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Coronary artery bypass graft (CABG)
Expert reviewer, Mr Mark Yeatman, Cardiothoracic Surgeon
Next review due June 2023
Coronary artery bypass graft surgery is a procedure to improve blood flow to your heart. It’s used to treat coronary heart disease, which can block blood flow due to a build-up of fatty deposits in your arteries.
Coronary artery bypass graft surgery is also known as CABG, which is pronounced ‘cabbage’.
This animation will show how a coronary artery bypass graft (CABG) is used to treat coronary heart disease.
The network of blood vessels that branch over the surface of the heart are called the coronary arteries.
Coronary heart disease occurs when fatty deposits build up and form a plaque, or atheroma, on the artery wall.
This causes the artery to narrow and harden, reducing blood flow to the heart.
A CABG can bypass the blocked arteries so that blood can flow more easily.
A coronary bypass graft (CABG) is carried out under general anaesthetic, which means that you'll be asleep during the procedure and feel no pain.
If blood vessels from your leg or arm are being used for grafts, your surgeon will remove and prepare these first.
A blood vessel such as a superficial vein in the leg, which lies just below the surface of the skin can be removed to use as a graft.
A cut is then made down the middle of the breastbone (sternum) and the ribcage is opened so the surgeon can reach the heart.
The surgeon may attach the new grafts while the heart is still beating, but it's more common for medication to be used to temporarily stop the heart.
The blood is then re-routed to a heart-lung bypass machine. This takes over from the heart and lungs. It adds oxygen to the blood and maintains circulation.
The graft is attached from your aorta (your main artery) to a point in the coronary artery beyond the blockage.
Sometimes a graft is also created from the internal mammary artery, which is diverted from behind the sternum or chest bone.
After the graft is attached, the heart is restarted with controlled electrical shocks and the sternum is rejoined using wires.
The skin on the chest is closed with dissolvable stitches.
This is the end of the animation click on the animation screen to watch it again.
About CABG
Blood vessels called coronary arteries supply your heart with oxygen and nutrients. These arteries can become narrowed or blocked if you have coronary heart disease. This can starve your heart of oxygen, which can cause angina (chest pain, chest tightness and breathlessness) or a heart attack.
CABG can relieve angina symptoms and improve your quality of life, and it may reduce the risk of having a heart attack.
During the procedure, your surgeon will take a blood vessel (graft) from your chest, leg or arm and use this to bypass the narrowed or blocked coronary artery. It’s common to have more than one graft at a time. If you have two, three or four grafts, it’s known as a double, triple or quadruple bypass.
CABG isn’t suitable for everyone – ask your surgeon if it’s a good option for you.
CABG won't cure coronary heart disease, so it's possible that you might get more blockages in the future. It’s important to make some healthy lifestyle changes to help reduce the chance of this happening.
Preparing for CABG
Your surgeon will discuss with you what will happen before, during and after CABG and answer your questions. Once you understand the procedure, you’ll be asked to sign a consent form.
Your hospital may do some tests before the operation, including:
- a chest X-ray to look at the size, shape and condition of your heart and lungs
- an electrocardiogram (ECG) to check your heart’s electrical activity
- an echocardiogram to see how well your heart is working
- a Doppler ultrasound of the arteries in your neck to check if there are any problems with blood flow
CABG is done under general anaesthesia, which means you’ll be asleep during the operation. Your hospital will give you instructions on when to stop eating and drinking. This is usually at least six hours before your procedure – but always follow the advice you’re given. If you smoke, you’ll be asked to make every effort to stop because smoking increases the risk of complications.
You may need to have hair removed from your chest, arms and legs. Don’t shave yourself at home before your procedure because this can increase your risk of infection.
CABG procedure
Open surgery
CABG usually takes between three and six hours but this will depend on the type of operation you have.
Your surgeon will take an artery or vein from your leg, arm or chest to use as a graft. Removing these blood vessels doesn’t affect circulation in the parts they’re taken from, although you may get some short-term weakness. For more information, see our FAQ: Will taking the graft cause any problems? below.
To reach your heart, your surgeon will make a cut down the middle of your breastbone (sternum) and open your chest. They’ll then attach the grafts in the correct places to bypass the narrowed parts of your coronary arteries.
Your surgeon will temporarily stop your heart and divert your blood to a heart–lung (bypass) machine. This machine will pump your blood from outside your body while your surgeon attaches the new grafts. The bypass machine also takes over the job of adding oxygen to your blood while maintaining your circulation.
After attaching the grafts, your surgeon will restart your heart. They’ll then re-join your breastbone using stainless steel wires that will stay inside your body permanently. Your surgeon will close the skin on your chest with staples or stitches.
