Coronary Artery Bypass Surgery Treatment Cost in India

Coronary artery bypass graft surgeries are very common in the field of cardiac surgeries that are performed on coronary heart disease patients. The best Coronary artery bypass graft surgeries are done in India. This kind of surgery is usually selected for patients who have significant problems of narrowing and blockages developed on the heart arteries. The surgery aims to create new paths around the blocked and narrowed arteries which can permit the access for proper blood flow enabling the oxygen and nutrients to be delivered to the muscles of heart adequately for its functioning.

Your doctor uses coronary artery bypass graft surgery (CABG) to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to your heart muscle. When plaque builds up in the walls of the arteries that supplies to the heart condition are atherosclerosis which further hardens the wall of the arteries. Cholesterol mainly comprises of plaque and can finally give rise to Coronary artery diseases. Plaque accumulation can get severe with high blood pressure, high cholesterol, diabetes, and smoking. Patients are at greater risk after the age of 55 (for women) and 45 (for men) and if they have a family history of developing coronary heart disease. The process of atherosclerosis(a  disease in which plaque builds up inside your arteries) can result in narrowing at a significant level in more than one coronary artery. If any artery narrows by 50 to 70% then the blood supply beyond the plaque formation becomes insufficient to cater to the oxygen demand raised during physical activities. The heart muscles do not get enough oxygen giving rise to a condition called ischemia. When the blood oxygen demand cannot take care of this raised demand then patients experience chest pain. 25% of patients have been found to experience no angina but that means they are suffering from silent angina and are at the same risk as other patients to become a victim of a heart attack.

In this stage, if a blood clot is formed on the top of this plaque, the artery in question becomes totally blocked leading to a heart attack.

CABG surgery in India is required for treating coronary artery disease and the following diagnosis steps are taken to detect the presence of the illness.

The electrical activity of the heart is recorded through an electrocardiogram or EKG that can check for the signs and symptoms of ischemia or a heart attack. Resting EKG is found to be normal in some patients or coronary artery disease or angina. But working out on treadmills results in useful screening outcomes for the patients. These tests are 60 to 70% accurate when it comes to detecting coronary artery diseases.

When stress tests are not revealing with great accuracy then further nuclear agents like thallium and Cardiolite can be injected intravenously while performing the stress test. With the help of an external camera, a nuclear imaging agent allows the vision of the blood flow to various parts of the heart. Any region of the heart having a reduced flow of blood during the workout but normal blood flow at the resting stage indicates a good amount of artery narrowing in the region.

Another way to detect  CAD is to combine echocardiography with the above stress testing method to detect narrowing of the artery. If the blockage can be located, then it can be observed that the heart muscle supplied by this artery does not contract the way the rest of the heart muscle does. The two combined can result in getting 80 to 85% accurate detection of coronary artery disease.

In some cases, patients are unable to undergo stress tests due to problems in joints or nervous systems and medications must be administered intravenously for the simulation of the stress on the heart and imaging is done with a nuclear camera or ultrasound.

Cardiac catheterization combined with angiography or coronary arteriography is by far the most accurate test for the detection of coronary artery narrowing. With the help of X-Ray guidance small and hollow plastic tubes are advanced to the openings of the right and left heart arteries. Iodine contrast or dye is thereafter injected into these arteries while an X-Ray video is captured.

Nowadays high-speed CT scanning angiography is made available. This technique uses very powerful X-ray methods to see the arteries of the heart. 

The first incision is made by the cardiac surgeon with the help of saws through the sternum (breastbone) right down the middle of the chest. This surgical procedure is referred to as a median sternotomy or the cutting of the sternum.

Now the heart must be cooled with iced saltwater. A preservative solution is injected into the heart arteries to ensure the least damage caused due to reduced blood flow while the surgery is being performed and this is called cardioplegia.

A cardiopulmonary bypass has to be fixed before the surgery is started and this device is also called a heart-lung bypass machine. This machine is responsible for taking over the function of the heart throughout the surgery.

For the correct channelization of venous blood out of the body, a plastic tube is placed in the right atrium of the heart. This arrangement is made through a plastic sheeting or a membrane oxygenator associated in the machine. The oxygenated blood produced, will now be returned to the body.

In order to permit the bypasses from being connected to the aorta, the main aorta is knocked off or cross clamped during the surgery. This also ensures a bloodless field.

