What is coronary artery disease?

Coronary artery disease is a disease of the arteries that surround the heart and supply blood to the heart muscle. When those arteries harden and become partially obstructed by atherosclerosis, coronary artery disease exists. The obstruction of the coronary arties reduces the amount of blood reaching the heart muscle. When coronary artery blood flow is reduced, it may lead to pain called angina pectoris or a heart attack that scars part of the heart muscle.

What is coronary artery bypass graft surgery (CABG)?

Coronary artery bypass graft surgery is an operation in which arteries removed from inside the chest wall or hand, or veins removed from the legs are used on the surface of the heart to bypass obstructions in the coronary arteries. The blood supply to the heart muscle thus is restored to areas where it was reduced by atherosclerosis.

What will coronary artery bypass graft surgery accomplish?

The purpose of coronary artery bypass graft surgery is to improve the blood flow to the heart muscle. More blood flow should mean less angina or no angina at all. It should reduce the need for medication and improve exercise capability. The operation also may prolong life.

What are the indications for CABG surgery?

Decision to do surgery is taken by your cardiologist and cardiac surgeon after looking at your coronary angiogram. Surgery may be recommended for a variety of reasons: If medications no longer relieve your angina, if you have life-threatening coronary blocks or if you have complications following a heart attack.

Traditionally, the vein used for bypass surgery is taken from the leg after a long incision is made. Dr. Gokhale CT Associates has mastered the art of taking the vein with an endoscope, after making one to three small incisions. Such endoscopic vein harvesting (EVH) helps patients recover faster and avoid a long scar.

What is beating heart bypass surgery?

Coronary arteries are 1.5 to 2.5mm in diameter. When heart is beating, it is difficult to do surgery on such small blood vessels. Traditionally bypass surgery is done after stopping your heart. During this time your blood is circulated using an artificial heart-lung machine. Now with the advent of newer devices, it is possible to do coronary artery bypass surgery without stopping heart. What method suits you will be decided by your surgeon in the operating room.

How does one prepare for coronary artery bypass graft surgery?

Both you and your family should have sufficient information about the operation and hospital procedure to relieve your natural anxiety. You should feel free to discuss any concerns with the doctor. Because procedures vary from one hospital to another, be sure to find out about visiting hours, discussions with physicians and any other hospital related concerns you may have.

What about hospital admission?

Admission to the hospital is usually scheduled for two or three days before the date of the operation to allow time for pre-operative testing, control of diabetes etc. Instructions for clearing the lungs of mucus secretions, coughing techniques and deep breathing exercises will be given. During this time, you will become acquainted with the team of surgeons, anesthetists, nurses and therapists who provide your care during and after the operation.

Are people frightened or nervous before the operation?

It is normal to feel nervous before important events. Nervousness or anxiety before an operation is a normal reaction just as athletes often are nervous before important games. Nervousness often is lessened by understanding the need for the operation, meeting members of the professional team and asking questions. Sometimes mild sedatives may be needed.

How long do these operations usually last?

Generally, this operation takes from three to six hours. However, the length of the operation depends on its complexity. Because of this, each operation is different and the duration is difficult to predict accurately.

What happens immediately after the operation?

Once the operation is over, patients are cared for in an intensive care unit. It is here that patients regain consciousness after the anesthesia wears off. Tubes and wires are attached to parts of the body to provide for safe and efficient recovery. You may spend a few days in the intensive care unit, although everyone recovers from surgery at a different pace. During this time one visitor will be allowed in the morning and again in the evening to see you. Make sure that atleast one of your attendants will be available in the morning outside the intensive care unit area. After doing rounds in the morning, the doctor will discuss with them about your progress.

Where will the incisions be made?

The incision used to reach the heart is made along the midline of the chest trough the breastbone. There usually will be one or more incisions in the leg where the vein is removed and sometimes in the forearm where the radial artery is removed for use for the bypass.

What can be done to help in recovery?

Deep breathing exercises and coughing are important ways to help recover quickly. Coughing reduces the chances of pneumonia and fever and will not disturb the incision or bypass grafts. The nurse or therapist will clap her/his hands against the side of your chest, causing internal vibrations that loosen the secretions in the lungs. This makes it easier to cough them up. Most patients, fearing pain or discomfort, do not like to cough after an operation. But it is essential that it be done. Some patients find it easier to cough if the chest is supported by a pillow. You may be asked to inhale or exhale into a spirometer, a device to expand and exercise your lungs.

What activity levels are prescribed?

