Coronary Artery Bypass Graft(CABG) Surgery in India

Coronary Artery Bypass Graft

Coronary artery bypass graft surgery (CABG) is a procedure that is used to treat coronary artery disease. Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries. This buildup causes the inside of the arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle. Coronary artery bypass graft surgery is designed to detour blood around a narrowed segment of a heart artery in an effort to restore blood flow to the heart muscle. Usually a vein graft from the leg is used for the bypass however other vessels may be used for the graft. The surgery can eliminate chest pain, improve exercise capability and lengthen life.

Symptoms of Coronary Artery Diseases

Symptoms of coronary artery disease may include the following:

• chest pain
• fatigue
• palpitations
• shortness of breath

Unfortunately, there may be no symptoms of early coronary artery disease, yet the disease will continue to progress until sufficient artery blockage exists to cause symptoms and problems.

Coronary Artery Bypass Graft(CABG) Surgery in India
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Causes of Coronary Artery Diseases

• Major reason or causes for coronary artery disease are smoking, high blood pressure (hypertension), large amounts of fatty substances in the blood (hypercholesterolemia and hypertriglyceridemia), lack of exercise, diabetes, and positive family history of coronary artery disease.
• Other relative causes include obesity (more than 20% of ideal body weight), and tension or stress.

Diagnosis and Tests of Coronary Artery Diseases

Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures. He or she may suggest one or more diagnostic tests as well, including:

• Blood tests: to confirm presence of special enzymes released by the damaged heart muscle
• Chest X-ray
• Electrocardiogram (EKG)
• Exercise stress test with or without injection of a radioisotope called thallium
• If any of the above tests are positive for coronary artery disease, cardiac catheterization may be performed to demonstrate the site and severity of the coronary artery narrowing.
• Following cardiac catheterization the doctor may recommend coronary artery bypass surgery.

Types of Coronary Artery Bypass Grafting Surgery

There are two types of Coronary Artery Bypass Grafting operations currently available:

• On-Pump Surgery : On-pump procedures require the surgeon to open the chest bone (sternum), stop the patient's heart, and place the patient on a heart-lung machine. This machine takes over the function of the patient's heart—delivering oxygenated blood through out the body and brain—while the bypass is performed.
• Off-Pump Surgery : A new, minimal access procedure, the off-pump method eliminates the need for the surgeon to stop the heart and to place the patient on bypass. The surgeon operates directly on the beating heart, reducing the risk for preoperative bleeding and stroke associated with the on-pump procedure. Selection of an on- versus off-pump procedure partly depends on the health of the individual patient.

Preparations for Coronary Artery Bypass Graft (CABG) Surgery

• The physician will have a detailed discussion of the procedure with the patient.
• The physician may enquire about the complete medical history of the patient; he may also perform a complete physical examination, blood tests or other diagnostic tests to ensure you are in good health before undergoing the procedure.
• The patient may not be allowed to eat 8-10hrs before the procedure.
• The patient should notify the physician of any history of bleeding disorders or if he is taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of these medications prior to the procedure.
• The patient should stop smoking as soon as possible prior to the procedure. This may improve his chances for a successful recovery from surgery and benefit his overall health status.

Coronary Artery Bypass Graft Surgery Procedures

• On-Pump Surgery Procedure : Tubes will be inserted into the heart so that the blood can be pumped through your body by a cardiopulmonary bypass machine as the heart must be stopped to allow the physician to perform the procedure of sewing grafts onto the very small coronary arteries.
  When the heart has been stopped, the physician will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the coronary artery just above the blockage, and the other end over a tiny opening made in the coronary artery just below the blockage.
  If the internal mammary artery inside your chest is being used as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage.
  Once the bypass grafts have been completed, the blood circulating through the bypass machine will be allowed back into your heart and the tubes to the machine will be removed. The heart will be restarted.
  Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and the heart can be paced, if needed, during the initial recovery period.
  The sternum will be pushed back together and sewn together with small wires. The skin over the sternum will be sewn back together. Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to keep fluids pulled away from the heart. A tube will be inserted through your mouth or nose into your stomach to drain stomach fluids.
• Off-Pump Surgery Procedure : Once the chest has been opened, the area around the artery to be bypassed will be stabilized with a special type of instrument. The rest of the heart will continue to function and pump blood through the body.
  The physician will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the coronary artery just above the blockage, and the other end over a tiny opening made in the coronary artery just below the blockage. Before the chest is closed, the physician will examine the grafts to make sure they are working.
  The sternum will be pushed back together and sewn together with small wires. The skin over the sternum will be sewn back together. Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to keep fluids pulled away from the heart. A tube will be inserted through your mouth or nose into your stomach to drain stomach fluids.

