertension, or high blood cholesterol.
Today, we would like to introduce everyone to Coronary Artery Surgery, also known as ‘Coronary Artery Bypass Grafting (CABG)’, which is one of the effective treatment methods for coronary artery stenosis or blockage and can save many patients’ lives.
What is Coronary Artery Surgery?
Coronary artery surgery, commonly called coronary artery bypass grafting (CABG), is a surgery to create a new blood flow pathway (graft) in patients with severe coronary artery stenosis or blockage, or those with acute myocardial ischemia. Surgeons take blood vessels from other parts of the body to create a new blood pathway, allowing blood to flow to the heart muscle without passing through the narrowed or blocked original vessels. This ensures the heart muscle receives sufficient blood and oxygen, effectively reducing chest tightness symptoms and increasing survival rates in many cases.
Who is suitable for Coronary Artery Bypass Surgery (CABG)?
Coronary artery surgery or bypass surgery (CABG) is a treatment for patients with severe or complex coronary artery stenosis, where other treatments such as medication or balloon angioplasty with stenting (Percutaneous Coronary Intervention: PCI) may be ineffective or limited, especially in patients with the following conditions:
- Severe multi-vessel coronary artery disease or stenosis in the left main coronary artery, which is unsuitable for balloon angioplasty and stenting
- Diabetic patients with multi-vessel coronary artery disease, who respond better to bypass surgery than balloon angioplasty and stenting
- Patients with complications after balloon angioplasty and stenting that cannot be resolved by other methods
- Patients with chronic myocardial ischemia unresponsive to medication, with viable heart muscle that can recover if adequately supplied with blood
- Patients who survive acute myocardial infarction with multiple vessel stenoses or concurrent heart failure
- Severe refractory angina not responsive to medication or vessel dilation
- Heart failure patients due to ischemic heart disease who still have potential for cardiac function recovery after surgery
Preparation before Coronary Artery Bypass Surgery (CABG)
CABG is a complex procedure requiring cooperation from a multidisciplinary team including cardiologists, anesthesiologists, and cardiac surgeons. The preparation process aims to assess patient suitability, plan the safest surgery, and reduce risks during and after surgery. Key steps include:
- Diagnosis of coronary artery disease starts with symptom history such as chest tightness and easy fatigue, physical examination by specialists, electrocardiogram (EKG), and cardiac stress testing (EST). Echocardiogram is used to assess heart muscle and valve function. Coronary angiography is the most important step to identify the location, number, and severity of narrowed or blocked vessels.
- Preoperative readiness assessment involves blood tests to evaluate blood completeness, kidney and liver function, blood sugar and lipid levels, and blood clotting, along with chest X-rays or CT scans if necessary.
- Before surgery, patients must fast from food and drink for at least 6-8 hours to prevent aspiration during anesthesia. In some cases, small sips of water or necessary medications may be allowed.
- Medication adjustment must be under physician guidance. Some medications, such as blood thinners, need to be stopped 5-7 days prior or switched to injections to reduce bleeding risk. Meanwhile, medications for blood pressure, diabetes, and thyroid disease should be continued until surgery as prescribed and not stopped independently.
Coronary Artery Bypass Surgery (CABG) Procedure
On the day of surgery, the patient will be anesthetized by an anesthesiologist, with intubation, catheter insertion, and vital sign monitoring devices attached. The surgeon will perform a median sternotomy to access the heart and harvest quality blood vessels such as the internal mammary artery, saphenous vein from the leg, or radial artery to create new blood pathways, allowing blood to flow to the heart muscle instead of the narrowed or blocked original vessels.
After grafting, the surgeon will check heart and graft function, close the incision, and transfer the patient to the cardiac intensive care unit (ICU) for close monitoring. Surgery typically takes about 3-6 hours depending on severity, complexity, and number of vessels operated on.
Types of Coronary Artery Bypass Surgery (CABG)
There are two main types of bypass surgery:
- On-pump CABG uses a heart-lung machine to stop the heart during surgery. The machine pumps blood and oxygenates it instead of the heart and lungs. This method allows precise and safe surgery, suitable for patients with multiple or complex vessel stenoses, and is the traditional method with proven good short- and long-term outcomes.
