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Coronary artery bypass graft (CABG)This factsheet is for people who are considering having a coronary artery bypass graft (CABG, pronounced "cabbage") operation. A CABG is surgery to treat coronary artery disease. It is usually "open heart" surgery but minimally invasive techniques are being developed. CABG surgery uses a blood vessel (called a graft) taken from the chest, leg or arm to bypass a narrowed or blocked coronary artery. This can improve blood flow to the heart and reduce the chance of a heart attack. Coronary artery bypass graft (CABG) surgery animation Why have a CABG?If you have coronary artery disease (heart disease), your coronary arteries can become narrowed or blocked, restricting the supply of oxygen and nutrients. This starves the heart of oxygen, which causes pain in the chest called angina. For more information about angina, please see the separate BUPA factsheet, Angina. CABG surgery can bypass the blocked arteries so that blood can flow more easily. A new blood vessel is attached from your aorta (your main artery) to a point in the coronary artery beyond the blockage. The new blood vessel is called a graft and is created from lengths of vein taken from your leg or arm, and/or, by diverting the internal mammary artery from behind the sternum (chest bone). The body usually functions perfectly well without the blood vessels used for the grafts. CABG surgery will not cure coronary artery disease so it is possible for blockages to recur in both the grafts and other vessels but it does improve symptoms. Between 6 and 9 out of every 10 people who have a CABG experience relief from symptoms for five years or more. What are the alternatives?Alternative procedures include percutaneous transluminal coronary angioplasty (PTCA), which flattens material that is blocking the coronary artery so blood can flow again - for more information, please see the separate BUPA factsheet, Coronary angioplasty. Your doctor will advise you which treatment is best for you. What happens before a CABG?Your surgeon will discuss how to prepare for a CABG. For example if you smoke, you will be advised to give up, as smoking increases the risk of chest infection and slows the healing of wounds as well as increasing the risk of blood clots in the legs. In the longer term it reduces the chance of your surgery being successful and the heart grafts are likely to block up more quickly. What should I expect in hospital?CABG surgery usually requires five to seven days in hospital. The operation will be performed under general anaesthetic, so you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. This is a good time to ask any questions you have about the operation. The operationThe procedure lasts around three hours, but may take longer depending on how many grafts need to be done. A CABG is carried out under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. If veins from your leg or arm are being used for grafts, these will be removed (harvested) first. Your surgeon will then make a cut, about 25cm (10") long, down the middle of your breastbone (sternum) and will open your ribcage to reach your heart. Your surgeon may attach the new grafts while your heart is still beating, but it is more common for medication to be used to temporarily stop your heart. Your blood is then re-routed to a heart-lung (bypass) machine. This will take over from your heart and lungs, and will add oxygen to your blood and maintain your circulation. The grafts will be attached and your heart will be restarted with controlled electrical shocks. Your sternum will be rejoined using wires and the skin on your chest will be closed with dissolvable stitches. Minimally invasive surgeryLess commonly "minimally invasive" or "key hole" surgery is used. Techniques include port-access and minimally invasive direct coronary artery bypass (MIDCAB) surgery. Instead of making a cut down the sternum, the CABG operation is performed through small incisions between your ribs. Special instruments are passed through the small incisions and the surgeon looks at a video monitor to see inside the chest. These methods are not suitable for all patients - your surgeon will advise you if they are suitable for you. After the operationAfter a CABG, you will be taken to the intensive treatment unit (ITU) of the hospital and will be closely monitored for a day or two before you go back to your ward. When you wake up from the anaesthesia, you will be connected to machines that record the activity of your heart, lungs and other body systems. These might include a ventilator machine to help you breathe. You will be given painkillers to help relieve any pain and discomfort as the anaesthetic wears off. A physiotherapist will usually visit you every day to help you do exercises designed to help your recovery. Before discharge, your nurse will give you advice about caring for your wounds, diet and exercise, and will give you medicines to take home with you. You should tell your GP when you are discharged from hospital so he or she can provide any ongoing care you need. Recovering from CABGAt home, take painkillers if needed, as advised by your surgeon or nurse. It is normal to tire easily or feel breathless to begin with, and it is important to take it easy for a few days. You should not do any strenuous exercise or lifting for at least a week. If you have questions about what you can and can't do, ask your surgeon or nurse for guidance. The wires holding your sternum together are usually permanent, but the stitches closing the skin will gradually dissolve as the skin heals. The sternum (chest bone) takes about six weeks to heal. You shouldn't drive until you can perform an emergency stop without discomfort - this is generally at least four weeks after a CABG. If you drive a large vehicle such as a minibus or truck, you should not drive for at least six weeks and you will need to tell the DVLA about your operation. When you see your surgeon for a follow-up appointment, he or she will advise you about when you can resume other activities such as returning to work. A full recovery can take two to three months. RehabilitationYour hospital will give you information about a rehabilitation programme. Rehabilitation aims to gently increase cardiovascular fitness through gentle, progressively increasing activity. Maintaining a good level of fitness may also help to delay any return of the problems associated with heart disease, such as angina or heart attack. Other lifestyle choices such as keeping to a healthy weight, eating a balanced diet and not smoking will also help. For more information about maintaining your weight, a healthy diet, and stopping smoking see the separate BUPA factsheets, Healthy weight for adults, Healthy eating and Giving up smoking. The emotional impact of a CABGIt's natural to feel a bit low or anxious following heart surgery and most people have good and bad days. It can help to track your progress by weeks rather than days. It may help to share your experiences with other people who have had heart surgery. Your GP or the British Heart Foundation (see Further information) can provide details of local support groups. Deciding to have a CABGFor most people, the benefits of having a CABG are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. Side-effects are the unwanted but mostly temporary effects of a successful procedure. For a CABG, side-effects include:
Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic. Specific complications of a CABG are rare but can include:
The chance of complications depends on the exact type of procedure you are having and factors such as your general health. Ask your surgeon to explain how these risks apply to you. Further information
Sources
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre. Published by BUPA's health information team, healthinfo@bupa.com, July 2006.
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Cardioace - A nutritional supplement to help maintain a healthy heart
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