CORONARY artery bypass graft surgery is commonly called CABG (pronounced “cabbage” is actually Coronary Angio Bypass Grafting), or other terms like bypass and “plumbing job”.
The terms all describe the process that takes place during the surgery. CABG (the most common acronym) is essentially a plumbing job, done by skilled cardiothoracic surgeons.
The accuracy of the latest cardiac scan has not been proven, but these scans may be used to convince patients to undergo unnecessary procedures. In CABG, the surgeon uses a vein to re-establish the blood flow caused by a blockage in the heart artery, almost like what a plumber would do if the kitchen sink is blocked.
Although I put this rather simply, it is actually a very complicated surgery. This will become obvious as I go along.
Just to recall, that in 1965, Dr Mason Sones discovered the use of coronary angiogram, a technique that allowed us to see the coronary artery in a live person, thereby allowing us to identify blockages accurately.
Dr Sones was working in Cleveland Clinic, Ohio, in the United States. The cardiac surgeon there at that time was a brilliant Argentinean called Rene Favaloro.
One day, as the story goes, a young man came in with acute severe chest pains. Dr Sones did an angiogram, which showed a right coronary artery blockage.
As the patient was not responding well to medical therapy, Dr Sones asked Dr Favaloro to help, using this new technique that Dr Favaloro had been experimenting with in the animal laboratory.
The patient was an ideal candidate, and Dr Favaloro did the CABG. As they say, the rest is history.
In the history of CABG, two earlier important advances must be recognised. In 1950, Dr Arthur Vineberg had shown that you can cut an artery and bury it in the heart muscle, and this can help to bring blood to the heart muscle.
Dr Gibbons’ role is also important as he invented the heart-lung machine. To operate on the heart, you need a clean and clear surgical field, with the heart stopped. To stop the pumping heart, the blood circulation has to be diverted to a heart-lung machine, which will maintain the patient’s circulation until the heart operation is completed.
After the heart operation is completed, use of the heart-lung machine is discontinued and the patient’s own circulation is re-established.
Thre is a substantial risk factor involved in this procedure.
