Coronary artery bypass graft (CABG) operation

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

How is heart disease diagnosed?

Your doctor may do the following:

  • Feel your pulse and listen to your heart to see if it's beating at a steady rate
  • Check whether you have high blood pressure
  • Assess your general health
  • Arrange a blood cholesterol test

Tests to diagnose coronary artery disease

Your doctor may also arrange for you to have some tests to help with the diagnosis:

  • Electrocardiogram (ECG) - patches are stuck on to your chest, arms and legs. The patches are attached to a machine that painlessly records the electrical activity of your heart muscle. If the blood supply to your heart is poor, this may show up on the ECG tracing
  • You may have to use treadmill or exercise bike while the ECG is carried out (an exercise ECG or exercise stress test), as physical activity, which speeds up the heart rate, can trigger angina (chest pain). If a disability prevents you from doing any exercise, you can be given an injection that speeds up the heart
  • Coronary angiogram - a catheter (a fine tube) is fed through an artery (usually in your groin) up toward your heart. A dye is injected, and while it is flowing through your coronary arteries, X-ray pictures are taken. These show where your arteries have become narrowed
  • Cardiac perfusion scan - involves having an injection of a radioactive substance and having scans of the heart taken while exercising to show how well the heart muscle is being supplied with blood

The coronary angiography will usually help your cardiologist decide whether a coronary angioplasty or a CABG procedure will be the most effective treatment for your heart.

During the operation

Heart bypass detail CABG surgery is carried out under general anaesthetic, and usually takes from three to six hours (1), depending partly on the number of grafts you need.

Some people have more than one narrowed artery and so need more than one graft. You've probably heard of a triple bypass. This involves three grafts, to bypass three different areas of narrowed arteries.

The surgeon will carry out all the grafts in the same CABG operation, as this is the most efficient approach. This approach should get you feeling well again sooner without the need for another operation.

When you are under the general anaesthetic, the surgeon will make an incision down the centre of your chest, over your breastbone. The surgeon will then use a vein - usually from your leg, or an artery (often the internal mammary artery) - to provide an alternative route for the blood to flow through.

One end of the section of blood vessel is attached to your aorta (the heart's main artery) and the other end is attached to the coronary artery, beyond the narrowed area.

In most cases, your heart is stopped while the CABG operation is carried out, and a heart-lung machine is used to keep your blood circulating. This is known as "on-pump" surgery.

Sometimes the operation is carried out without a heart-lung machine, and with the heart still pumping, which is known as "off-pump" surgery.

A new development in CABG surgery is the use of keyhole surgery, which doesn't stop the heart. Only a few centres in the UK offer this type of minimally invasive surgery at the moment.

After the operation you will be taken to the Cardio Thoracic Critical Care Unit (CTCC) where you will receive intensive cardiothoracic and nursing care. If all goes well, you will be transferred to the Cardiothoracic Ward after about one or two days. Most people stay in hospital for about six to eight days (1).

Infolinks

Reference:

  1. Oxford Radcliffe Hospital NHS Trust | Coronary Artery Bypass Grafting (CABG) (pdf) | Accessed Sep 2009 | Version 3 Feb 2008 | Reviewed Feb 2009

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