Coronary Artery Bypass Graft

Overview

A coronary artery bypass graft — often called a bypass, or CABG (say "cabbage") — is an operation that gives blood a new route to your heart muscle. Your heart gets its own blood supply from coronary arteries. When these arteries become narrowed or blocked by fatty patches called plaques, part of the heart muscle does not get enough blood and oxygen. During a bypass, the surgeon takes a healthy piece of blood vessel from somewhere else in your body — usually the chest, leg or arm — and uses it to build a detour around the blocked section. Blood can then flow past the blockage and reach the heart muscle again.

Yes. Bypass surgery is one of the most common heart operations in the world and is done routinely by specialist heart teams. Thousands of people have it every year.

It is most often done in adults over 60 who have coronary heart disease, and it is more common in men. It can also be needed by younger people, and by people with diabetes, kidney disease or a strong family history of early heart disease. Bypass surgery is very rare in children — children with heart problems usually have a different kind of condition and need other types of surgery.

Symptoms

Common symptoms

• Chest pain or tightness (called angina) — often felt as pressure, heaviness or a squeezing feeling, usually brought on by activity, cold weather, a big meal or emotional stress
• Shortness of breath during everyday activities, or when lying flat
• Unusual tiredness or lack of energy
• Feeling dizzy or light-headed
• Discomfort spreading to the arm, jaw, neck, back or stomach
• In some people — especially those with diabetes — little or no chest pain, just breathlessness, tiredness or indigestion-like discomfort

Symptoms in children

• Bypass surgery is very rarely needed in children, so the symptoms below are about heart problems in general rather than about bypass surgery itself.
• Chest pain, bluish lips or skin, feeding poorly, sweating during feeds, or tiring quickly when playing
• Fainting or unusual breathlessness with activity
• If you are worried about a child's heart symptoms, speak to their doctor promptly

Symptoms in older adults

• Chest pain may be less obvious or absent; breathlessness, weakness and tiredness may be the main signs
• Confusion or feeling generally unwell can sometimes be the first clue
• Discomfort that feels like indigestion or a dull ache rather than classic chest pain
• Symptoms may come on with much lighter activity than before, or even at rest

Causes

Main causes

• Almost always coronary heart disease — fatty plaques (atherosclerosis) build up slowly inside the coronary arteries over many years
• The plaques narrow the artery, so less blood and oxygen reach the heart muscle, especially when the heart works harder
• Sometimes a plaque tears and a clot forms on it, which can block the artery suddenly and cause a heart attack

Risk factors

• Smoking or using tobacco
• High blood pressure
• High cholesterol levels in the blood
• Type 2 diabetes, or prediabetes
• Being overweight, especially around the waist
• Not being physically active
• A diet high in saturated fat, salt and added sugar
• A family history of early heart disease
• Getting older (risk rises with age)
• Long-term stress, heavy alcohol use and poor sleep
• Some medical conditions, such as kidney disease or inflammatory conditions

When to see a doctor

See a doctor urgently if:

• Chest pain that is new, changing, or coming on more easily than usual
• Chest pain at rest, or pain that wakes you at night
• Breathlessness that is getting worse, or that stops you doing normal tasks
• Palpitations that feel fast or irregular, or a fainting spell
• Swelling in your legs or ankles that is new
• After surgery: fever, wound redness or discharge, or worsening pain

Book a routine appointment if:

• You have a strong family history of heart disease or an early heart attack in a close relative
• You have high blood pressure, high cholesterol or diabetes and want to check your heart risk
• You have chest discomfort only on heavy exertion and want to get it looked at
• You are due a review after heart surgery, or have questions about your recovery or medicines

Diagnosis

A bypass is not diagnosed in one step; it is planned after tests show that your coronary arteries are narrowed and that surgery is likely to help you most. Your GP usually starts by asking about your symptoms and history, examining you, and arranging blood tests and a heart tracing. If those suggest a problem, you will be referred to a heart specialist (a cardiologist) for more detailed pictures of your arteries. The surgical team then reviews your results, your general health and your wishes with you before recommending an operation.

Tests that may be done

• Blood tests — including cholesterol, blood sugar and markers that show if the heart muscle is under strain
• An electrocardiogram (ECG) — sticky patches on your chest record the heart's electrical signals
• An echocardiogram — an ultrasound scan that shows how well the heart is pumping and how the valves are working
• An exercise stress test — walking on a treadmill while your heart is monitored
• A coronary angiogram — a thin tube is passed to the heart and dye is used to take X-ray pictures of the coronary arteries; this shows exactly where and how badly they are narrowed
• A CT coronary angiogram — a detailed scan that can show the arteries without a tube being passed into the heart
• A chest X-ray, and sometimes a heart MRI scan or lung function tests, to help plan the operation safely

What to expect at your appointment

You may have several appointments over a few weeks, and some tests are done as a day case. A coronary angiogram involves a small tube being placed in a blood vessel in the wrist or groin, usually with numbing medicine so it is not painful, and you can often go home the same day. Once tests are complete, your heart team will meet to discuss your case and then talk you through the options — medicines, a stent procedure, or bypass surgery — including the benefits and risks of each. You will have time to ask questions and should feel able to bring someone with you.

