Coronary artery bypass graft surgery (CABG) is among the most common operations performed in the world and accounts for more resources expended in cardiovascular medicine than any other single procedure.

Surgical revascularization for Atherosclerotic heart disease is one of the great successes in medicine. Relief of angina after revascularization, improvement in exercise tolerance and the realization of survival benefit have attended the operation since its early stages. Nowadays, with the improvement pharmacological agents, anesthetics, surgical techniques and perfusion techniques, the surgical mortality and morbidity are kept to an acceptable rate when done on the proper time.

In the Philippines, coronary bypass surgery has been done since the mid 70's, mostly at the Philippine Heart Center. Throughout the years, many tertiary hospitals in the country had also established Heart Institutes and had been regularly performing coronary bypass surgery.

What is coronary arterial disease (CAD)
ICAD is a degenerative disease when arteries supplying blood to the heart gets clogged over time by the buildup of fatty plaques. This can eventually lead to repeated episodes of chest pains, or heart attacks. Increasing blood flow to the heart muscles can alleviate the chest pains and reduce the risk of myocardial infarction in the future.

What is coronary artery bypass surgery (CABG)?
This is a type of heart surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen delivery to the heart.

How is coronary bypass done?
The surgery involves getting a section of the saphenous vein from the leg, and/or an artery from the chest (internal mammary artery) to bypass a part of the diseased coronary artery. A patient may undergo one or more bypass grafting in the same operation, depending on how many coronary arteries are blocked.

Before surgery
The operation will usually be scheduled at a time that is best for the patient and the surgeon, except in urgent cases. Preoperative evaluation of by the cardiologist, the surgeon and the anesthesiologist will be done immediately before surgery. It would be ideal for you to volunteer information regarding some changes in your health conditions such as recent infections, nose discharges, etc.

Your attending cardiologist and surgeon would also want to know all the medicines you are taking, especially Non-steroidal anti-inflammatory agents, which may affect your clotting activities in the perioperative period.

On admission
Patients are usually admitted to the hospital a day or two before surgery. The night before surgery, you will be asked to bathe to reduce the amount of bacteria on your skin. The area to be operated on will be washed and, if needed, shaved.

An anesthetic, which is a medicine, will be given to make you sleep during the operation. You will be asked not to eat or drink after midnight the night before surgery.

Smokers will be asked to quit smoking at least two weeks before surgery. Smoking before surgery can lead to problems with blood clotting and breathing.

Day of Surgery
You will be given a mild tranquilizer before you are brought into the operating room.

At the operating suite, your heart's rhythm and electrical activity will be monitored during surgery with metallic electrodes connected to the monitoring apparatus. A plastic tube (called a line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in your vein. The IV line will give you the anesthesia during the operation.

After you are completely asleep, a mechanical ventilator will control your respiration. A heart-lung machine is used for most bypass operations. A perfusion technologist or blood-flow specialist operates the machine. After hooking the heart to this machine, the heart is stopped, and the surgery will proceed. The surgery involves getting a section of the saphenous vein from the leg, and/or an artery from the chest (internal mammary artery) to bypass a part of the diseased coronary artery. The procedure can take from 3 to 6 hours, depending on the number of bypasses needed.

The surgical team is led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist, and surgical nurses.

Recovery Time
After surgery, the patient will be moved to a hospital bed in the recovery room where intensive cardiovascular and pulmonary monitoring will be given for the next 12 to 24 hours. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). As soon as the physicians are confident that the patient is awake and ready to breathe comfortably on his or her own, he or she will be weaned from the ventilator.

Painkillers are given as needed. You can expect to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU), but this may take longer sometimes. During this time, some tests will be done to assess and monitor the patient's condition.

Postoperatively, patients may experience side effects such as loss of appetite, swelling of the leg where the vein graft was removed, muscle pain or tightness in the shoulders and upper back. Many of these side effects usually disappear in four to six weeks, but a full recovery may take a few months or more.

Life After CABG
After bypass surgery, you should limit the fat and cholesterol in your diet. Your doctor may recommend some forms of exercises or rehabilitation programs to help you make lifestyle changes, like starting a new diet and exercise program, quitting smoking, and learning to deal with stress.

You can usually go back to office jobs in 4 to 6 weeks. Those who have more physically demanding jobs may need more recuperation period.

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