Coronary Artery Bypass Grafting (CABG)

Coronary artery disease is becoming increasingly common, with as much as 1 in 20 adults over the age of 20 suffering from the disease throughout their lifetimes. Consequently, CABG is a procedure that is on the rise.

Why Might People Need Coronary Artery Bypass Grafting Surgery?

When someone has one or more coronary arteries that are blocked, it can be dangerous; blood flow
is hindered, which may lead to a heart attack. CABG allows us to avoid this, restoring blood flow
to the heart.

A narrowed artery can be caused by CAD (coronary artery disease), characterized by a plaque
accumulation.

How Does the CABG Surgery Work?

To bypass the blockage, healthy blood vessels from your body may be used (usually taken as
parts of a vein from a leg, chest arteries, or wrist arteries). These vessels are then connected: One
part will be attached above and below the narrowed area. This allows blood to flow properly by
flowing through the new connection rather than the narrowed artery.

While the CABG surgery can be performed in minimally invasive ways, its traditional procedure explores the main principles. 

Firstly, an incision is made near the sternum, and the heart is temporarily stopped for the surgery. Typically, an on-pump procedure can be employed (typically called Cardiopulmonary bypass), which involves inserting tubes into the heart via a heart-lung bypass machine pumping blood to the heart during the surgery. Off-pump procedures are still employed.

Minimally Invasive Techniques for CABG Surgery

Of course, the introduction of minimally invasive techniques for CABG surgery, much unlike the traditional ways, has been revolutionary to the field. Minimally invasive procedures involve small incisions, which have little scarring and guarantee quicker recovery time post-op. 

Minimally invasive procedures include:

• Minimally invasive direct coronary artery bypass (MIDCAB)
• Robotic-assisted CABG
• Totally Endoscopic Coronary Artery Bypass (TECAB)

Minimally invasive direct coronary artery bypass (MIDCAB) involves making two tiny incisions near the ribs on the left side of the chest, while the heart is still beating. Due to the absence of a heart-lung bypass machine, the procedure is safer; risks of complications such as post-op bleeding, strokes, and kidney failure are reduced. Basic principles remain the same: an artery from the chest is cultivated and grafted to optimize blood flow. 

Robotic-assisted CABG

In robotic-assisted CABG, a tiny incision is also made near the ribs. However, the basic procedure is done using a robotic machine, which is controlled by the surgeon. This allows for higher precision and more clarity. 

Totally Endoscopic Coronary Artery Bypass (TECAB)

This is a form of robotic-assisted CABG. This is the least invasive procedure as it does not require any large incision. Instead, incisions are made so tiny they are better named as simply being holes in the chest. A robotic machine is then used to perform the CABG procedure, as shown in the picture below.

Works Cited

“Coronary Artery Bypass Grafting – What Is Coronary Artery Bypass Grafting? | NHLBI, NIH.” Www.nhlbi.nih.gov, www.nhlbi.nih.gov/health/coronary-artery-bypass-grafting#:~:text=CABG%20uses%20healthy%20blood%20vessels.

John Hopkins Medicine. “Coronary Artery Bypass Graft Surgery.” Hopkinsmedicine.org, 2019, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/coronary-artery-bypass-graft-surgery.

Cleveland Clinic. “Coronary Artery Bypass Surgery | Cleveland Clinic.” Cleveland Clinic, 2018, my.clevelandclinic.org/health/treatments/16897-coronary-artery-bypass-surgery.

‌CDC. “Coronary Artery Disease | Cdc.gov.” Centers for Disease Control and Prevention, 9 Dec. 2019, www.cdc.gov/heartdisease/coronary_ad.htm#:~:text=Coronary%20artery%20disease%20is%20caused.

‌CDC. “Coronary Artery Disease | Cdc.gov.” Centers for Disease Control and Prevention, 9 Dec. 2019, www.cdc.gov/heartdisease/coronary_ad.htm#:~:text=Coronary%20artery%20disease%20is%20caused.

Cleveland Clinic. “What Is Cardiopulmonary Bypass?” Cleveland Clinic, 31 Aug. 2022, my.clevelandclinic.org/health/treatments/24106-cardiopulmonary-bypass.

‌Thakare, Vaishnavi S., et al. “Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review.” Cureus, vol. 15, no. 9, 1 Sept. 2023, p. e45511, pubmed.ncbi.nlm.nih.gov/37868547/, https://doi.org/10.7759/cureus.45511.

Centers for Disease Control and Prevention. “Heart Disease Facts | Cdc.gov.” Centers for Disease Control and Prevention, 2 Dec. 2019, www.cdc.gov/heartdisease/facts.htm#:~:text=Coronary%20Artery%20Disease.

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) | LHSC.” Www.lhsc.on.ca, www.lhsc.on.ca/cardiac-care-services/minimally-invasive-direct-coronary-artery-bypass-midcab.

‌Cao, Christopher, et al. “Robotic Coronary Artery Bypass Graft Surgery.” Annals of Cardiothoracic Surgery, vol. 5, no. 6, Nov. 2016, pp. 594–594, https://doi.org/10.21037/acs.2016.11.01

‌“Heart Bypass Surgery.” www.umms.org/ummc/health-services/heart-vascular/services/coronary-artery-disease/heart-bypass-surgery#. Accessed 24 Jan. 2024.

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