CABG:
Even a Past President isn't Immune
from CABG.
Recent news of former President Bill Clinton's heart disease
has us all wondering about coronary artery disease and the coronary
artery bypass grafting procedure. Known as CABG, this procedure
is one of the most aggressive approaches to treating heart disease
and is advised for a select group of patients with significant
heart disease who are also able to withstand the insult of the
surgery.
Each year, about 350,000 patients undergo CABG with a mortality
rate of 3-4%. Fortunately for President Clinton, CABG has a proven
track record of success and safety.
What is coronary artery disease? The heart
is a muscle that requires blood supply. Exercise and activity
will cause a demand for an
increased blood flow to the heart muscle. When the blood vessels
are narrowed with a plaque, inadequate blood flow is provided
to the muscle. As a result, a person may experience chest pain
or an aching feeling. A variety of other symptoms may be present
including nausea, vomiting, sweating, jaw pain, arm pain, and
shortness of breath. This may be an indication of decreased blood
supply to the heart, due to the narrowed arteries.
The narrowing of the arteries will occur over years. The well-known
risk factors that lead to the narrowing include smoking, high
blood pressure, high cholesterol, diabetes, and family history.
Many of these risk factors can be controlled to decrease the risk
of developing coronary artery disease.
How is this diagnosed? When a patient
experiences chest pain and shortness of breath, as in the case
of Clinton, a medical workup
is required. This includes an electrocardiogram (EKG), blood tests,
possible stress test, and coronary angiography. Coronary angiography
or catheterization injects dye into the heart vessels, as they
are x-rayed. This test actually shows the architecture of vessels
and if they are narrowed. A narrowed vessel of 50-70% may produce
symptoms. A single narrowed vessel may be opened with a balloon,
but if several vessels are involved, balloon angioplasty may not
be safe or curative. Then, CABG is recommended.
What is CABG? In order to improve blood
supply to the heart muscle, the narrowed portion of the coronary
artery, must be bypassed.
A healthy artery or vein taken from the chest wall, arm, or leg
is attached above the narrowing and then attached to vessel below
the narrowing. This allows for adequate blood supply to be provided
below the blocked artery.
A Cardiothoracic or heart surgeon will perform the operation.
A Cardiologist or heart doctor is the physician that performs
the catheterization prior to the surgery and helps the heart surgeon
manage the patient medically in the hospital. The surgical procedure
usually takes about 4 hours and a patient may be hospitalized
for about 5 days. It is interesting to note that the heart is
actually stopped while the doctors work on the heart and the patient's
life is sustained by the heart-lung machine.
What are the risks? CABG is one of
the most common major surgical operations performed in the United
States today. The mortality
or chance of dying from the procedure is about 3-4%. Exposure
to anesthesia is a risk and exposure time should always be minimized.
There is a small risk of stroke that can occur during the surgery.
In the post-operative period, a patient may develop bleeding at
the surgical sites. There is a possibility of infection at the
surgical site. Pneumonia may develop since the patient has been
placed on a breathing machine and it may be difficult to breath
after the surgery. In addition, there is a risk of the grafts
blocking and they may need to be replaced.
Some other post-operative complications may involve the heart
developing an arrhythmia or irregular heart beat. Many patients
develop atrial fibrillation. Most of these problems can be treated
with additional medications.
What happens after surgery? Most patients
are hospitalized for about 5 days. Activities are slowly increased
and cardiac rehabilitation
is started. This is a very important aspect of the recovery period
and must be continued for several weeks after the procedure. The
patient must alter their life style, in order to insure success
and a long healthy life. In general, in a patient such as former
President Clinton, it can be expected that he will have an uneventful
recovery and experience a normal life span. His medical condition
will be closely monitored by his physicians for the rest of his
life, as it is with all CABG patients.
