Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is a cardiac surgical procedure aimed at restoring normal blood flow in the coronary arteries. These arteries supply the heart muscle (myocardium) with oxygen and nutrients. When they become significantly narrowed or blocked, most commonly due to atherosclerosis, coronary artery disease develops. CABG is used to bypass the affected segments of the arteries by creating alternative pathways for blood flow using grafts.

When is coronary artery bypass grafting performed in Belarus?

CABG is indicated for patients with severe coronary artery narrowing when other treatment methods, such as medical therapy or angioplasty (arterial dilation with stent placement), are ineffective. The main indications include:

1. Severe coronary artery disease (CAD). Persistent chest pain (angina pectoris) that does not respond adequately to medication.
2. Multivessel coronary artery disease. Especially when major arteries, such as the left anterior descending artery, are involved.
3. Reduced left ventricular function. In cases of significant impairment of myocardial blood supply affecting cardiac performance.
4. The need to improve coronary blood flow prior to other cardiac surgery, for example before heart valve replacement.

Preoperative preparation

Medical evaluation

• Electrocardiography (ECG): to assess heart rhythm and detect myocardial damage.
• Echocardiography: to evaluate cardiac function and valve performance.
• Coronary angiography: a specialized imaging study that visualizes the coronary arteries and identifies the location and severity of stenosis.
• Blood and urine tests: to assess overall health status and kidney function.

Preparation before surgery

• Patients may be prescribed specific medications to prepare the body for surgery.
• Food intake is usually restricted after midnight on the day before surgery.

How is coronary artery bypass grafting performed?

1. Anesthesia. The operation is performed under general anesthesia, so the patient is unconscious and does not feel pain.
2. Access to the heart. The surgeon makes an incision in the chest and divides the sternum to gain access to the heart.
3. Use of grafts. Grafts may be created using veins from the leg (most commonly the great saphenous vein) or arteries, most often the internal mammary arteries. One end of the graft is connected to the aorta and the other to the coronary artery beyond the site of narrowing, creating a new route for blood flow.
4. Cardiopulmonary bypass. In most cases, a heart–lung machine is used to temporarily take over the function of the heart and lungs during surgery. In some cases, CABG may be performed on a beating heart (off-pump CABG).
5. Closure of the chest. After graft placement, the chest is closed using metal wires to stabilize the sternum, and the incision is sutured.

Postoperative recovery

1. Postoperative monitoring. The patient is transferred to the intensive care unit, where their condition is closely monitored for several days, followed by transfer to a general ward.
2. Pain and discomfort. Pain in the chest and incision area is common and is managed with analgesic medications.
3. Physical activity. Gradual return to activity under medical supervision. Patients are encouraged to perform breathing exercises and light physical activity to prevent complications.
4. Diet and lifestyle. After CABG, a low-fat diet rich in fruits, vegetables, and whole grains is recommended. Smoking must be completely discontinued.
5. Rehabilitation. Cardiac rehabilitation may be prescribed, including supervised exercise, education on healthy lifestyle habits, and psychological support.

Outcomes of coronary artery bypass grafting

1. Duration of effect. CABG significantly improves coronary blood flow and can relieve angina symptoms for many years. The effect often lasts 10–15 years, depending on lifestyle and overall health.
2. Improved quality of life. Most patients experience substantial improvement in quality of life and a reduced risk of heart attacks.
3. Need for follow-up. Regular medical follow-up is essential to monitor heart health, especially if new symptoms appear.

Coronary artery bypass grafting (CABG) in Belarus is an effective surgical treatment that can significantly improve the quality of life of patients with severe coronary artery disease. Surgical success depends on proper preparation, surgeon expertise, and adherence to postoperative recommendations. Close cooperation with healthcare providers and a healthy lifestyle are essential to maximize long-term outcomes and minimize the risk of complications.