- Off-pump CABG or Beating-Heart Surgery is performed without the heart-lung machine, keeping the heart beating throughout surgery. The surgeon uses a local stabilizer to immobilize the heart surface where grafting occurs while the rest of the heart continues beating normally. This reduces complications related to the heart-lung machine, such as systemic inflammation or abnormal bleeding, and is suitable for high-risk patients or those with complications unsuitable for the machine.
In some cases, minimally invasive or robotic CABG techniques may be considered, offering smaller incisions, faster recovery, and fewer complications.
Recovery after Coronary Artery Bypass Surgery (CABG)
After CABG, patients are closely monitored in the ICU for 1-2 days to assess and manage possible complications such as arrhythmias, bleeding, or abnormal blood pressure. Then, patients are transferred to a general recovery room. The total hospital stay is usually about 5-7 days depending on physical condition, comorbidities, and complications.
During recovery, doctors may prescribe antiplatelet drugs, lipid-lowering agents, blood pressure medications, and other treatments as appropriate, such as diabetes control, to prevent recurrent vessel stenosis.
Some patients may participate in a cardiac rehabilitation program, a comprehensive program that promotes heart function, physical strength, reduces stress, and lowers the risk of future coronary artery disease recurrence.
Self-care at home after Coronary Artery Bypass Surgery (CABG)
After discharge, patients must continue health care, including strict adherence to prescribed medications to prevent recurrent vessel stenosis, control risk factors such as diabetes, hypertension, high cholesterol, and adopt healthy lifestyle changes such as:
- Get adequate rest by sleeping 7-9 hours per night
- Avoid smoking and alcoholic beverages
- Avoid lifting heavy objects over 2 kilograms for about 1-2 months or until permitted by the doctor
- Refrain from driving for 6-8 weeks or until the doctor deems it safe
- If daily activities cause fatigue, take breaks of 20-30 minutes at least twice a day
- Eat nutritious food avoiding saturated fats, sugar, and high cholesterol. Use vegetable oils instead of animal fats and prefer boiling, steaming, or baking over frying
- Engage in light exercise such as walking, gradually increasing intensity as advised by doctors or physical therapists. Generally, light activities can start within 4-6 weeks, and sports can resume after 3-6 months depending on physical strength, always consulting a doctor first
- Manage stress appropriately through meditation or talking with friends and family
- Keep the surgical wound clean and dry. Avoid wetting the wound for the first 1-2 weeks. Once dry and healed, normal bathing can resume
- Monitor for abnormal symptoms. If high fever, pain, swelling, redness, or discharge from the wound occurs, see a doctor immediately
Differences between Coronary Artery Bypass Surgery (CABG) and Balloon Angioplasty with Stenting (PCI)
| Characteristic | Coronary Artery Bypass Surgery (CABG) |
Balloon Angioplasty with Stenting (Balloon Angioplasty / PCI) |
| Treatment | Open chest surgery, using blood vessels from the body to bypass narrowed vessels | Catheter insertion through blood vessels, balloon dilation of narrowed vessels with stent placement |
| Procedure size | Major surgery (Invasive) | Small to moderate procedure (Minimally Invasive Procedure) |
| Procedure time and hospital stay | 3-6 hours surgery, 7-10 days hospital stay | 1-2 hours procedure, 1-2 days hospital stay |
| Recovery time | Several weeks to months | Quick recovery, return to daily life within days |
| Suitability for disease | Multiple vessel stenoses or with diabetes | Single, uncomplicated vessel stenosis |
| Long-term results | Reduces risk of recurrent ischemic heart disease long-term | Risk of restenosis, especially without drug-eluting stents |
| Repeat procedure | Less likely than balloon angioplasty | More likely, especially with restenosis |
| Surgical risk | Higher risk such as bleeding, infection, heart failure | Lower risk such as vessel rupture, blood clots |
| Overall cost | Higher | Lower |
Coronary artery bypass surgery (CABG) is a standard treatment that meets the needs of patients with severe coronary artery stenosis or blockage at Phyathai Phaholyothin Hospital. We provide comprehensive cardiac care by a specialized medical team covering diagnosis, medication, interventions, and bypass surgery using modern technology and equipment under the Value Health Care concept, combining quality treatment and cost-effectiveness to ensure patients access excellent medical services confidently without worrying about unnecessary expenses.
‘Treat your heart to be strong for a better quality of life every day’
Dr. Nipon Srisuwan
Cardiologist
Phyathai Phaholyothin Hospital
