CABG Surgery at Apollo Hospitals, Lucknow

Coronary Artery Bypass Grafting (CABG) is one of the most established heart operations performed in India, and Apollo Hospitals Lucknow offers it as part of a full-spectrum cardiac sciences programme covering diagnosis, surgery, intensive care and cardiac rehabilitation under one roof.

• Part of the Apollo Hospitals group, established in 1983 ? India's first corporate hospital chain, with a group-wide cardiac experience of well over 200,000 cardiac surgeries across its network, and a documented institutional protocol culture for bypass surgery.
• Dedicated cardiac sciences team at Lucknow ? cardiothoracic and vascular surgeons, interventional cardiologists, cardiac anaesthetists, cardiac intensivists and perfusionists working as one unit, with senior consultants typically carrying between 15 and 30 years of individual practice and several decades of combined operative experience.
• Heart team decision-making ? as recommended by both Indian and international guidelines, the choice between CABG, angioplasty (PCI) and medical therapy is made jointly by a cardiologist and a cardiac surgeon rather than by a single doctor.
• Full range of surgical techniques ? conventional on-pump CABG, off-pump (beating heart) CABG, total arterial revascularisation using both internal mammary and radial arteries, and minimally invasive/small-incision approaches in selected patients.
• Technology support ? cardiac catheterisation laboratory, echocardiography including transoesophageal echo, CT coronary angiography, intra-operative graft flow assessment, intra-aortic balloon pump and ECMO capability, and a dedicated cardiac ICU with ventilator and dialysis backup.
• Structured post-operative programme ? physiotherapy from day one, incentive spirometry, graded walking protocols, dietitian counselling in Hindi and English, and a phase-wise cardiac rehabilitation plan.
• Care pathways adapted to age and risk ? separate planning for elderly patients (frailty, kidney function, carotid disease), diabetic patients (very common in North India), patients with poor ejection fraction, and re-do or emergency cases. Congenital and paediatric cardiac problems are assessed by the paediatric cardiac team, since CABG itself is almost never a childhood operation.
• Insurance and TPA desk on site for cashless processing with major insurers, Ayushman Bharat and government schemes where applicable ? eligibility is confirmed at the hospital's insurance desk.
• A referral centre for eastern and central Uttar Pradesh, receiving patients from Kanpur, Barabanki, Sitapur, Unnao, Rae Bareli, Hardoi, Sultanpur, Ayodhya, Gonda, Bahraich, Lakhimpur Kheri, Pratapgarh, Jaunpur, Basti and parts of Bihar and Nepal.

Overview

Coronary Artery Bypass Grafting (CABG) surgery is a critical procedure designed to improve blood flow to the heart. At Apollo Hospitals Lucknow, we aim to provide well-organised, evidence-based cardiac surgical care supported by current technology. Our team of cardiologists, cardiac surgeons, anaesthetists and intensivists works together to build treatment plans tailored to each patient's anatomy, symptoms and other medical conditions. Our focus is on careful patient selection, transparent counselling and consistent peri-operative care rather than on any single technique.

In CABG, a healthy blood vessel is taken from the chest wall, leg or forearm and used to create a new route for blood around a blocked segment of a coronary artery. One, two, three or more grafts may be needed depending on how many arteries are involved.

Why CABG Surgery is Necessary

CABG surgery is often necessary for patients suffering from coronary artery disease (CAD), a condition where the coronary arteries become narrowed or blocked due to plaque buildup. This can lead to chest pain (angina), shortness of breath, and even heart attacks. The primary goal of CABG surgery is to restore adequate blood flow to the heart muscle, thereby alleviating symptoms and reducing the risk of serious complications.

The benefits of CABG surgery are significant. By bypassing blocked arteries, the procedure can improve heart function, enhance quality of life, and in appropriately selected patients improve long-term survival. Many patients experience relief from angina and are able to return to their normal activities with renewed energy. At Apollo Hospitals Lucknow, we use current techniques and technologies with the aim of achieving the best achievable outcome for each patient, while recognising that results depend on individual risk factors.