The saphenous vein from the leg is the most commonly selected blood vessel for bypass surgery. The bypass graft is sewn through the narrowing or blocked coronary artery section. The saphenous vein's other terminus is connected to the aorta.

Now, the arteries of the chest wall, as specifically the left internal mammary artery, are chosen for the bypass graft. This artery is connected to the left anterior descending artery or one of its branches after being disconnected from the chest wall. The advantage of these arteries is that it has the nature of remaining open for a longer period of time compared to venous grafts.

It has been observed that after 10 years 66% of vein grafts are found to be opened while for internal mammary arteries almost 90% were found to be open. But the disadvantage with internal mammary arteries is that the length is small and can only be utilized when the disease is located at the beginning of the coronary arteries and not too far away. Usage of the internal mammary artery can prolong the time taken to conduct the total surgery since it takes some time to segregate it from the chest wall. Hence in case of emergency CABG surgeries, these kinds of arteries may not be employed to restore coronary artery blood flow.

The normal time to finish a CABG surgery is around 4 hours in which the aorta is clamped off for about an hour and the body is assisted via the heart-lung bypass machine for 1.5 hours. It is now a routine to make use of triple, quadruple and quintuple bypasses.

After the surgery is completed the sternum with the help of stainless steel is wired together and the incision in the chest is sewn closed. Plastic tubes or chest tubes are kept in place to permit the drainage of blood that has remained in the space (mediastinum) around the heart.

5% of the patients require some exploration within the first day in order to check for continued bleeding post-surgery. Chest tubes can be removed after one-day post-surgery. While the breathing tube can be removed immediately after the surgery.

Right after the day of surgery patients are shifted from the intensive care unit. 25% of patients have been observed to have developed heart rhythm disturbances within 3 to 4 days post-surgery. These irregularities are temporary atrial fibrillation and can be associated with surgical trauma suffered by the heart during surgery.

Patients are now discharged 3 to 4 days after surgery and one can expect a faster recovery. Another advance that has been made in the process is that surgery can be performed without cardiopulmonary bypass, and this can actually reduce the frequent memory defects and other related complications that have occurred in patients who have undergone surgery.

CABG surgery is never the only option available for angina or CHD / CAD treatment. Patients must discuss in detail whether medicines can be used to reduce the demand for oxygen in the heart muscles with their healthcare provider. Drugs like beta-blockers, nitrates, and calcium blockers are used. Aspirin can also be administered to treat troubles of unstable angina. Aspirin works by relieving clots and preventing platelets from clumping.

When the above does not work then percutaneous coronary intervention(PCI) where a small stent is introduced for opening the blockage is introduced.

In some patients, angioplasty can produce very good results and in this operation, a stent with a balloon tip is introduced via the groin till the heart. Near the blockage, the balloon is inflated to widen the region and the stent is implanted to keep the constricted region open.

The patient's medical history must be shared with his or her health care provider. The doctor may advise on food and rest right before surgery and may advise on the reduction or total cessation of certain medicines to aid in smooth operation. If several blockages and serious ones are found during the diagnosis, the patient may be advised to be admitted immediately as this poses a major threat to life and well-being.

Within 7 to 10 days of the surgery, the sutures are removed from the chest and the legs. As smaller veins play the role of saphenous vein, a certain amount of swelling will persist in the affected ankles. Elastic support stockings are worn by patients after surgery to keep the position of the leg elevated while in the seated posture. One of the primary limitations to the recovery from CABG surgery is that it takes at least 6 to 8 weeks for the breastbone to heal.

Lifting of anything more than 10 pounds is strictly prohibited and even though sexual life can be resumed but as long as there is the least stress on various positions that puts the stress on arms and chest. Patients can expect to get back to work after 6 weeks if the job in hand is not a tough one.

Exercise stress testing must be done 4 to 6 weeks on a regular basis to aid the patient in a cardiac rehabilitation program. The program is usually a 12-week program where the intensity of the workout will be increased gradually for a period of 1 hour conducted three times in a week.

During the program, the patient is advised on their lifestyle changes to prevent the chances of CAD again. They will be advised on how to lower their cholesterol intake, quit smoking and consumption of alcohol and more stress will be given on light physical activities to improve the quality of life.

The cost of Coronary artery bypass surgery, the cost ranges from $4500 to $7000 in India. Any kind of heart surgery is much cheaper in India compared to the UK and USA with the same quality treatment.