Treatment

Treatment for narrowed coronary arteries aims to relieve symptoms, protect the heart muscle and lower the chance of a heart attack. For many people, a combination of lifestyle changes and medicines is enough. When the arteries are severely narrowed, or several are affected, a procedure to restore blood flow may be recommended — either a stent (a tiny mesh tube that holds an artery open) or a bypass operation. The right choice depends on which arteries are blocked, how well your heart is pumping and your general health.

Self-care at home

• Stop smoking — this is the single biggest thing you can do for your heart, and your doctor can offer practical support
• Take your medicines exactly as prescribed, and ask your pharmacist or doctor if anything is unclear
• Attend a cardiac rehabilitation programme — these supervised groups help you recover safely and meet others in the same position
• Build activity gradually; short, gentle walks several times a day are a good start
• Keep your wound clean and dry, and follow the advice you are given about bathing and lifting
• Eat a heart-friendly diet and keep an eye on your weight
• Limit alcohol and find healthy ways to manage stress
• Go to your follow-up appointments, even if you feel well

Medical treatments

Medicines are a central part of heart care before and after surgery. Different types are used to lower blood pressure, lower cholesterol, reduce the workload on the heart, prevent unwanted blood clots, and ease chest pain. Your doctor will tailor a combination to you, taking into account your other conditions and any side effects. Never start, stop or change a medicine on your own — speak to your doctor or pharmacist first, especially if you notice side effects. Procedures such as angioplasty with a stent may be an alternative to surgery for some people, and your heart team will explain which option suits you best.

When is surgery considered?

Bypass surgery may be recommended when the main artery on the left side of the heart is narrowed, when several coronary arteries are blocked, when chest pain is not controlled by medicines, when a stent procedure is unlikely to work well, or when the heart muscle is still healthy enough to benefit. It is usually a planned operation, booked in advance, though occasionally it is done more urgently after a heart attack or when symptoms become unstable.

Living with this condition

The first few weeks at home are mostly about resting, gentle movement and letting your body heal. You may feel tired easily and your chest and wound sites may ache; this usually settles. Many people find their appetite and sleep take a little while to return to normal. You will gradually be able to do more, and most people return to driving, work and everyday activities within a few weeks to a few months, depending on their recovery and the type of work they do. Your team will give you clear guidance about lifting, driving and returning to work.

Lifestyle tips

• Stay smoke-free — ask for help if you need it, as it greatly improves your long-term outlook
• Keep active in a way you enjoy, building up slowly and safely
• Take your medicines every day as prescribed
• Have your blood pressure, cholesterol and blood sugar checked regularly
• Keep alcohol within recommended limits
• Protect your sleep and make time to relax
• Keep your follow-up appointments and tell your team about any new symptoms

Diet and exercise

A heart-friendly way of eating means plenty of vegetables, fruit, beans, lentils, whole grains, nuts and oily fish, with less processed food, salt, saturated fat and added sugar. You do not need a strict or expensive diet — small, steady swaps work well. For activity, start with short walks and build up gradually; cardiac rehabilitation gives you a safe, supervised plan. Aim for regular moderate activity such as brisk walking, swimming or cycling once you have recovered, and include some gentle strength work. If you get chest pain, unusual breathlessness or dizziness during activity, stop and seek advice.

Mental health and emotional wellbeing

It is very common to feel low, worried or tearful in the weeks after heart surgery. Some people feel frightened about their heart, frustrated at needing help, or unsettled by changes to their routine and identity. These feelings usually ease as recovery progresses, but they deserve attention rather than being pushed aside. Talk to your GP or cardiac team — they can offer support, talking therapies or further assessment. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service straight away; you deserve help right away.

Prevention

The coronary heart disease that leads to bypass surgery is largely preventable, and the same healthy habits matter just as much after surgery. Bypass grafts can also narrow over time, so protecting them with a smoke-free life, heart-friendly food, regular movement and any medicines your doctor advises makes a real difference to how long the benefit lasts.

Vaccines

Ask your doctor or pharmacist about routine vaccinations. Infections such as flu and pneumonia can put extra strain on the heart, and people with heart conditions are often advised to have them. Your local health service can tell you what is recommended where you live.

Screening programmes

Regular checks of blood pressure, cholesterol and blood sugar can pick up heart risk early, before symptoms appear. Many countries offer a general health check for adults at certain ages — in the UK, for example, this is the NHS Health Check. If you have a strong family history of early heart disease, ask your GP whether extra checks are appropriate for you.

Complications

If left untreated

• Worsening chest pain that limits everyday life
• A heart attack, which can damage the heart muscle permanently
• Heart failure, where the heart becomes too weak to pump efficiently
• Dangerous heart rhythms
• In serious cases, sudden cardiac death

Long-term outlook

The outlook after bypass surgery is generally good. Most people feel noticeably better — with less chest pain and more energy — and many return to work and the activities they enjoy. Grafts can last many years, especially when you protect them with a healthy lifestyle and the medicines your doctor recommends. Recovery takes time and everyone's pace is different, so try not to compare yourself with others. Keep your appointments, ask questions when you need to, and remember that your heart team is there for the long term.

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