Coronary Artery Bypass Grafting (CABG) in Singapore

Introduction to CABG in Singapore

Narrowing of blood vessels on the heart or coronary arteries is typically caused by atherosclerosis. This can result in ischaemic heart disease (IHD) or coronary artery disease (CAD).  Contributory factors include diabetes mellitus, high blood pressure, high blood cholesterol, heavy smoking, family history and possibly high stress lifestyle and diet.

Chest pain or angina is the primary symptom of coronary artery disease (CAD). It is typically a squeezing chest pain that may spread to the neck, jaw, shoulder or abdomen. The pain is a signal from the heart that it is receiving insufficient blood and oxygen.  However sometimes chest pain can be silent especially in patients with long standing diabetes or kidney failure. Other symptoms may include:

  • Shortness of breath
  • Irregular heartbeats (palpitations)
  • Dizziness
  • Nausea
  • Sweating

Treatment may be lifestyle changes, medications, a procedure called percutaneous coronary intervention (PCI) or surgery called coronary artery bypass grafting (CABG).

CABG is a surgery which specifically targets Coronary Heart Disease. It improves blood flow to the heart and relieves fatigue, chest pains and promotes better health for your circulatory system.

Seasoned practitioner Dr Loh Yee Jim conducts CABG in Singapore. With numerous years of experience as a surgeon in Singapore, Dr Loh has performed many CABG treatments to help patients in Singapore.

More about Dr Loh

Besides CABG, Dr Loh is an active researcher and contributor in the medical field. Using his experience as a practitioner, he contributes actively to research on CABG and medicine in Singapore.

Currently, Dr Loh is also a member of the Residency Advisory Committee (RAC). He continues to use his skills and expertise to spearhead research and initiatives to improve overall health in the nation.

How to contact us

If you have any questions about Dr Loh or CABG, feel free to reach out to us by clicking here.

When and why do you need a “heart bypass operation” or CABG?

CABG may be an option if you have severe blockages in multiple coronary arteries, especially if your heart’s pumping action has already grown weak. It is also an option if the blockages in the heart can’t be treated with stenting.  CABG has also demonstrated significant benefits in patients who suffer from diabetes mellitus. The goals of CABG may include:

  • Improving your quality of life and reducing angina
  • Allowing you to resume a more active lifestyle
  • Improving the pumping action of your heart if it has been damaged by a heart attack
  • Lowering the risk of a heart attack
  • Improving your chances of survival and help you live longer
  • Lower future reinterventions

What to expect before CABG?

You may have some tests to prepare you.  These include:

  • Blood tests
  • Electrocardiogram (ECG)
  • Echocardiography
  • Chest X-Ray (CXR)
  • Coronary angiography (Angiogram)

What to expect during CABG?

CABG requires a team of experts.  A cardiothoracic surgeon will do the surgery with the support from an anaesthesiologist, perfusionists (heart-lung bypass machine specialist), assistants and nurses.  Surgery typically lasts 3-6 hours, depending on the number of vessels being bypassed.

 

(Source: https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting)

 

Veins or arteries will be harvested from your body – for example, from your chest, legs or hands – to use as the bypass graft.  These can be harvested using the traditional open method or the latest minimally invasive endoscopic method.

Endoscopic radial artery harvest

(Remarks: Online Source)

Open vein harvest

(Remarks: Online Source)

(Remarks: Online Source)

Risks of Coronary Artery Bypass Grafting (CABG)

These include:

  • Wound infection
  • Bleeding – sometimes requiring going back to the operating theatre
  • Reactions to anaesthesia
  • Fever
  • Pain
  • Kidney dialysis
  • Stroke
  • Heart attack or even death

Others include inflammation involving the lung and heart sac.  Some patients may as a result develop fluid build-up around the heart and lungs that require drainage. Memory loss and problems concentrating may occur in a minority of people. Risks of complications are higher if CABG is done in an emergency situation. Occasionally an external device, called the Intra-Aortic Balloon Pump (IABP) may be required to be inserted to support the heart during the times when the pumping action of the heart is weak before or even after surgery.

Recovery

After surgery, you’ll typically spend 1-2 days in an intensive care unit (ICU) and move to a less intensive care area of the hospital for 3-5 days before going home. After effects from surgery often go away after 6-8 weeks, but may include:

  • Discomfort or itching from healing incisions
  • Swelling of the area where an artery or vein was removed for grafting
  • Muscle pain or tightness in the shoulders and upper back
  • Fatigue, mood swings or depression
  • Problems sleeping or loss of appetite
  • Constipation
  • Pain around the site of the chest bone incision
  • Numbness or paraesthesia (pins and needles) around the harvest sites

Full recovery may take 3-6 months or more. Most people can resume sexual activity within about 4 weeks and driving after 3-8 weeks. Some have even returned to golfing earlier. Returning to work after 6 weeks is common unless your job involves specific and demanding physical activities. Some people may need to find less physically demanding types of work or “light duties” for a short period of time.

In order to stay healthy after surgery, there is a need to reduce the progression of your disease.  These may include making changes to your diet, quitting smoking, doing physical activities regularly, controlling your blood sugar level, lowering and managing stress. Everyone has unique and special circumstances. Consult your cardiologist or cardiothoracic surgeon if you have further questions.