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Having a CABG

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

A coronary artery bypass graft (or CABG) is “open heart” surgery to improve blood flow to the heart. It can relieve symptoms such as angina, improve your ability to exercise, and reduce the chance of a heart attack.

The arteries that supply blood to the heart (the coronary arteries) can become narrowed or blocked, restricting the supply of oxygen and nutrients. During bypass surgery, a new blood vessel is attached from your main artery (the aorta) to the heart and blood is re-routed through this, bypassing the old vessel. The new blood vessel is called a graft and is created from lengths of vein taken from your leg (usually the saphenous vein) or arm, or by diverting the internal mammary artery from the chest wall. Most people have several grafts done during one operation. The body will usually function perfectly well without the blood vessels used for the grafts.

The operation requires a hospital stay of 5 to 7 days. It is performed under general anaesthetic, which means you will be asleep during the procedure.

Bypass surgery does not cure coronary artery disease, so it is possible for narrowing and blockages to recur in both the grafts and other vessels.

Before you come into hospital, you may be asked to attend a pre-admission clinic for routine tests. You may also be invited to visit the ITU (intensive treatment unit) and meet the nursing staff so that you are familiar with the environment you will be in after your surgery. You will also be asked to:

  • Have a bath or shower at home on the day of your admission,
  • Remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with sticky tape,
  • Follow the fasting instructions in your admission confirmation letter. 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.

 

When you arrive at the hospital, your nurse will explain how you will be cared for during your stay. Usually, your specialist will arrange for you to have blood and urine tests, a chest X-ray, and an ECG. If you had the tests at a pre-admission clinic, you may not need them again. Your specialist and anaesthetist will also visit you. This is a good time to ask any unanswered questions about your treatment.

You may also have a visit from a physiotherapist, who will discuss your rehabilitation programme.

Your nurse will help you prepare for surgery. You will have a bath or shower using antibacterial wash. Men may be asked to shave their chest and an area of their leg (if a vein from here is being taken). You may be asked to put on compression stockings to help prevent blood clots forming in the veins of your legs.

Consent

You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

About the operation

If leg or arm veins are being used for grafts, these will be removed (‘harvested’) and prepared first. Typically, your specialist will then make a cut, about 25cm (10) long,
down the middle of your breastbone (sternum) and open your rib cage to reach the heart.

The heart is temporarily stopped (using medication) and blood is rerouted to a heart-lung (bypass) machine. This takes over the pumping action of the heart and lungs, adding oxygen to the blood and maintaining the circulation.

With the heart not moving, the grafts are attached. Blood is then redirected from the machine back to your heart, and the heart is restarted with small electrical shocks. The sternum is rejoined using wires and the skin on your chest is sealed using dissolvable stitches. After the operation, you will have a scar down the length of your sternum and on your leg (or arm) where the vein was harvested.

Tubes are put into small holes in your chest to drain blood and fluid that collects as part of the normal healing process.

The operation lasts about three hours. Occasionally, it is performed while the heart is still beating. Your specialist will discuss the exact technique with you.

After surgery

You will be taken from the operating theatre to the ITU where you will be closely monitored for around 24 hours. When you wake up from the anaesthetic, you will be connected to machines that record the activity of your heart, lungs and other body systems.

You may have a tube in your mouth, which passes into your windpipe, and is connected to a
machine to help you breathe (a ventilator). This will be removed once you are alert and can breathe by yourself. A clip on your finger will measure the oxygen level in your blood and there may be various other lines and tubes for draining fluid and monitoring the circulation
of blood.

Once you are stable and the medical team is satisfied with your progress, you will be be able to return to your room.

In some cases, where you no longer need intensive care but still need close monitoring, you may move to an HDU (high dependency unit), where each nurse is dedicated to caring for a small number of patients.

For most people, the benefits of having a CABG are much greater than the disadvantages. However, all surgery carries some element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side effects

These are the unwanted but mostly temporary effects of a successful treatment. After the operation, you will feel tired and weak for several days.

Some people experience "postbypass syndrome" which refers to the effects of the heart-lung machine.

Symptoms include poor memory and concentration, restlessness and mental confusion. These symptoms usually wear off after a few days.

If a vein has been removed from your leg, this area may be sore and swollen. Feeling sick is common, but can be easily treated. It's also common to get constipation, so you will be encouraged to eat plenty of fruit and vegetables to help avoid this.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any major surgery are excessive bleeding, infection, an unexpected reaction to the anaesthetic and blood clots, usually in a vein in the leg (deep vein thrombosis, or DVT). Specific possible complications of a CABG include:

  • Heart attack and stroke,
  • An abnormal heart beat (arrhythmia) - a fluttery sensation in the chest. Medication or an electrical shock can help treat this,
  • Low cardiac output – the heart pumps insufficient blood to meet the bodys needs. Medication or further surgery may be needed,
  • Pericarditis – fluid can build up in the sac surrounding the heart, causing chest pain and fever. This is called pericarditis and may require antibiotics to prevent infection,
  • Wound infection – the chest wound can be slow to heal, become infected or fail to seal properly,

Complications may require further treatment, such as returning to theatre to stop the bleeding, or antibiotics to deal with an infection.

