Understanding coronary bypass surgery: a guide for patients

Coronary bypass surgery, also known as coronary artery bypass grafting (CABG), is a common and effective treatment for severe coronary heart disease. It is performed to improve blood flow to the heart when the arteries supplying it become narrowed or blocked. This article by consultant cardiac surgeon Mr Espeed Khoshbin offers a clear overview of the coronary bypass surgery, who it is suitable for, and what to expect before and after surgery.

What is coronary bypass surgery?

Coronary bypass surgery involves rerouting blood flow around blocked or narrowed coronary arteries using blood vessels taken from other parts of the body – typically sourced from the leg (saphenous vein), chest (internal mammary artery), or arm (radial artery). These grafts are connected to the coronary arteries beyond the site of the blockage, allowing blood to reach the heart muscle more effectively.

The operation does not remove the blockages, but it creates new pathways for blood to flow, relieving symptoms and reducing the risk of a heart attack in many patients.

What does coronary bypass surgery treat?

This type of surgery is used to treat coronary heart disease, a condition where the coronary arteries become narrowed due to the build-up of fatty deposits known as plaque. When this narrowing becomes severe, it can reduce oxygen supply to the heart muscle, especially during exertion.

Patients with CAD may experience chest pain (angina), shortness of breath, fatigue, or in more serious cases, have already suffered a heart attack. When lifestyle changes, medication, and less invasive procedures such as stents are no longer effective or suitable, coronary bypass surgery is often recommended.

Who is suitable for coronary bypass surgery?

Suitability for coronary bypass surgery depends on several factors, including the severity and location of the artery blockages, the patient’s overall health, and the function of the heart. It is most commonly recommended for patients with:

• Multiple blocked coronary arteries
• Blockages in the left main coronary artery
• Diabetes, in whom bypass surgery may provide better long-term outcomes than stents
• Insufficient response to other treatments or ongoing symptoms despite medication

The decision is typically made after thorough investigation using tests such as an angiogram, and discussions with a multidisciplinary team including cardiologists and cardiac surgeons.

What happens during coronary bypass surgery?

Coronary bypass surgery is usually performed under general anaesthetic and can take several hours. There are different surgical approaches:

• Traditional open-heart surgery involves temporarily stopping the heart and using a heart-lung machine to maintain circulation while the grafts are attached.
• Off-pump (beating heart) surgery is done without stopping the heart, using specialised equipment to stabilise the area being operated on. This approach may be preferred in some patients, particularly those at higher risk from the heart-lung machine.
• Minimally invasive or robotic-assisted techniques are available in selected centres and suitable for certain patients, involving smaller incisions and potentially shorter recovery times.

Your surgeon will discuss the most appropriate technique for you based on your condition and overall health.

Recovery after surgery

Most patients spend between five to 10 days in hospital after coronary bypass surgery, with the first day or two in a high-dependency or intensive care unit. Full recovery can take up to 12 weeks, depending on individual progress and any complications, with four to eight weeks of post-surgery reviews.

Post-operative care includes pain management, wound care, and a carefully structured cardiac rehabilitation programme, which combines physical activity with education and emotional support. Patients are strongly advised to:

• Stop smoking
• Follow a healthy diet
• Stay active and exercise
• Take medications as per strict prescription, including those to control diabetes, reduce cholesterol and blood pressure
• Attend all follow-up appointments

By making these long-term lifestyle changes and adhering to medical advice, many patients following CABG enjoy a significant improvement in quality of life, reduction in symptoms and a significant improvement in their life expectancy (prognosis).