Risks of Delay

Delaying CABG surgery can have serious consequences. As coronary artery disease progresses, the risk of heart attacks and other cardiovascular events increases. Patients may experience worsening symptoms, which can lead to a decline in overall health and quality of life. In some cases, delayed treatment can result in irreversible damage to the heart muscle, making recovery more challenging.

At Apollo Hospitals Lucknow, we understand the importance of timely intervention. Our team aims to provide prompt evaluation and clear treatment options so that patients are not left waiting unnecessarily. If you or a loved one is experiencing symptoms of CAD, do not wait ? arrange a consultation with our cardiac team. Chest pain at rest, chest pain that is increasing in frequency, or breathlessness with sweating should be treated as an emergency.

Benefits of CABG Surgery

• Improved heart function: By restoring blood flow to the heart muscle, CABG can improve pumping function in hearts where muscle is starved of blood but still viable, and reduce symptoms of heart disease.
• Enhanced quality of life: Many patients report a marked improvement in quality of life after surgery, with reduced chest pain and better ability to carry out daily activities.
• Improved survival in selected groups: Studies show a survival advantage from CABG in patients with left main disease, extensive three-vessel disease, diabetes with multivessel disease, and reduced left ventricular function.
• Personalised care: Each patient receives a plan matched to their coronary anatomy, kidney function, lung status, diabetes control and family support.
• Advanced technology: Modern operating theatres, cardiac ICU monitoring and current surgical techniques support recovery, though outcomes always depend on individual risk.

If you are considering CABG surgery, Apollo Hospitals Lucknow can provide a detailed assessment and a frank discussion of the expected benefits and risks in your particular case.

Preparation and Recovery

Preparation Tips

• Consultation: Arrange a thorough consultation with the cardiology and cardiac surgery team to discuss your medical history, symptoms and concerns.
• Preoperative testing: You may undergo blood tests, imaging studies, echocardiography, carotid Doppler, lung function tests and dental review to assess fitness and plan the operation.
• Medications: Follow your doctor's instructions regarding medicines. Some drugs, such as certain blood thinners, may need to be stopped or changed before surgery ? never stop them on your own.
• Lifestyle modifications: Stopping smoking and tobacco chewing, controlling sugar and blood pressure, and gentle activity all improve surgical safety.
• Support system: Arrange help for the recovery period, as you will need assistance with bathing, dressing and household work for several weeks.

Recovery Tips

• Follow-up care: Attend all follow-up appointments so that wound healing, sugar control and medicines can be reviewed.
• Gradual return to activities: Resume normal activities in stages as advised. Listen to your body and avoid overexertion.
• Cardiac rehabilitation: A supervised cardiac rehabilitation programme gives structured guidance on exercise, nutrition and lifestyle change.
• Healthy lifestyle: Continue with a balanced diet, regular exercise and complete avoidance of smoking and tobacco.
• Emotional support: Low mood and anxiety after heart surgery are common. Seek support from family, friends or a counsellor if needed.

Apollo Hospitals Lucknow aims to support you throughout the surgical journey, from preparation to recovery.

Current Guidelines Guiding CABG in India

Decision-making at Apollo Hospitals Lucknow follows nationally and internationally accepted guidance rather than individual preference:

• Cardiological Society of India (CSI) position statements and the CSI?IAE consensus documents on the management of coronary artery disease and on cardiac rehabilitation in Indian patients, which emphasise heart-team decisions and structured post-discharge rehabilitation.
• Indian Association of Cardiovascular and Thoracic Surgeons (IACTS) practice standards for adult cardiac surgery, including the preference for internal mammary artery grafting and the growing use of multiple arterial grafts in younger Indian patients.
• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization ? the most recent major revascularisation guideline. Notable changes in this edition include a downgrade of the previously strong survival-benefit recommendation for CABG in stable three-vessel disease with normal pumping function (now a weaker recommendation), a strong recommendation for radial artery grafts over saphenous vein for suitable second targets, and a strong recommendation for the multidisciplinary heart team in complex disease.
• 2018 ESC/EACTS Guidelines on Myocardial Revascularization, still widely referenced for the use of the SYNTAX score in choosing between CABG and PCI.
• Recognition of the Indian CAD pattern ? Indian patients often present a decade earlier, with more diffuse disease, smaller vessels, high rates of diabetes and a strong family history. Both CSI and the Indian Heart Association highlight this, and it influences graft choice and long-term medical therapy.