Follow- Up Care Post Coronary Artery Bypass Graft Surgery

• The average hospital stay is 4-6 days
• Deep breathing exercises and coughing are encouraged to help speed recovery. Coughing reduces the chance of pneumonia and fever and will not disturb the incision
• It is wise to reduce coronary risk factors as much as possible by reducing dietary intake of salt, cholesterol and saturated fats
• It is important to maintain an appropriate weight and avoid smoking
• Weakness is a common feeling on returning home due to lack of use of big muscles. Exercise, such as walking, is a good way to regain muscle strength
• Sedentary workers may have to wait four to six weeks before returning to work
• The physician will give you specific bathing instructions before discharging the patient. The sutures or surgical staples will be removed during a follow-up office visit.
• The patient should notify his physician of any redness, swelling, or bleeding or other drainage from the incision site, increase in pain around the incision site, fever and/or chills, etc.

Advantages of Coronary Artery Bypass Grafting (CABG) Surgery

• Although traditional Coronary Bypass Grafting Surgery is performed with a 2-3% mortality and average hospital length of stay of less than 7 days, retrospective studies suggest that off-pump CABG may be safer, with fewer procedure-related deaths and complications. OPCABG is associated with fewer blood transfusions, decreased ventilator dependence, less renal insufficiency, and fewer strokes.
• Other advantages/benefits of Coronary artery bypass grafting surgery are reduced pain following bypass surgery, less time in the hospital recovering, usually no need for a blood transfusion, reduced risk of complications, fewer infections and quicker recovery.
• For minimally invasive procedures done without putting the patient on a heart-lung machine, there are additional potential benefits, since being on this machine may increase the risk of kidney problems, difficulties with memory, and the need for transfusion.

Risks Associated with Coronary Artery Bypass Grafting (CAGB) Surgery

One possible complication is atrial fibrillation, or irregular heartbeats, which occur in about 25% of all heart surgery patients. Typically not dangerous, this condition typically happens in older patients. Other complications include fevers, pain, and drainage from your wounds.

Coronary Artery Bypass Graft (CAGB) Surgery in India

In India, most hospitals have a team of dedicated healthcare professionals who have international recognition in the field of research, diagnosis and treatment of coronary artery bypass graft. These hospitals offer a “cutting-edge" treatment for different cardiac disorders and make management decisions based on opinions informed by the latest scientific data. Most hospitals in India have plenty of heart and vascular specialists who are widely known for their surgical skills. Cases that appear to benefit from coronary bypass include patients who have symptomatic heart disease in multiple coronary arteries, and those who have suffered a prior or acute myocardial infarction.

Cities in India offering Coronary Artery Bypass Graft Surgery at some of the best and top cardiac hospitals are as follows;

Cost of Coronary Artery Bypass Graft (CABG) Surgery in India

India is the most cost effective medical tourism destination of the world. The cost of coronary artery bypass graft surgery in India is very low as compared to the cost of the similar procedure charged in other western countries. This applies to treatment and surgeries associated with coronary artery bypass graft surgery. Even after adding travel and accommodation costs, treatment of coronary artery bypass graft surgery in India can result in up to 50 to 80% cost savings.All surgery and treatments are tailored to consider the needs of the travelling patient. India gives you the opportunity to have high class immediate surgical and medical treatments which includes coronary artery bypass graft surgery at low cost.

Some of the common countries from which patients travel to India for surgery are:

ABOUT INDIA

Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

• Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.
• Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.
• Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.
• Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India,
• Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra..
• Kerala - Welcome to Kerala, state in India's southern tip and a state known as God's Own Country. Kerala is one of the ten 'Paradises Found' by the National Geographic Traveler, for its diverse geography and overwhelming greenery. It is a land much acclaimed for the contemporary nature of its cultural ethos, and much appreciated for the soothing, rejuvenating paradise that it is.
• Delhi - Delhi, the capital of India is situated in the northern part of the country. Apart from being the capital of India, Delhi is also the travel hub of northern India. It serves as an excellent base for visiting the colorful state of Rajasthan, and Agra, the city of the Taj Mahal, is less than three hours away. Discover the many tales behind Delhi’s ancient, bewitching existence. Feel the excitement of stepping foot on a piece of the world’s oldest land!
• Pune - Pune is the eighth largest city in the India state of Maharashtra. The city derives its name from Punya Nagari, which means 'the city of virtuous deeds.'Pune or the 'Queen of Deccan' is known for its educational, research and development institutions. This beautiful city has many exotic locales attracting innumerable tourists.
• Jaipur – Jaipur is located in India and attracts a flurry of tourists from all over the world. Sited within eastern Rajasthan, North India, the city of Jaipur is famed for its hilltop fortresses, magnificent royal palaces and historic pink-painted sandstone architecture, earning it the affectionate nickname of the 'Pink City'.
• Chennai - Chennai formerly known as Madras is the capital city of the Indian state of Tamil Nadu. It is famous for its culture and tradition. Chennai hosts a large cultural event, which includes performances by hundreds of artists. The city has a vibrant theatre scene and is an important centre for the Bharatanatyam, a classical dance form.
• Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium City.' Gurgaon has recently emerged as the latest hub for Medical Tourism. Apart from being IT hub and a favorite haunt for MNC offices, the city has a number of world class hospitals that not only treat Indian citizens but also people from outside.
• Chandigarh - Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads. India’s first planned city, Chandigarh is a rich, prosperous, spic and span, green city rightly called “THE CITY BEAUTIFUL”.