Off-pump CABG surgery
In off-pump CABG (beating heart CABG), you don’t have to be connected to a heart–lung machine. Your heart continues to beat while your surgeon performs the bypass grafts. A device is used to minimise your heart’s movement and selected arteries are held still while the healthy blood vessel grafts are stitched to them.
Your doctor will talk to you beforehand about whether an off-pump procedure is suitable for you. It may be the best option if you have kidney problems or are at risk of stroke, for example. It’s possible that your surgeon may need to switch from off-pump to using a bypass machine during the operation.
Keyhole surgery
Keyhole CABG can be done without opening your chest. In keyhole surgery to place a coronary artery bypass graft, your surgeon will make one or more small cuts in your chest and pass instruments through the cuts. They may use remote-controlled surgical instruments (this is known as robot-assisted surgery).
Keyhole surgery for CABG isn’t as common as open surgery but it’s becoming more widely used. Research suggests that although the procedure may take longer than open surgery, you may recover quicker, with less pain. It isn’t suitable for everybody – your surgeon will explain if it's appropriate for you.
If you do have keyhole surgery, there's a chance your surgeon may need to convert to open surgery during the procedure.
Aftercare for CABG
Intensive care
You’ll be monitored for six to 24 hours in the intensive care unit (ICU) before you move to a specialist ward for heart patients. Altogether, you’ll probably be in hospital for about a week.
You’ll be offered pain relief to help with any discomfort as the anaesthetic wears off.
While in hospital, you’ll be connected to machines that record the activity of your heart, lungs and other body systems. These might include a ventilator to help you breathe. You may have an intravenous (IV) tube placed into your vein to give you fluids and medicines. You may have a catheter to drain urine from your bladder into a collection bag. You may also have tubes running out from your chest wound to drain fluid into another bag. The drains are usually removed after a day or two.
You may be wearing compression stockings on your legs to help maintain circulation. Nurses will encourage you to get out of bed and move around. This will help prevent chest infections, and blood clots from developing in your legs.
Physiotherapy and rehabilitation
A physiotherapist may visit you while you’re in hospital. They’ll guide you through exercises designed to help your recovery, including breathing and walking on your own without help. You may be given advice on how to sit to encourage normal blood flow.
You may meet a nurse or physiotherapist who specialises in cardiac rehabilitation. For more information on this, see our section on Recovery below.
Going home
When you're ready to go home, ask a friend or relative to drive you and to stay with you for the first week or so. You may find it more comfortable to put a cushion between your chest and the seat belt on your way home.
Your nurse will give you some advice about caring for your healing wounds before you go home. Some discharge from the wounds is normal for a few days. You’ll be shown how to change your dressings or a district (community) nurse may visit you at home to do this.
You may be prescribed painkillers to take for the first couple of weeks. And you’ll be given advice about how to support your chest wound so it hurts less when you cough, sneeze, laugh or move around. You may be given support stockings to wear at home.
You may be given a date for a follow-up appointment – this is usually six to 12 weeks after your operation.
Recovering from CABG
You may make a full recovery after two or three months but this will depend on your personal circumstances. Any discomfort in your chest will usually be gone after six months. You may notice pain that’s worse when you first wake up and when you move your arms, shoulders and legs.
It can take two months or more for your breastbone to join together again if you had open surgery. You might notice an occasional clicking sound while it heals – let your hospital know if this happens.
How long dissolvable stitches in your skin take to disappear depends on what type you have, it’s usually about four to eight weeks. If your stitches aren’t dissolvable, a district nurse or your GP can remove them after eight to 10 days.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Cardiac rehabilitation
Cardiac rehabilitation is a programme of exercise and support to help you regain physical strength and self-confidence and improve your health. It can reduce the risk of complications after your operation, and will prepare you for life after bypass surgery.
The programme may run for at least six weeks and can include group or individual sessions, at home or in a community setting. It may involve regular contact to motivate you to stop smoking, keep active or eat healthily. You’ll get advice on exercising safely and activities to avoid while your breastbone heals.
The programme will encourage you to build up your stamina gradually, especially through regular walks. It will also help you access support if you’re depressed or anxious after your surgery. For more information, see our FAQ: Is it common to feel depressed after CABG? below.
Driving and flying
Follow your surgeon's advice about when it’s safe to drive. Unless you drive for a living, you don’t need to tell the Driver and Vehicle Licensing Agency about your operation but you mustn’t drive for at least a month after CABG. It’s best to contact your motor insurer too so that you’re aware of their recommendations. You shouldn’t drive if you’re taking strong painkillers that make you drowsy.
It’s normally safe to fly around six weeks after your operation. However, let your travel insurance company know and speak to your surgical team before you book a flight.