Guidelines change with new evidence, and individual recommendations may differ from the general rule. Your surgeon will explain which guideline recommendation applies to your case and why.

Timing of Surgery and the Pre-Procedure Phase

How urgent is the operation?

What happens before admission

1. Coronary angiography, either already done elsewhere or performed here, is reviewed by the heart team.
2. Echocardiogram to assess pumping function and valves; carotid Doppler in older patients or smokers.
3. Blood tests including kidney function, HbA1c, viral markers and blood grouping; blood arranged in advance.
4. Chest X-ray and lung function assessment, particularly in smokers and those with asthma or COPD.
5. Dental check-up to clear any infected teeth, and treatment of any urine or skin infection.
6. Physiotherapy teaching of breathing exercises and cough support before surgery, which reduces lung complications.
7. Anaesthesia review, consent, and a family discussion covering risk, expected ICU stay and cost estimate.

Smoking or tobacco should ideally be stopped at least two to four weeks before surgery. Blood sugar control is reviewed carefully, as poorly controlled diabetes increases the risk of wound and chest infection.

Technique and Treatment Options Compared

Comparative benefit varies with anatomy, diabetes status and pumping function. There is no single best option for everyone, and the heart team will explain what fits your scan.

Procedures Sometimes Done at the Same Time

• Valve repair or replacement ? most often the aortic or mitral valve, when significant disease is found alongside coronary blockages.
• Mitral valve repair for leakage caused by a previous heart attack.
• Left ventricular aneurysm repair where a weakened, bulging area of muscle has formed.
• Closure of a patent foramen ovale or atrial septal defect if detected on echo.
• Surgical ablation or left atrial appendage closure in patients with atrial fibrillation.
• Carotid intervention, staged or combined, in patients with severe neck-artery narrowing.
• Ascending aorta repair when the aorta is significantly enlarged.

Combined operations take longer and carry higher risk than isolated CABG. The decision is discussed with the family before surgery, and consent covers the possibility of an additional step being needed based on intra-operative findings.

Phase-by-Phase Recovery Timeline

These are general patterns. Diabetics, elderly patients, those with kidney or lung disease, and those who had emergency surgery may take considerably longer.

Returning to Normal Activity, Work and Sport

General criteria before stepping up

• Wound dry, closed and free of discharge.
• No chest pain, no breathlessness at the current activity level.
• Breastbone stable ? no clicking, grating or movement when you cough.
• Blood sugar and blood pressure reasonably controlled.
• Cleared at follow-up, ideally after a rehabilitation assessment.

Everyday Indian activities

• Sitting cross-legged on the floor: usually comfortable early, but getting up and down needs arm support at first. Use a wall or a stool for the first six weeks rather than pushing up with the arms.
• Squatting and Indian-style toilets: the squat itself does not strain the breastbone, but rising from it often does. A Western commode or a commode chair over the Indian toilet is strongly advised for at least six to eight weeks, and a grab bar helps.
• Floor sleeping: best avoided for six to eight weeks, since getting up from the floor loads the chest and arms. A firm bed at knee height is preferable; some patients sleep semi-propped on pillows initially because of chest discomfort.
• Bathing: shower with lukewarm water once the wound is sealed and the team permits. Avoid bucket-and-mug bathing that requires bending and lifting for a few weeks, and avoid full tub immersion, ponds and rivers.
• Cooking and housework: light chopping and stirring after two to three weeks; lifting pressure cookers, gas cylinders, wet clothes or grinding stones only after eight to twelve weeks.
• Prayer and religious practice: prostration and repeated floor kneeling should wait until the sternum is comfortable, usually six to eight weeks. Sitting prayer is fine earlier.
• Driving and two-wheelers: car driving usually after four to six weeks with clearance; two-wheeler riding and pillion travel on rough roads later, often after eight to twelve weeks, because of jolting.
• Work: desk and office work often at four to six weeks; shop work, teaching or field visits at six to eight weeks; farming, loading, construction and other heavy manual work usually at three months or more.

