Our Summary

This research paper looks at how patients fare after undergoing coronary artery bypass grafting (CABG), a type of heart surgery that creates a new route for blood to flow to the heart. The study revealed that only a small group of patients (1.8%) needed an emergency angiogram (a test to examine blood vessels) after the surgery. However, among those who did require this emergency test, more than half needed additional heart procedures and had a high risk of death within 30 days. The study also found that certain groups, including women, younger patients, smaller patients, and those who had a combination of arterial and venous revascularization (a procedure to restore blood flow), were more likely to need this emergency angiogram. The researchers recommend that high-risk patients should have this angiogram done as soon as possible after surgery. Alternatively, they suggest a hybrid approach that involves an intraoperative angiogram during the initial surgery.

FAQs

  1. What is coronary artery bypass grafting (CABG) and who typically needs it?
  2. What percentage of patients need an emergency angiogram after CABG surgery and what are the risks associated with it?
  3. What are the recommendations for high-risk patients undergoing CABG surgery according to the research?

Doctor’s Tip

A helpful tip a doctor might give a patient about CABG is to follow all post-operative care instructions closely, including taking prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation. It is also important to maintain a healthy lifestyle with regular exercise, a balanced diet, and no smoking to improve long-term outcomes after surgery. Additionally, being aware of potential symptoms of complications such as chest pain, shortness of breath, or swelling in the legs and seeking medical attention promptly can help ensure the best possible recovery.

Suitable For

Patients who are typically recommended for CABG include those with severe coronary artery disease, particularly those who have:

  1. Significant blockages in multiple coronary arteries
  2. Left main coronary artery disease
  3. Severe angina (chest pain)
  4. Failed medical management or other less invasive treatments
  5. High-risk features such as diabetes, advanced age, kidney disease, or previous heart attacks

Patients who have complex coronary anatomy, including heavily calcified or tortuous arteries, may also be candidates for CABG. Additionally, patients with certain high-risk conditions such as heart failure, heart valve disease, or those who have previously undergone coronary stenting but require further intervention may benefit from CABG.

Ultimately, the decision to recommend CABG is made on a case-by-case basis by a multidisciplinary team of cardiac surgeons, interventional cardiologists, and other healthcare providers based on the individual patient’s specific medical history, symptoms, and overall risk profile.

Timeline

Before CABG:

  1. Patient undergoes diagnostic tests such as angiography to determine the extent of blockages in the coronary arteries.
  2. Patient may undergo lifestyle changes, medication management, and other non-surgical treatments to manage their heart condition.
  3. Patient may experience symptoms such as chest pain, shortness of breath, and fatigue due to reduced blood flow to the heart.

After CABG:

  1. Patient undergoes the CABG surgery, during which a new route for blood flow is created to bypass the blocked coronary arteries.
  2. Patient is monitored closely in the intensive care unit (ICU) immediately after surgery to ensure proper recovery.
  3. Patient may experience pain, fatigue, and limited mobility in the days following surgery.
  4. Patient undergoes cardiac rehabilitation to improve their heart health and overall recovery.
  5. Patient may need additional tests, procedures, or interventions if complications arise post-surgery.
  6. Patient continues to follow up with their healthcare team for long-term monitoring and management of their heart condition.

What to Ask Your Doctor

  1. What is the success rate of CABG surgery?
  2. What are the potential risks and complications associated with CABG surgery?
  3. How long is the recovery period after CABG surgery?
  4. What lifestyle changes will I need to make after undergoing CABG surgery?
  5. Will I need to take any medications after the surgery?
  6. How often will I need to follow up with you after the surgery?
  7. Are there any restrictions on physical activity after CABG surgery?
  8. What signs or symptoms should I watch out for that may indicate a complication?
  9. How long will the benefits of CABG surgery last?
  10. Are there any alternative treatments to CABG surgery that I should consider?

Reference

Authors: Fleißner F, Issam I, Martens A, Cebotari S, Haverich A, Shrestha ML. Journal: Thorac Cardiovasc Surg. 2017 Jun;65(4):292-295. doi: 10.1055/s-0035-1564927. Epub 2015 Oct 30. PMID: 26517115