Coronary Artery Bypass Graft (CABG) Surgery Waiting Times Update

Find out about the latest waiting times and length of hospital stay for coronary artery bypass graft (CABG) surgery with Dr Foster Health

Coronary artery bypass graft (CABG) surgery summary

A coronary artery bypass operation (CABG) - commonly known as a heart bypass operation - is a surgical treatment which helps many people overcome the health threats posed by coronary heart disease (CHD).

A CABG operation is designed to restore blood flow to the heart. If you have blocked coronary arteries they will not be able to supply blood and oxygen to your heart. If blood flow is severely cut off or stops, your heart muscle can die and a heart attack may result.

During a CABG procedure the heart will normally be stopped and the circulation and oxygenation of the blood is taken over by a heart-lung machine.

The surgeon bypasses the blocked arteries by taking a blood vessel from another part of your body and grafting these between the main artery to your heart (the aorta) and the unblocked section of the affected vessel/s. This restores blood flow to the heart.

A CABG is often the next step on from a coronary angioplasty procedure, if you are experiencing chest pain due to angina.

The waiting times and length of stay figures in this update refer to CABGs that are elective (planned admissions to hospital) and not emergency CAGBs.

How common is coronary heart disease (CHD)?

Approximately 2.5 million people in the UK live with CHD ⁽¹⁾, which causes over 117,000 deaths a year - or one in five deaths in men and one in six deaths in women ⁽²⁾.

The majority of CHD cases in the UK are caused by smoking, eating too much saturated fat and not exercising enough.

A heart bypass operation is not a cure for CHD. If you don't make lifestyle changes after the operation by stopping smoking or improving your diet, you'll be back at square one again.

Waiting times for heart bypass operation

Government targets have gone some way to reducing waiting times for CABG.

Dr Foster data show that waiting times for CABG have varied across all Strategic Health Authorities (SHA) since 2006/7, but have mostly been falling:

Figure 1 - Average waiting times for CABG surgery by Strategic Health Authority (SHA)

The average waiting time for CABG surgery across all ten SHAs in 2008/9 was 57 days. You will wait the longest for CABG surgery if you live in the East of England SHA region and you will wait the shortest if you live in the North West and East Midlands SHAs (39 days).

Figure 2: Hospital spells & length of stay for CABG surgery

The following graph shows you the average length of stay in hospital after CABG surgery according to age group.

Inpatient spell: a patient's stay in hospital consists of at least one finished consultant episode (period of care under one consultant/team)

The above graph shows that as patients get older they are more likely to stay in hospital for longer after a CABG procedure.

Minimally invasive CABG surgery

A conventional CABG operation is invasive and involves a large incision down the chest, so the surgeon can access the heart more easily. While an "open CABG" can result in excellent health outcomes, recovery can be uncomfortable and take a while.

A relatively new development in CABG surgery is the use of keyhole surgery and robot-assisted surgery, which doesn't involve the large incisions of conventional CABG surgery.

Only a few centres in the UK offer these types of minimally invasive CABG surgery at the moment and they are not suitable for everyone.

Ask your cardiac consultant if minimally invasive CABG surgery would be suitable for you.

Figure 3: Minimally invasive robot surgeon

Benefits of minimally-invasive CABG operations ⁽³⁾:

1. Reduced post-operative pain and scarring
2. Shorter hospital stay and recovery times
3. Less bleeding and reduced need for blood transfusions
4. Lower risk of infection
5. Reduced need for blood-thinning medication

Types of minimally invasive CABG surgery

1) Minimally invasive direct coronary artery bypass (MIDCAB) surgery: In a MIDCAB procedure, the surgeon connects a vein graft to diseased coronary arteries on a beating heart through a small 10 to 12cm access incision in the patient's chest. A disadvantage with the MIDCAB procedure is that the bypassed coronary artery must lie directly beneath the incision, so it is only possible to bypass one or two coronary arteries. If multiple grafts are needed then MIDCAB will not be suitable for you ⁽⁴⁾.

Figure 4: Comparison of incision sizes for MIDCAB versus conventional "open" CABG

2) Totally endoscopic minimally invasive coronary bypass (TECAB) surgery: A TECAB operation is performed through small portholes made through the rib cage. A very small incision is made in the groin for connection of the heart-lung machine, which takes over the blood circulation while the heart is stopped for the bypass graft connection. Surgical trauma and scarring for the patient are reduced because a surgical robot allows the doctor to perform complex surgical procedures inside the chest. The bypass vessels are prepared and attached inside the chest cavity ⁽⁵⁾.

Figure 5: Incision site portals for minimally invasive robotically assisted TECAB operation

3) Single-Vessel Small Thoracotomy (SVST): In a SVST, a surgical robot helps the surgeon harvest a single artery to be used as a bypass graft. Through a small incision between the ribs, the surgeon can perform bypass surgery. In an endoscopic procedure, the surgeon uses a special medical instrument (thoracoscope) to see inside the chest. A stabilisation and exposure device allows the heart to keep beating while the surgery is performed ⁽⁶⁾.

4) Multi-Vessel Small Thoracotomy (MVST): In an MVST, the surgeon uses a robot to harvest a number of different types of arteries to be used as bypass grafts. The surgeon can then perform bypass surgery by using a thoracoscope to view the inside the chest. A stabilisation and exposure device allows the heart to keep beating while the surgery is performed ⁽⁶⁾.