The activity level is prescribed individually for each patient. At first, it may be sitting in a chair or walking around the room. Later, there will be short walks in the hall and eventually, stair climbing and brisk, longer walks in preparation to go home. Sponge baths are given right away and it is only a few days before a shower and shampoo are permissible.

Will I feel pain after the operation?

Most patients complain of being sore but do not have severe pain. This soreness originates from the surgical incisions and muscle spasms. It can be helped by good posture and frequent movement of the arms and shoulders. If the pain is severe, medication may be obtained from the nurse upon request.

What about the healing of the incisions?

You can keep the incisions clean by washing them gently in your daily bath or shower. If you find excess swelling, redness, oozing or tenderness, call your doctor. About six weeks are required for complete healing of these wounds. External stitches are removed about 2 weeks from the day of surgery.

What can i look forward to after the operation?

As your recovery progresses, you will be able to appreciate more fully the effects of the surgery. The increased blood flow through your coronary arteries would mean less angina or none at all. You may find you need much less medication, if any, and that you are able to sustain physical activity and exercise with a greater capacity. In addition to feeling better, there is also a chance that your surgery may prolong your life.

Cardiothoracic surgeons perform Coronary Artery Bypass Graft surgery procedure to treat coronary arteries disease to prevent attack or sudden death. Dr.Gokhale is one of the very few surgeons in India with large experience in “Minimally invasive cardiac surgery” including coronary bypass surgeries, valve replacements and closure of holes in the heart.

What is endoscopic vein harvesting (EVH)?

During coronary artery bypass graft surgery, a surgeon takes a segment of a healthy blood vessel (an artery or vein) from another part of the body and uses it to create a detour or bypass around the blocked portion of the coronary artery. That process is called graft harvesting. Traditionally, vein harvesting is accomplished through a lengthy surgical incision in the leg (see Figure 1).

But in recent times leading surgeons have been practicing a minimally invasive procedure called Endoscopic Vein Harvesting – EVH (see Figure 2).

EVH requires one to three small incisions, each less than 1 inch in length. With this less invasive technique, the surgeon removes the vein with the aid of a special video camera, or endoscope.

The advantages of endoscopic vein harvesting go beyond faster recovery and avoiding a long leg scar. Patients undergoing EVH are less likely to experience events like wound complications, swelling, leg pain and infection. Obese persons, diabetics and patients suffering from peripheral vascular disease are at greater risk for leg wound complications.

Dr Alla Gopala Krishna Gokhale was the first successful doctor to perform heart transplantation surgery in the states of Telangana and Andhra Pradesh. In Hyderabad, now he is practicing as Chief Cardiothoracic, Transplant and Minimally invasive procedure called Endoscopic Vein Harvesting.

1. Your heart is in the center of your chest. Your heart is not right under your skin but lies behind your breastbone, inside your rib cage, and between your lungs. The bottom of the heart is tipped to the left, so you feel more of your heart on the left side of your chest.
2. The heart is about the size of your fist. (When you were a baby it was the size of your baby fist). The heart is a muscle, just like the other muscles in your body. It weighs about a pound, or less than half a kilogram.
3. Your system of blood vessels – arteries, veins and capillaries – is over 60,000 miles (96,000 km) long. That’s long enough to go around the world more than twice!
4. Blood is about 78 percent water. Blood takes about 20 seconds to circulate throughout the entire vascular system.
5. The adult heart pumps approximately 2,000 gallons (7600 liters) of blood each day throughout the body.
6. The heart’s rate when you are a baby is about 120 beats per minute. As you grow, your heart rate slows. A seven-year-old child’s heart beats about 90 times per minute. By the age of 18, the heart rate is about 70 beats per minute.
7. The heart beats about 100,000 times each day. In a 70-year lifetime, the average human heart beats more than 2.5 billion (250 crore) times.
8. During exercise, more oxygen and nutrients are needed by the muscles. Therefore, blood must be delivered faster than when the body is resting. To meet these demands, the heartbeat increases.
9. The heart pumps blood in a one-way path around your body through blood vessels. The heart and the vessels are called the circulatory system. The heart valves stop blood from flowing the wrong way.
10. The heart pumps blood in two directions. First it sends blood without any oxygen to the lungs to get oxygen. It then pumps the blood containing oxygen around all the other parts of the body. After delivering its oxygen, the blood returns to the heart to start the process of getting oxygen all over again.

Heart disease is any disorder that affects the hearts ability to function normally and there are different diseases. Dr.Gokhale explains about signs and symptoms that cause heart failure. Seek emergency treatment if you experience any of the Heart failure symptoms.