Very rarely, complications may mean the chest needs to be reopened, either on the ward or back in theatre.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your specialist to explain how these risks apply to you.

On average, about 1% of people having a CABG will not survive surgery or will die shortly afterwards. However, its important to consider that having no treatment, or having an alternative treatment, may be a higher risk.

1. What can I do to prevent my arteries narrowing?

To help prevent your arteries narrowing you can take medicines and make lifestyle changes. That way you may not need surgery to treat coronary heart disease.

If you have coronary heart disease, it's not possible to reverse the damage that has already taken place. If you have angina (the feeling of chest pain, chest tightness and breathlessness), you may be able to manage your symptoms with medicines. Medicines for angina include:

  • aspirin
  • ivabradine (eg procoralan)
  • beta-blockers (eg atenolol, bisoprolol)
  • long-acting nitrates (eg isosorbide mononitrate)
  • calcium-channel blockers (eg nifedipine)
  • potassium-channel activators (eg nicorandil)
  • statins (eg simvastatin)

These medicines aren't suitable for everyone. Your doctor will advise you which is best for you.

Life-style changes can help to prevent your condition from getting worse. These include:

  • giving up smoking
  • getting medical treatment to reduce your blood pressure and cholesterol levels, if high
  • maintaining a healthy weight and eating a balanced diet
  • staying active

Your doctor can advise you on how you can make changes to keep your heart healthy.

2. My doctor says that I may be able to have 'off-pump' CABG. What is this?

'Off-pump' CABG (OPCAB) or 'beating heart surgery' is an alternative technique to conventional CABG that doesn't require you to be connected to a heart-lung (bypass) machine.

In a conventional CABG operation your heart is stopped using medicines containing potassium. Your heart and lungs are then connected to a bypass machine that takes over to add oxygen to your blood and maintain your circulation.

OPCAB is an alternative technique where the heart continues to beat as the surgeon performs the bypass grafts. OPCAB is thought to be just as effective as a traditional CABG operation but may have a slightly lower risk of complications. However, research is ongoing to determine the safety of OPCAB and whether it is as effective as the traditional technique.

3. Since my CABG I have been feeling depressed. Is this normal?

Yes. Feeling depressed, unhappy or anxious is often a natural reaction to having major surgery.

After your surgery you may find that you feel depressed or unhappy. This is quite common and you may even find that you experience a range of emotions, from being happy that the operation is over to being sad that it will take time to recover.

It's a good idea to have someone stay with you for the first week or two to keep you company and to take care of you. If you live alone, it should be possible to arrange extra care visits.

When you get out of the hospital you should notify your GP so that he or she can provide you with any care that you may need.

Further information

Sources

  • CABG information. The Society of Thoracic Surgeons. www.sts.org, accessed 21 June 2010
  • Angina. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 21 June 2010
  • Having heart surgery. British Heart Foundation. www.bhf.org.uk, published July 2010
  • Coronary bypass surgery. British Heart Foundation. www.bhf.org.uk, accessed 21 June 2010
  • Endoscopic saphenous vein harvest for coronary artery bypass grafting. National Institute for Health and Clinical Excellence (NICE), 2010. Interventional procedure guidance 343. www.nice.org.uk
  • Interventional procedures overview of totally endoscopic robotically assisted coronary artery bypass surgery. National Institute for Health and Clinical Excellence (NICE), 2005. www.nice.org.uk
  • At a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency (DVLA), February 2010. www.dft.gov.uk
  • CABG (conventional, MIDCAB or OPCAB) versus PTCA (with or without stenting). BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 21 June 2010
  • Biancari F, Tiozzo V. Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery. Cochrane Database of Systematic Reviews 2010, Issue 5. doi:10.1002/14651858.CD008057.pub2
  • Lipid modification - primary and secondary CVD prevention. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 21 June 2010
  • Debate continues over use of off-pump CABG - eyes on evidence commentary. NHS Evidence. www.evidence.nhs.uk, published February 2010
  • Off-pump coronary artery bypass (OPCAB). National Institute for Health and Clinical Excellence (NICE), 2004. Interventional Procedure Guidance 35. www.nice.org.uk
  • Shroyer Al, Grover Fl, Hattler B, et al. On-pump versus off-pump coronary-artery bypass surgery. New Engl J Med 2009; 361(19):1827 

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