Procedure of Coronary Surgery

Introduction

Coronary surgery is a life-saving procedure for individuals with severe coronary artery disease (CAD). When the arteries that supply blood to the heart become blocked due to plaque buildup, the heart muscle is deprived of oxygen, increasing the risk of heart attacks. Coronary surgery, particularly Coronary Artery Bypass Grafting (CABG), helps restore normal blood flow to the heart by bypassing the blocked arteries using healthy blood vessels from other parts of the body.

This procedure of coronary surgery is recommended when medication, lifestyle changes, or angioplasty with stenting aren’t sufficient to manage the condition. It’s typically performed by a cardiothoracic surgeon under general anesthesia in a highly specialized cardiac care facility.

Procedure of Coronary Surgery

Here’s a step-by-step breakdown of the coronary surgery process, explained point-wise for easier understanding:

1. Preoperative Preparation :- Before surgery, patients undergo several tests such as blood work, chest X-rays, ECG, echocardiograms, and coronary angiography. These tests help doctors assess the extent of the blockage and overall heart function. Patients are instructed to fast, stop certain medications, and are often admitted a day prior to surgery for monitoring.

2. Administering Anesthesia :- The procedure is done under general anesthesia. An anesthesiologist administers drugs to ensure the patient remains unconscious and pain-free during the surgery. A breathing tube is inserted, and the patient is connected to a ventilator to assist in breathing.

3. Making the Incision :- The surgeon makes an incision down the middle of the chest and separates the breastbone (sternum) to access the heart. In some minimally invasive techniques, smaller incisions between the ribs may be used, avoiding the need to open the entire chest.

4. Using the Heart-Lung Machine :- In most CABG surgeries, a heart-lung machine is used to take over the function of the heart and lungs during the operation. This allows the heart to be stopped temporarily while the surgeon works on it in a motionless field.

5. Harvesting the Graft Vessels :- Healthy blood vessels (grafts) are taken from other parts of the body usually the leg (saphenous vein), chest (internal mammary artery), or arm (radial artery). These vessels will be used to create new pathways for blood flow.

6. Bypassing the Blocked Arteries :- The surgeon attaches one end of the graft above the blockage in the coronary artery and the other end below it. This creates a new route for blood to flow to the heart muscle, effectively bypassing the obstructed segment.

7. Restarting the Heart :- Once all grafts are in place, the surgeon restarts the heart. In some cases, electric shocks may be required to restore a normal heartbeat. The heart-lung machine is then gradually disconnected.

8. Closing the Chest :- After confirming that the new grafts are functioning properly, the sternum is wired back together, and the chest is closed with sutures or staples. The breathing tube is usually left in place until the patient can breathe independently.

9. Postoperative Care and Monitoring :- Following surgery, the patient is shifted to the intensive care unit (ICU) for close monitoring. Vital signs, heart function, oxygen levels, and surgical sites are continuously observed. Pain management, infection prevention, and fluid management are priorities during this period.

Recovery After Coronary Surgery

Recovery after coronary surgery varies by patient but generally involves a hospital stay of about 5–7 days. Here’s what the recovery process typically looks like:

1. Initial Hospital Recovery :- Most patients spend the first 1–2 days in the ICU, then are moved to a general cardiac ward.
   
2. Wound Healing :- The chest incision takes about 6–8 weeks to heal. Patients are advised to avoid heavy lifting or straining during this time.
   
3. Medications :- Blood thinners, beta-blockers, statins, and pain relievers are commonly prescribed.
   
4. Lifestyle Changes :- Cardiac rehabilitation programs help patients adopt heart-healthy habits such as quitting smoking, eating low-fat meals, and managing stress.
   
5. Follow-up Appointments :- Regular checkups are essential to monitor heart health and ensure grafts are functioning properly.
   

Conclusion

Coronary surgery is a major yet highly effective procedure for treating severe coronary artery blockages. By bypassing clogged arteries, this surgery significantly improves blood flow to the heart, reduces chest pain (angina), and decreases the risk of future heart attacks. Understanding each step of the procedure can help patients and families feel more prepared and informed. With proper care and adherence to post-operative guidance, most patients experience a significant improvement in quality of life and long-term heart health.