Returning to work
It could be about two or three months before you can go back to work, but it depends on how strenuous your job is.
Side-effects of CABG
Side-effects are the unwanted but mostly temporary effects you may get after having a procedure. Side-effects of CABG include:
- discomfort and itchy wounds
- swelling and bruising around the area where your graft was taken
- tingling and weakness in your arm if a graft was taken from there
- tiredness, and mood swings – feeling upset and emotional
- loss of appetite
- muscle pain in your shoulders or upper back, and possibly pain in your neck and bottom from sitting or lying in one position
- constipation
- problems sleeping
Complications of CABG
Complications are when problems occur during or after a procedure. Complications of CABG can include:
- memory loss and problems thinking clearly – this is usually only temporary
- irregular heartbeat (arrhythmia)
- heart attack
- stroke
- kidney failure
- infection of your wound
- problems with your sight
- bleeding (you’ll be taken back to the operating theatre to treat this)
Tell your GP if you get sudden or severe pain in your chest or calf, or if a wound gets red, inflamed or discharges pus.
The potential complications of CABG can be serious. But it’s important to remember that you’d also be at risk of some of these, like heart attack, if you didn’t have the procedure. Your doctor can help you weigh up the benefits and risks before you decide whether or not to have the procedure.
Alternatives to CABG
There are several other treatments for angina that your doctor may consider before or instead of coronary artery bypass grafting. These include the following.
- Medicines, such as calcium channel blockers and/or beta-blockers may improve your symptoms.
- A coronary angioplasty (percutaneous coronary intervention) is a procedure to widen your coronary artery from inside using a balloon. A stent (small metal tube) may be put in your artery to help keep it open.
The treatment you’re offered will depend on how severe your symptoms are, the condition of your coronary arteries, and how healthy you are. Your surgeon will discuss which treatment is best for you.
There are also some lifestyle changes you can make yourself to help improve your condition. For more information, see our FAQ: How can I stop my arteries narrowing further? below.
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How can I stop my arteries narrowing further?
Coronary artery bypass grafts can get blocked and narrow again after CABG. You may need a further procedure in future, such as a coronary angioplasty. But there’s a lot you can do to stop this happening. For example, it’s a good idea to get your blood pressure and cholesterol checked regularly.
Lifestyle changes that may help to prevent your condition from getting worse include:
- giving up smoking – this is the single most important thing you can do to help your heart
- maintaining a healthy weight
- eating a balanced diet
- staying active
- keeping your alcohol intake down
Cardiac rehabilitation can support you to make these changes..
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Is it normal to feel depressed after CABG?
Yes. After your surgery, you may well find that your mood swings and you have good days and bad days. Don’t worry; depression and anxiety are normal and happen to many people after heart surgery. The ‘post-op blues’ can make you feel tearful and irritable, and can mean you struggle to concentrate.
Cardiac rehabilitation can help you deal with these feelings. Your wellbeing will be monitored during your rehabilitation programme, and you may be offered individual help such as cognitive behavioural therapy and stress management.
Regular exercise, getting enough rest, and relaxing will all help your recovery. So can resuming hobbies or trying new ones when you’re able to.
It’s important to talk to someone about how you’re feeling. Your GP, practice nurse or the cardiac rehabilitation team will all be able to help.
If you have a job, getting back to work can also help you avoid depression and isolation.
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Will taking the graft cause any problems?
Before your surgeon takes an artery or vein to use as a graft, they’ll check to see if blood will continue to circulate without it. For example, if they’re taking an artery from your arm, they may check if another artery can supply enough blood to your hand.
After the graft is taken, you may get mild pain and ‘pins and needles’ in your arm. It may also feel weak but these effects don’t usually last long and get better on their own over time.
If your surgeon takes a graft from your leg, you may get swelling, pain and problems with your wound and how it heals. It’s also possible that the nerves in your leg may be damaged. This can sometimes cause numbness and pain in your leg that doesn’t go away. The risk of this happening depends on the type of procedure you have to remove the graft. Speak to your surgeon about your options.
If your surgeon takes the graft from your chest, you may be at risk of the cut becoming infected. Ask your surgeon for more information about grafts.
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Related information
Coronary angioplasty
A coronary angioplasty is a procedure to open up narrowed or blocked arteries that can be caused by coronary heart disease.
Coronary heart disease
Angina
Angina is when you have chest pain or an uncomfortable tight feeling in your chest.
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Other helpful websites
- British Heart Foundation
0300 330 3311
www.bhf.org.uk
- British Heart Foundation
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Author information
Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2020
Expert reviewer, Mr Mark Yeatman, Cardiothoracic Surgeon
Next review due June 2023
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