Exercise and sport

• Walking is the mainstay from week one, increasing gradually in time rather than speed.
• Structured cardiac rehabilitation, as recommended by CSI, is the safest route back to exercise and is linked with better long-term outcomes.
• Cycling, swimming, badminton and yoga are usually reintroduced after eight to twelve weeks with clearance; upper-body weight training and any activity with a risk of chest impact only after full sternal healing, generally around three months.
• Competitive or contact sport requires individual assessment, often with an exercise test.
• Yoga asanas that involve heavy chest opening, inversions or breath-holding should be started only under guidance.

Preventing Recurrence and Graft Failure

CABG bypasses existing blockages but does not stop the underlying disease. Grafts can narrow, and new blockages can form in native arteries. Protecting the result depends heavily on the patient:

• Medicines: antiplatelet therapy, high-intensity statin, and blood pressure and heart-rate medicines as prescribed. Do not stop any of these because you "feel fine".
• Cholesterol targets: guidelines advise aggressive LDL lowering after revascularisation; your target will be set by your cardiologist and checked with periodic blood tests.
• Diabetes control: particularly important in Indian patients, where diabetes is a major driver of graft and native-vessel disease.
• Complete tobacco cessation, including bidi, gutka, khaini and hookah. Continued smoking is one of the strongest predictors of graft failure.
• Diet: reduce deep-fried food, vanaspati, sweets, refined flour and excess salt; increase vegetables, whole grains such as bajra and jowar, pulses, nuts in moderation and fruit. Reduce ghee and coconut/palm oil quantity rather than eliminating traditional cooking entirely.
• Weight and waist: Indian cut-offs for abdominal obesity are lower than Western ones ? waist above 90 cm in men and 80 cm in women is considered high risk.
• Activity: at least 150 minutes of moderate activity weekly once cleared.
• Follow-up: regular review, with repeat testing only if symptoms return. Routine angiography without symptoms is not recommended.

Older Patients, Younger Patients and Children

Elderly patients

Age alone does not disqualify anyone from CABG. What matters is frailty, kidney function, lung capacity, carotid disease and independence in daily activities. Older patients have a higher chance of atrial fibrillation, temporary confusion after surgery, slower wound healing and longer hospital stay, and off-pump techniques are sometimes preferred. Extra family support is usually needed at discharge.

Younger patients

Coronary disease in the thirties and forties is unfortunately common in India. In such patients, arterial grafts are favoured because they tend to last longer, and lifelong risk-factor control matters even more, since the patient may live several decades after surgery.

Women

Women often present later and with atypical symptoms such as fatigue or breathlessness rather than classic chest pain, and tend to have smaller coronary vessels. Recovery advice around housework and lifting needs to be explicit, because women frequently return to heavy domestic work too early.

Children and adolescents

CABG is very rarely required in children. It is considered only in unusual situations such as Kawasaki disease with coronary aneurysms, congenital coronary anomalies, homozygous familial hypercholesterolaemia or after certain congenital heart operations. These cases are managed by the paediatric cardiac team with age-specific anaesthesia, ICU care and graft planning, and long-term follow-up into adulthood.

