Coronary Artery Bypass

Coronary artery bypass surgery creates a new path for blood to flow around blocked or narrowed arteries in the heart, helping to restore oxygen-rich blood supply to the heart muscle and reduce the risk of heart attack.

Table of contents

• What Is Coronary Artery Bypass Surgery?
• Why You Might Need This Surgery
• How the Surgery Is Performed
• Preparing for Surgery
• Recovery After Surgery
• Possible Risks and Complications
• Living a Heart-Healthy Life After Surgery

Coronary artery bypass grafting, CABG, Coronary artery bypass graft surgery, Heart bypass surgery

• Heart
• Coronary arteries
• Chest
• Legs
• Arms

What Is Coronary Artery Bypass Surgery?

Coronary artery bypass surgery creates a new path for blood to go around a blocked or partially blocked artery in the heart. The surgery involves taking a healthy blood vessel from another part of your body, such as the chest, leg, or arm. This vessel is then connected to blood vessels above and below the blocked area in your heart artery^[1][2].

The new blood vessel creates a bypass, which works like a detour for your blood to get around an obstacle. This allows blood to flow more freely to the heart muscle, restoring oxygen-rich blood supply to areas that need it^[2][3].

The blood vessels used for the bypass are usually arteries from the chest, called the internal mammary artery, or veins from the legs, called the saphenous vein. Sometimes arteries from the arm, called radial arteries, are also used^[1][7].

If you have more than one blocked artery, you may need multiple bypasses. These are called double (2), triple (3), or quadruple (4) bypasses^[3].

Coronary artery bypass surgery is the most common heart surgery in the world. Almost 400,000 of these surgeries are performed each year^[7][3].

Why You Might Need This Surgery

Your doctor might recommend coronary artery bypass surgery if you have coronary artery disease. This condition happens when a sticky material called plaque builds up in your coronary arteries. Plaque is made of fat, cholesterol, and other waxy substances. Over time, this buildup can narrow or block your arteries, a process called atherosclerosis, or hardening of the arteries^[3][4].

When arteries narrow or become blocked, some parts of your heart don’t get enough blood. This can cause symptoms like chest pain (called angina), shortness of breath, fatigue, or heart palpitations. It can even lead to a heart attack^[1][4].

Before recommending surgery, your healthcare provider may try other treatments first. These could include lifestyle changes, medicines, or angioplasty, a procedure to open your arteries. If these treatments don’t help, you may need coronary artery bypass surgery^[4].

Your healthcare professional might recommend surgery if you have^[1][4]:

• A blockage in the left main heart artery, which sends a lot of blood to the heart muscle
• Diabetes with multiple blocked coronary arteries
• Serious heart failure
• Coronary heart disease with angina (chest pain)
• Multiple blocked coronary arteries

You might also need emergency coronary artery bypass surgery to treat a severe heart attack if other immediate treatments aren’t working^[1][4].

The surgery can help lower your risk of a heart attack, reduce symptoms, improve heart function, and may reduce the risk of death due to heart disease^[1][2].

How the Surgery Is Performed

During coronary artery bypass surgery, you will be given medicine called anesthesia to put you into a deep sleep^[3].

The surgeon will make a cut in the center of your chest and split your breastbone (called the sternum) down the middle. They will spread and lift your rib cage to reach your heart^[3].

There are two main types of coronary artery bypass surgery^[7]:

On-pump surgery: In this traditional approach, your heart is stopped, and a heart-lung bypass machine takes over the job of pumping blood throughout your body. This is still the most common type of bypass surgery^[2][7].

Off-pump surgery: In this approach, the heart does not need to be stopped. The surgeon operates on the beating heart, slowing only the area closest to the blocked vessel. Off-pump surgery may be a better option for older or sicker patients^[2][4].

The surgeon creates a bypass using a healthy blood vessel from elsewhere in your body. One end of the blood vessel is attached above the blockage and the other end below the blockage. This allows blood to bypass the blocked area and reach the heart muscle^[3].

After creating the bypass, the surgeon will restart your heart if it was stopped, lower your rib cage back into place, and wire it together so it can heal. The cut in your chest is then closed with stitches^[3].

Some medical centers also offer less invasive methods, including robotic procedures or minimally invasive surgery with small cuts in the chest^[3][4].

Preparing for Surgery

Coronary artery bypass surgery is major surgery. Before the operation, you’ll need to have several tests to help your healthcare provider see if it’s safe for you to have this surgery^[3].

Tests may include^[3]:

• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Exercise stress test
• Cardiac catheterization
• X-ray or CT scan
• Blood and urine tests

Your healthcare provider will discuss what medications you’re taking before the surgery. They’ll tell you which ones to keep taking and which ones you should stop. You’ll need to fast, which means stop eating and drinking, several hours before surgery^[3].

