Coronary artery bypass grafting (CABG)

There are following indications for CABG:

• over 50% obstruction of the left coronary artery;
• 70% narrowing of cardiac vessels;
• stenosis of the anterior interventricular branch;
• disabling angina;
• ongoing ischemia that is unresponsive to medical therapy.

Before performing the operation, physicians examine patient’s medical history. Some factors may lead to complications during the intervention or rehabilitation period. There are following contraindications for CABG:

• recent myocardial infarction;
• recent cardiac surgery;
• chest radiation exposure;
• conditions that predispose to bleeding (poor coagulation);
• renal dysfunction;
• infections (including STDs and dental abscesses);
• chronic non-specific pulmonary pathologies;
• oncology.

Coronary artery bypass grafting is divided into:

• On-Pump CABG. This operation presumes using heart-lung bypass machine to allow surgeons operating on the still heart. During surgery, the chest bone is opened and the heart stopped with medicines. When the operation is complete, the heart usually starts beating by itself. Otherwise, a small electrical shock is used to start it up.
• Off-Pump CABG on the beating heart. In some cases, off-pump operation on the beating heart is more viable, as it allows to avoid certain complications. An off-pump procedure is recommended for patients with advanced stages of atherosclerosis of the aorta, kidney malfunction, or pulmonary diseases. Off-pump CABG reduces risks of postoperative inflammation, infection, and arrhythmia.
• Minimally invasive direct CABG. This procedure is similar to off-pump surgery. The difference is surgeons make few small incisions between the ribs instead of cutting the chest bone.

In some cases several bypasses are required. Find out how much does a triple heart bypass cost by submitting a request on Bookimed site. Our Doctor Coordinator will contact you shortly to provide a consultation.

The coronary artery bypass surgery cost is calculated for patients individually in each particular case.

Coronary artery bypass graft procedure can be performed in 3 ways. The choice of particular type of graft depends on the location of the blocked area, size of the damaged area and diameter of the artery.

“Grafts” are vein and artery that act as an anastomosis, creating a bypass on obstructed cardiac vessels and restoring normal blood flow. The vein is usually taken from the leg of a patient, while the artery is relocated from the chest wall. During the operation, a surgeon sews up the original vessel of the patient to the coronary artery near the area of narrowing. That allows the blood flow to “bypass” the blocked area.

Grafting process

Internal thoracic artery is commonly used graft as it has the best long-term results: veins are less likely to become blocked over time. A surgeon takes the artery from its area and sews its ends in the coronary artery bypassing obstructed segment.

Radial artery is located in the hand together with the ulnar artery. Considering that the ulnar artery is a dominant blood supplier of the hand, removal of the radial artery during the operation does not pose a threat to the organism.

Great saphenous vein is often used as a graft. It is a long vessel running along the inner side of the leg. To take the vein a surgeon makes an incision or several small incisions along its location.

A patient is hospitalized 3-5 days prior to the surgery. They undergo necessary examinations and prepare for the operation in the inpatient department. Following tests and examinations are conducted before the surgery:

• coronary angiography;
• chest radiography;
• liver function test;
• clotting screen;
• ECG.

Premedication

Before the operation, a patient is administered a general anesthesia. Other medications are also introduced to patient’s body to reduce heart demand for oxygen by lowering arterial pressure and reducing heart rate. Myocardial blood flow is improved by the use of vasodilators.

In case of off-pump CABG, medications that temporary stop the heart will be administered after the incision in the chest bone.

Each patient is cross-matched with at least 2 units of blood to compensate for blood loss during or after the operation.

Operation process

The surgery lasts from 3 to 5 hours. The duration depends on the amount of bypassed arteries and health particularities of a patient. During the surgery, a heart-lung bypass device carries out functions of the heart and lungs. It is vital if physicians opted to operate on the non-beating heart. When finishing CABG, a doctor installs drain tubes in the chest to drain liquid from the operated area. Then the wound is stitched and a patient is delivered to the intensive care unit where they stay until complete stabilization.

Recovery in hospital

A patient stays in intensive care unit for 1-3 days after the operation. This period may take longer if complications take place, hospitalization duration influences how much does a heart bypass cost. Patient’s vitals will be constantly monitored. Various medicines that control blood circulation and pressure will be delivered through IV. Special catheter is inserted to drain urine. In some cases, oxygen therapy (oxygen delivered through a mask or nasal tubes) and/or temporary pacemaker is utilized. A physician may provide a patient with compression stockings. They apply gentle pressure on the legs preventing blood from pooling and clotting.

During the first days after the operation a patient must strictly follow these recommendations:

• control the amount of consumed and excreted water; make notes for the attending doctor;
• make respiratory exercises to stabilize breath and prevent pneumonia development. Respiratory gymnastics includes air toys, massage of the area above the lungs with tapping manipulations;
• at the early stage of rehabilitation it is extremely important to cough up because some patients can aggravate the situation by coughing;
• chest corset should be worn for the quickest healing of the wound.

Recovery at home

Before a patient is dismissed, a doctor gives them specific instructions and guidelines for recovery, including:

• how to care for healing operative incisions;
• how to recognize progressing complications;
• when to make follow-up appointments.

A patient also receives information on how to deal with various side effects that may appear after the surgery. They include:

• itching of incisions;
• discomfort or muscle pains in the shoulders and upper back;
• depression, mood swings, fatigue;
• constipation;
• insomnia;
• loss of appetite.

Complete recovery usually takes up to 3 months. A physician will provide more information about recovery status, but usual physical activities can be re-engaged after approximately 6 weeks of rehabilitation.

Outlook

A patient can return to the sedentary work within 1.5 months after discharge from the hospital. Heavier physical work can require a longer period of recovery. Patients after CABG may lead their usual lifestyle. Walking and stair climbing are particularly useful during the rehabilitation period. Patients should avoid longtime walks during very cold or too hot weather which exhausts the organism.

Bad habits should be quitted: smoking and/or drinking can provoke a heart attack. A patient should constantly monitor their blood pressure. Diet must be revised: consumption of salt, fats, and cholesterol-rich products should be minimized. Weight control is desired.

Coronary artery bypass surgery cost depends on the following factors:

• Type of performed CABG operation. Different types of procedure put different requirements on operating team and may prolong the duration of the operation thus influencing heart bypass cost.
• A number of required bypasses. Some patients need two or three bypasses conducted in a single operation. Cost of triple heart bypass operation is higher than the regular single-bypass operation.
• Patient condition. Coronary artery bypass graft cost is greatly influenced by patient’s health state during the operation. Additional medicines and devices might be used to ensure the operation success. A patient may be required to spend more time in intensive care unit.
• Location. The average cost of heart bypass surgery varies in different countries. For example, in India or Turkey heart bypass surgery cost is 2-3 times lower than in the USA or Israel.

To undergo CABG operation abroad, submit a request on Bookimed site. On the shortest notice, our Medical Coordinator will contact you via phone call. You will be able to ask any questions regarding the procedure, including how much does heart bypass surgery cost in your particular case. Bookimed will process your paperwork and organize your treatment abroad, including transfer to and from a hospital.