If You Choose Not to Have Surgery

Declining surgery is a legitimate choice, and the team will continue to care for you. It is important to understand what that path involves:

• Optimal medical therapy will be prescribed and should be taken lifelong; it reduces risk but does not remove the blockage.
• Angina may persist or worsen, limiting walking, work and religious or social activity.
• In high-risk anatomy such as severe left main disease or three-vessel disease with weak pumping function, the risk of heart attack, heart failure and death is meaningfully higher without revascularisation.
• Angioplasty may be an alternative in some patients who refuse surgery, though it may be less durable in complex disease.
• If breathlessness or heart failure develops, treatment shifts towards heart-failure medication, device therapy in selected cases, and symptom control.
• You can change your decision later, but risk generally rises with delay, and surgery on a weakened heart is more hazardous.

Ask for a second opinion if you are unsure. A clear written summary of your angiogram findings and recommendation will be provided.

Factors That Influence the Cost of CABG

Cost is not a single number. The hospital's billing and insurance desk will give you a written estimate after your tests, based on the factors below. No indicative figures are published here.

Insurance, Cashless Treatment and Government Schemes

• Cashless facility: Apollo Hospitals Lucknow works with most major insurers and third-party administrators. Confirm your specific insurer's empanelment with the hospital insurance desk before admission.
• Pre-authorisation: for planned surgery, the TPA request is filed with your angiogram report, consultation notes and estimate, usually a few days ahead. Approval time depends on the insurer, not the hospital.
• Emergency admission: intimation to the insurer is normally required within 24 hours; treatment starts immediately and paperwork follows.
• Documents to carry: health card or policy copy, government photo ID, previous prescriptions, angiography CD and report, and past discharge summaries.
• Waiting periods: most Indian health policies apply an initial waiting period of about 30 days for illness, and a specified waiting period commonly of two to four years for pre-existing conditions such as established heart disease and hypertension. Read your policy schedule ? CABG for a pre-existing condition may be excluded if the waiting period is incomplete.
• Accident versus planned cover: personal accident policies typically cover injury only and do not fund CABG for coronary disease. Cardiac surgery is covered under indemnity health insurance, or paid as a lump sum under critical-illness policies once the defined criteria and survival period are met.
• Room-rent and proportionate deduction: if you choose a room category above your policy limit, many policies reduce all associated charges proportionately. Ask before upgrading.
• Non-payable items: gloves, some consumables, attendant food and administrative charges are often excluded and settled by the family.
• Government schemes: Ayushman Bharat PM-JAY, CGHS, ECHS, state and PSU schemes are accepted where the hospital is empanelled for the relevant package. Eligibility, package availability and referral requirements must be confirmed at the hospital's scheme or insurance desk.
• Co-payment: senior-citizen and some corporate policies carry a co-pay percentage; the desk can estimate your likely share.

Planning Your Admission and What to Bring

Before you travel

• Confirm the admission date, reporting time and fasting instructions with the cardiac surgery coordinator.
• Arrange at least one attendant who can stay for the full stay, and ideally two who can rotate.
• Keep blood donors identified within the family, as replacement may be requested.
• Complete pending dental treatment and settle any infection before travelling.

What to pack

• All current medicine strips and boxes, plus a written list with doses.
• Angiography CD/report, echo report, all previous discharge summaries, ECGs and recent blood reports.
• Aadhaar or other photo ID for patient and attendant, insurance card, and scheme card if applicable.
• Loose front-open shirts or kurtas, pyjamas, slip-on chappals with grip, and a light shawl.
• Toiletries, comb, small towel, spectacles, dentures with case, hearing aid.
• Mobile phone with charger and a long cable, plus a notebook and pen for instructions.
• A small firm cushion or rolled towel for chest support while coughing after surgery.
• Avoid bringing jewellery, large amounts of cash or valuables.

Preparing the home for return

• Set up a bed at comfortable height on the ground floor if possible, avoiding stairs initially.
• Arrange a commode chair or Western toilet access and a bathroom grab bar or sturdy plastic stool.
• Keep a weighing scale, blood pressure monitor, glucometer and thermometer at home