There are several steps you can take to prepare for surgery^[22]:

Ask questions and take notes. Schedule an appointment before surgery to discuss all your questions. Bring a notebook or have a caregiver with you to help track instructions about medications and your surgical plan.

Stop smoking. If you smoke, quitting is one of the most important things you can do to support your heart health and recovery. Smoking increases your risk for complications after surgery.

Check your dental health. Your provider may recommend a dental exam before surgery. Infections from oral bacteria can travel through the bloodstream and increase your risk for heart complications.

Adopt heart-healthy habits. If your doctor approves, start eating a balanced diet and walking daily. Small changes before surgery can make a big difference after.

Get support at home. You’ll need someone to help you after surgery. If friends or family aren’t available, discuss arranging home health services with your care team. Prepare meals, pay bills in advance, and tidy your space to ease recovery.

Recovery After Surgery

Most people spend about a week in the hospital after coronary artery bypass surgery. You’ll usually be moved from intensive care to a regular ward after 1 or 2 days^[19].

You’ll have some pain or discomfort after surgery. You’ll be given pain relief to help with this. Nurses and physical therapists will help you start getting out of bed and moving around from the day after the operation^[19].

After you go home, you will feel tired and sore for the first few weeks. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The cut in your chest and the area where the healthy blood vessel was taken may be sore or swollen. These symptoms usually get better after 4 to 6 weeks^[15].

Healing of your breastbone usually takes about 4 to 6 weeks. It usually takes 1 to 2 months to get your energy back, and it may take 2 to 3 months to fully recover^[15][19].

You will probably be able to do many of your usual activities after 4 to 6 weeks. However, for at least 6 weeks, you’ll need to avoid lifting heavy objects and doing activities that strain your chest or upper arm muscles^[15].

Some people find that they are more emotional after this surgery. You may cry easily or show emotion in ways that are unusual for you. This is common and may last for up to a year. Some people get depressed after surgery. Talk with your doctor if you have sadness that continues or if you are concerned about how you are feeling^[15].

Your care team will give you advice about caring for your wounds while they heal and when you can return to activities like driving and going back to work. You may need to take 4 to 12 weeks off from work depending on the type of work you do^[15][19].

You may start a cardiac rehabilitation program in the hospital. You will continue with this program after you go home to help you recover and prevent problems with your heart. This program will give you an exercise plan and support to help you build up your fitness^[15].

Possible Risks and Complications

Like all surgery, coronary artery bypass has risks even though the results are often excellent^[4].

The risks can include^[4]:

• Bleeding
• Heart attack
• Infection
• Arrhythmia (abnormal heart rhythms)
• Stroke
• Kidney failure

After coronary artery bypass surgery, many people remain symptom-free for years. However, you may need surgery again if blockages form in the grafted arteries or veins, or if blockages happen in arteries that weren’t blocked before^[4].

Blockages can form again because the bypass surgery creates new pathways for blood flow but does not cure the underlying heart disease that caused the blockages in the first place^[1][23].

Living a Heart-Healthy Life After Surgery

Coronary artery bypass surgery doesn’t cure the heart disease that caused the blockage, such as atherosclerosis or coronary artery disease. It’s important to follow a heart-healthy lifestyle to help lower your risk of further heart problems^[1][16].

You should keep taking any prescribed medicines after the operation. This is to reduce your risk of getting heart problems in the future. Lifestyle changes and medicines may help stop your arteries from becoming clogged again^[4][16].

Eat a heart-healthy diet. Many risk factors for heart disease, such as high blood pressure, cholesterol, obesity, and diabetes, are affected by your food choices and eating habits. Choose foods that are low in saturated fat, such as lean meats and low-fat dairy products. Fruits, vegetables, and whole grain products are high in fiber and help to lower cholesterol. You should also limit your salt and sugar intake^[18].

Exercise regularly. When you’ve fully recovered from the effects of surgery, you should exercise regularly. This will reduce your risk of developing further heart problems. Adults should do at least 150 minutes of moderate-intensity activity every week. Moderate-intensity means an activity that’s strenuous enough to leave you slightly breathless, such as fast walking, cycling on level ground, or hiking^[16].

Stop smoking. Smoking can increase your risk of developing heart problems after bypass surgery. Smoking narrows your arteries and raises your blood pressure. If you want to stop smoking, your doctor will be able to refer you to a stop smoking support program and can prescribe medicine to help with withdrawal symptoms^[16].

Lose weight. You can reduce your risk of further heart problems by trying to reach a healthy weight. The best way to lose weight is to make sure you have a healthy diet and exercise regularly^[16].

Moderate your alcohol consumption. If you drink alcohol, do not exceed the recommended weekly guidelines. Going over the recommended alcohol limits can raise your blood pressure and cholesterol levels, which could increase your risk of heart problems^[16].

Patients who successfully undergo a heart bypass and make it through the first month of recovery have a survival rate similar to the general population. With proper care and lifestyle changes, people can live long, healthy lives after coronary artery bypass surgery^[23].