Our Summary

This review looks at the latest techniques and evidence for treating patients with low heart function, who need coronary artery bypass surgery (CABG). This type of surgery can be risky for these patients, particularly due to chances of developing shock after surgery. To reduce these risks, doctors need to carefully prepare patients before surgery, possibly using medication or mechanical assistance. The goal of the surgery is to quickly and completely restore blood flow to the heart. Some newer surgical techniques and solutions may not be more beneficial than traditional methods, so they should be used selectively. While there have been great improvements in this type of surgery, more research is needed to understand long-term outcomes. It’s crucial for doctors to assess each patient individually and work as a team to determine the best approach.

FAQs

  1. What is the goal of coronary artery bypass surgery (CABG)?
  2. What are some techniques that doctors use to prepare patients for CABG surgery?
  3. Are newer surgical techniques always better for CABG surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about CABG is to follow a healthy lifestyle before and after surgery to improve outcomes. This includes quitting smoking, maintaining a balanced diet, exercising regularly, and managing stress. These lifestyle changes can help reduce the risk of complications and improve the overall success of the surgery.

Suitable For

Patients who are typically recommended for CABG include those with:

  1. Severe coronary artery disease that cannot be managed effectively with medication or other interventions
  2. Left main coronary artery disease
  3. Three-vessel disease
  4. Two-vessel disease with involvement of the proximal left anterior descending artery
  5. Patients with diabetes mellitus
  6. Patients with low heart function (ejection fraction less than 35%)
  7. Patients with unstable angina or acute coronary syndrome
  8. Patients who have failed previous percutaneous coronary intervention (PCI) or have complex coronary anatomy

It’s important for patients to be evaluated by a multidisciplinary team of healthcare providers to determine if CABG is the best course of treatment for their specific condition. Each patient’s individual risk factors and overall health should be taken into consideration when determining the most appropriate treatment plan.

Timeline

Before CABG:

  1. Patient is diagnosed with coronary artery disease and low heart function.
  2. Patient undergoes various tests and evaluations to determine if CABG is necessary.
  3. Patient may be prescribed medication or undergo other treatments to stabilize their condition before surgery.
  4. Patient meets with their surgical team to discuss the procedure and potential risks.
  5. Patient may undergo pre-operative counseling and education to prepare for surgery.

After CABG:

  1. Patient undergoes the CABG procedure to restore blood flow to the heart.
  2. Patient is closely monitored in the intensive care unit immediately after surgery.
  3. Patient may need mechanical assistance, such as a ventilator or heart pump, to support their heart function.
  4. Patient is gradually weaned off of these interventions as their condition stabilizes.
  5. Patient begins a rehabilitation program to regain strength and improve heart function.
  6. Patient is monitored closely for any complications or signs of shock post-surgery.
  7. Patient receives follow-up care and monitoring to ensure long-term success of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with CABG surgery for a patient with low heart function?

  2. How will my heart function be monitored during and after the surgery?

  3. What medications will I need to take before and after the surgery to reduce the risk of developing shock?

  4. Are there any alternative treatments or procedures that may be more suitable for my condition?

  5. What is the expected recovery time and rehabilitation process after CABG surgery?

  6. How long will it take for me to return to normal activities and work after the surgery?

  7. What long-term outcomes can I expect after undergoing CABG surgery for low heart function?

  8. Are there any lifestyle changes or precautions I should take to improve my heart health and reduce the risk of future heart problems?

  9. Will I need to follow a specific diet or exercise regimen after the surgery to maintain the benefits of the procedure?

  10. How frequently will I need to follow up with my healthcare team to monitor my heart function and overall health after CABG surgery?

Reference

Authors: Iacona GM, Bakhos JJ, Tong MZ, Bakaeen FG. Journal: Curr Opin Cardiol. 2023 Nov 1;38(6):464-470. doi: 10.1097/HCO.0000000000001090. Epub 2023 Sep 18. PMID: 37751395