• Indiana Hospital & Heart Institute Ltd.

  • Understanding Bypass Surgery by Dr Anand K.T M.S(Gen Sur),MCh(CVTS)







    Coronary artery bypass surgery, commonly know to general public as CABG/Bypass surgery is the most commonly performed surgery the world over. Many a misunderstanding has prevented a deserving person from benefiting from what this surgery has to offer.


    What are coronary arteries and how does the heart get the blood supply it needs?

    Heart ensures adequate blood supply to the body; it is a complex muscular pump. The blood reaches via arteries to various parts of the body and carries the much needed oxygen and nutrients. Heart is supplied via coronary arteries, which are blood vessels of the heart.

    There are two coronary arteries, which supply blood to the heart, the right and the left and their branches. These two accounts for three arteries referred to in the term “Triple Vessel Disease” these arteries divide into branches and supply blood to the heart.


    What is coronary artery disease?

    Coronary arteries may be affected by occlusive atherosclerotic disease, which is what is commonly referred to as coronary artery disease.

    Fatty substances get accumulated with-in the walls of the arteries which leads to  narrowing in the arteries, leading to blocked arteries and decrease the blood reaching the heart muscles of that particular area supplied by that particular artery. This decrease in the blood supply to the heart causes chest pain, which is called as angina. A heart attack may occur in more severe cases, which damages the heart permanently and decreases its efficiency.

    What is CABG/Bypass?

    CABG is the shortened more popular name for coronary artery bypass grafting. The main aim of this surgery is to supply the heart muscle with more blood by bypassing the blocks. Various blood vessels from the patients own body are used to bypass the blocked arteries.

    The most commonly used vessels are the internal mammary artery, radial artery and the saphenous vein. There are many other conduits, which can be used to bypass the blocks.


    What are the surgical options available?

    The options available are:

    • Conventional CABG
    • Beating Heart Bypass Surgery (OP-CAB)
    • Minimally Invasive Cardiac Access Surgery (MICAS)
    • Key Hole Approaches.


    In Conventional CABG, the patient is put on a machine, heart lung machine and heart is stopped and the blocks are bypassed. After the procedure gradually the patient is separated from the machine.

    In Beating heart surgeries, the blocks are bypassed without using the heart lung machine and all the blocks are bypassed on beating heart used specialised instruments.

    In MICS, incisions are smaller and help in faster recovery of the patient.

    Key hole approaches, in other words is referred to as port access surgery or video assisted surgery.


    What are the benefits of MICAS?

    The benefits of the MICAS include:

    • Smaller incision
    • A small scar
    • Reduced risk of infection
    • Less bleeding
    • Less pain and trauma
    • Decreased length of stay in the hospital after the procedure
    • Decreased recovery time


    What type of surgeries can be performed by MICAS?

    • Valve replacement surgeries
    • CABG
    • Epicardial lead placement for cardiac resynchronisation therapy
    • Atrial fibrillation


    Coronary artery surgery is a very dynamic field and many changes keep the medical personnel on their feet. Robotic is one such example where Robotic surgery makes use of highly specialised Robots to execute many steps in the surgical procedure. Hybrid coronary bypass is a relatively new procedure and an alternative to traditional bypass surgery that is defined by the performance of CABG and coronary stenting during the same operation. This can be combined with MICAS very effectively.



    Dr Anand K.T M.S(Gen Sur),MCh(CVTS)

    Senior Consultant Cardio-vascular & Thoracic Surgeon

         Indiana Hospital & Heart Institute,

        Mangalore – 575 002