16897 Coronary Artery Bypass Surgery

Overview

Coronary artery bypass surgery, often called CABG (said like 'cabbage'), is an operation that creates a new path for blood to flow around blocked or narrowed arteries in the heart. The coronary arteries are the blood vessels that supply the heart muscle. During CABG, a surgeon uses a healthy blood vessel from another part of the body — often the chest, leg or arm — to make a bypass around the blocked area. This helps the heart muscle get more oxygen-rich blood. CABG does not cure coronary artery disease, but it can relieve symptoms and lower the risk of heart damage.

Yes. CABG is one of the most common major heart operations around the world.

It most often affects adults with coronary artery disease, especially people over 60 and those with diabetes, high blood pressure, high cholesterol, kidney disease or a smoking history. It can also be needed in younger adults with severe disease or a strong family history of early heart disease.

Symptoms

Common symptoms

• Chest pain or pressure, often brought on by activity or stress and eased by rest
• Shortness of breath with activity
• Feeling very tired or low on energy
• Dizziness or light-headedness
• Pain in the arm, jaw, neck, back or stomach without a clear cause
• Some people have no symptoms until the blockage is severe

Symptoms in children

• CABG is very rarely done in children.
• Children with heart artery problems usually need specialist paediatric heart care and different types of surgery.
• If a child has chest pain, fainting or severe breathlessness, get emergency help.

Symptoms in older adults

• Symptoms may be less obvious, such as tiredness, confusion or breathlessness rather than chest pain.
• Recovery can take longer and may need extra help at home.
• The heart team looks at overall health, other conditions and personal goals before recommending surgery.

Causes

Main causes

• Coronary artery disease: fatty plaque builds up inside the heart arteries and narrows them
• Blood clots can form on plaque and suddenly block blood flow
• Less common causes include heart artery spasm, congenital problems or damage after radiation

Risk factors

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Older age
• Family history of early heart disease
• Overweight, especially around the waist
• Lack of physical activity
• Unhealthy diet high in salt, sugar and saturated fat
• Stress and poor sleep can add to risk
• Kidney disease and inflammatory conditions

When to see a doctor

See a doctor urgently if:

• After surgery, fever, wound redness or drainage, worsening breathlessness, fast heartbeat, fainting, or rapid weight gain
• Chest pain that is new, severe or different from your usual recovery pain
• Leg swelling or pain that is getting worse after a vein was taken

Book a routine appointment if:

• Before surgery, if you have chest pain or breathlessness that is new or changing
• After surgery, for follow-up visits, medicine reviews, cardiac rehabilitation and wound checks
• If you feel low, anxious or struggle to cope after surgery

Diagnosis

Doctors diagnose the blocked heart arteries that may need CABG by asking about your symptoms, checking your health history and doing heart tests. A heart team then decides whether surgery, medicines or another procedure is best for you.

Tests that may be done

• Blood tests
• Electrocardiogram (ECG), a painless test that records the heart's electrical activity
• Echocardiogram, an ultrasound scan of the heart
• Stress test, which checks how the heart works during exercise or with medicine
• Coronary angiogram, a test that uses dye and X-rays to show blockages in the heart arteries
• CT scan or MRI scan in some cases
• Chest X-ray

What to expect at your appointment

Before surgery, you will have a pre-operative check to make sure you are ready for the operation. You may be asked to fast for a time before surgery and to arrange help at home for your recovery. The heart team will explain the risks, benefits and what the operation involves, and you can ask questions.

Treatment

CABG is a major operation that creates a new path for blood around blocked heart arteries. It can relieve chest pain and lower the risk of heart damage, but it does not cure coronary artery disease. Recovery takes time and works best with healthy habits and ongoing medical care.

Self-care at home

• Take all medicines exactly as your care team tells you; do not stop or change them on your own
• Keep the chest and leg wounds clean and dry; follow instructions about showering and dressing
• Do breathing exercises and gentle walking as advised to help your lungs and circulation
• Avoid heavy lifting, pushing or pulling for the time your team recommends while the breastbone heals
• Go to follow-up appointments and cardiac rehabilitation
• Do not smoke, and avoid being around second-hand smoke
• Call your care team if you notice new or worsening symptoms

Medical treatments

Medicines are often used before and after surgery to control blood pressure, cholesterol, blood sugar and blood clotting, and to manage pain. Your care team will choose what is safe for you and adjust it over time. Cardiac rehabilitation — a supervised program of exercise, education and support — is an important part of recovery. No single medicine replaces surgery or healthy habits.

When is surgery considered?

CABG may be recommended when one or more heart arteries are severely narrowed, when symptoms are not controlled by medicines and lifestyle changes, when the heart muscle is at risk, or when another procedure is not suitable. In some emergencies, such as certain heart attacks, surgery may be needed urgently. The decision is made with a heart team and based on your overall health and preferences.

Living with this condition

The first days and weeks are for rest and gentle recovery. You may feel tired and sore, and your chest may ache as the breastbone heals. Most people need several weeks before returning to light daily activities and longer before heavy work or driving. Follow your team's timeline.

Lifestyle tips

• Stop smoking and avoid second-hand smoke
• Eat a heart-healthy diet with plenty of vegetables, fruit, whole grains, beans, nuts and fish; limit salt, sugar, processed meats and saturated fat
• Be active in a gradual, planned way; walking is often a good start
• Keep to a healthy weight and manage blood pressure, cholesterol and blood sugar
• Limit alcohol and avoid recreational drugs
• Get enough sleep and find healthy ways to manage stress
• Take medicines as prescribed and keep appointments

Diet and exercise

A heart-healthy eating pattern and regular movement help your bypass last and protect your heart. Start with short walks and build up as your team advises. Cardiac rehabilitation can give you a safe exercise plan. Ask before starting vigorous activity, lifting weights or returning to sport.

Mental health and emotional wellbeing

It is common to feel worried, sad, irritable or overwhelmed before and after heart surgery. Some people have trouble sleeping or feel low for a while. These feelings can improve with support. Talk to your care team, a counsellor or a support group. If you ever feel you may harm yourself or are in crisis, contact your local emergency number or a crisis service right away.

Prevention

You cannot change some risk factors, such as age or family history, but you can lower your risk of coronary artery disease and help protect your bypass. Healthy habits and recommended medical care matter before and after surgery.

Vaccines

Ask your healthcare provider which vaccines are right for you, such as flu, pneumonia or COVID-19 vaccines. Preventing infections is especially important for people with heart disease.

Screening programmes

Regular checks of blood pressure, cholesterol and blood sugar can find problems early. If you have chest pain, breathlessness or a strong family history of heart disease, ask your clinician about heart risk assessment.

Complications

If left untreated

• If coronary artery disease is not treated, plaques can grow and reduce blood flow to the heart
• A plaque can rupture and cause a heart attack
• Long-term poor blood flow can weaken the heart muscle and lead to heart failure
• Dangerous heart rhythms and sudden cardiac arrest can occur
• After CABG, grafts can narrow over time, so follow-up and healthy habits are important

Long-term outlook

Many people have less chest pain, better breathing and a better quality of life after CABG. Recovery takes weeks to months, and some people need extra support along the way. The operation can help you live longer, but it works best alongside medicines, cardiac rehabilitation and healthy habits. Your heart team can talk with you about what to expect in your situation.

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