Coronary Artery Bypass Graft (CABG) - Triple Bypass Surgery

What is Triple Bypass Surgery?

A coronary artery bypass graft is an open-heart surgical procedure for treating blocked coronary arteries that supply blood to the heart. Following CABG, there is an improvement in blood flow and increased oxygen to the heart. The aorta, which supplies blood to the heart, is divided into 2 arteries, left and right. The left artery is further divided into 2 additional blood vessels. Triple bypass surgery, a form of CABG, reduces blocks in the 3 arteries, with grafts of blood vessels obtained from either the chest or the leg. This improves blood flow to the heart(1^✔).

What is the History behind Coronary Artery Bypass Grafting (CABG)?

In the 1960s, Dr. Frank C. Spencer of New York University (NYU), developed the technique of coronary artery bypass grafting (CABG), creating a foundation for modern cardiac surgery. Following this breakthrough, Dr. George Green (NYU) utilized an internal mammary artery (blood vessel) for grafting, instead of a leg vein. It was found that the mammary artery improved durability, and enhanced the sustainability of the CABG procedure.

Robot-assisted Triple Bypass Surgery. Is that a real thing?

In 2010, surgeons at the University of Maryland School of Medicine (UMMC), were successful in performing a robot-assisted endoscopic triple bypass surgery using the arrested heart approach. Surgeons at NYU, first performed this procedure in 1996. The arrested heart approach was performed with the help of a heart-lung machine. Generally, the chest needs to be opened to use the heart-lung machine. However, in the above procedure, the heart-lung machine was connected to a blood vessel in the groin and the heartbeat was stopped. Being minimally invasive, the surgeons were able to perform tight sutures, which improved the overall outcome. The blood vessels used for the graft, are durable for nearly 20-30 years(2^✔).

What Is the cost of Triple Bypass Surgery?

The cost of CABG ranges between ~$10 000 to $33 000 in Canada. The increase in cost is based on the number of blood vessels grafted. On the other hand, the cost of CABG in India is ~$8000(3^✔).

What Are the Risk Factors of Triple Bypass Surgery?

Causes of plaques or fatty deposits developing in blood vessels are advanced age, obesity, high-fat diet, and smoking among others. A study in 2012 has observed that the risk of stroke is greater in patients undergoing CABG, irrespective of the number of blood vessels grafted(4^✔).

How does it Effect One's Lifespan?

Triple bypass surgery may improve the lifespan of individuals only if there is also a change in lifestyle. The number of blood vessels grafted is not an indication of the gravity of coronary heart disease. A single bypass individual may have a more serious heart condition than the individual with triple bypass(5^✔).

Reference:

1. Coronary Artery Bypass Graft - (https://www.ncbi.nlm.nih.gov/books/NBK507836/)
2. Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies - (https://pubmed.ncbi.nlm.nih.gov/33155975/)
3. Association of Hospital Prices for Coronary Artery Bypass Grafting With Hospital Quality and Reimbursement - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450906/)
4. Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery - (https://pubmed.ncbi.nlm.nih.gov/14579211/)
5. Do Coronary Artery Bypass Operations Prolong Life? - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273712/)