What is coronary artery bypass grafting (CABG) triple bypass surgery?

From the Guidelines

Triple bypass surgery is recommended for patients with triple-vessel coronary artery disease as it confers a survival benefit over medical therapy, as evidenced by the 2022 ACC/AHA/SCAI guideline for coronary artery revascularization 1. The surgery involves taking blood vessels from another part of the body and using them to create new pathways around the blocked arteries, allowing blood to flow freely to the heart muscle. Key points to consider include:

• The use of antiplatelet and statin therapies, as well as beta-blockers and ACE inhibitors/ARBs, in conjunction with surgery to optimize outcomes.
• The importance of a Heart Team approach to weigh the risks and benefits of PCI as compared to medical therapy in patients deemed prohibitive surgical risk.
• The results of the ISCHEMIA trial, which may inform decision-making in certain patient subsets. Recovery typically takes 6-12 weeks, with patients staying in the hospital for about a week after surgery. Following discharge, patients need to follow a cardiac rehabilitation program that includes:
• Gradually increasing physical activity
• Taking prescribed medications, such as aspirin, statins, beta-blockers, and ACE inhibitors
• Maintaining a heart-healthy diet low in saturated fats and sodium
• Attending regular follow-up appointments The surgery is necessary because coronary artery disease restricts blood flow to the heart, which can lead to chest pain, shortness of breath, heart attacks, and potentially death if left untreated. While the procedure carries risks, including bleeding, infection, and stroke, it significantly improves quality of life and survival rates for patients with severe coronary artery disease, as supported by a meta-analysis of seven RCTs 1.

From the Research

Overview of Triple Bypass Surgery

• Triple bypass surgery, also known as coronary artery bypass grafting (CABG), is a surgical procedure used to treat severe coronary artery disease (CAD) by bypassing blocked or narrowed coronary arteries with grafts.
• The goal of CABG is to restore blood flow to the heart muscle, relieving symptoms such as chest pain and shortness of breath, and reducing the risk of heart attack.

Patient Selection and Outcomes

• Studies have shown that patient selection is crucial in determining the outcomes of CABG surgery 2, 3.
• Patients with severe CAD, including those with triple-vessel or left main disease, may benefit from CABG surgery, especially if they have comorbidities or are at high risk for surgical complications 2.
• However, patients with surgical ineligibility, such as those with advanced age or comorbidities, may have worse long-term outcomes after CABG surgery compared to those without surgical ineligibility 2.

Surgical Techniques and Complications

• Different surgical techniques, such as on-pump and off-pump CABG, may have varying effects on patient outcomes 3.
• Off-pump CABG may be associated with reduced postoperative complications, such as atrial fibrillation, and shorter hospital stays compared to on-pump CABG 3.
• The use of statins and beta-blockers before and after CABG surgery may also reduce the risk of postoperative complications, such as stroke 4.

Long-Term Management and Outcomes

• Long-term management of patients after CABG surgery is crucial to prevent graft failure and reduce the risk of cardiovascular events 5, 6.
• The use of statins and aspirin after CABG surgery is recommended to reduce the risk of graft failure and cardiovascular events, but adherence to these medications may be suboptimal 5.
• CABG surgery may be associated with better outcomes, such as reduced heart failure hospitalization, compared to percutaneous coronary intervention (PCI) in patients with severe CAD and reduced ejection fraction 6.