Who needs a CABG?

A heart bypass is usually performed on people who have angina, which causes chest pain that occurs when you exercise or, in more serious cases, when you're resting. Angina is caused when the arteries in your heart become narrowed by fatty deposits (plaques), known as atheroma.

When your arteries narrow, the flow of blood and oxygen to your heart is reduced, which means that it cannot work as efficiently as it should and causes pain in the chest. If an artery becomes completely blocked, it can stop the flow of blood and cause a heart attack.

You may need a CABG if you have narrowed heart arteries, angina, chest pain despite taking medication for angina, have undergone a coronary angioplasty (an operation to clear the blockage in your blood vessels) that has failed, or you have a narrowed artery which is unsuitable for treatment with coronary angioplasty.

Approximately 80 per cent of the people who have a heart bypass are men over 60 ⁽¹⁾ and more than 28,000 CABG operations are carried out every year in the UK ⁽²⁾.

Will I need any tests before the operation?

The first step is to undergo a coronary angiogram to check if you have narrowed arteries and, if so, to identify where they are and how severely they are restricting blood flow. This is carried out using keyhole surgery and normally means only a day - or possibly a night - in hospital. Your cardiologist will then decide whether a coronary angioplasty or a CABG will be the most effective treatment.

What does a CABG involve?

CABG surgery is carried out under general anaesthetic and usually takes from three to six hours ⁽³⁾, depending partly on the number of grafts you need. Some people have more than one narrowed artery and so need more than one graft. A triple bypass, for example, involves three grafts to bypass three different narrowed arteries. The surgeon will carry out all the grafts in the same CABG operation, as this is the most efficient approach.

When you are fully under the anaesthetic, the surgeon will make an incision down the centre of your chest, cut through your breastbone and expose the heart itself. A leg vein or an internal mammary artery is then taken 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.

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 with the heart still pumping (off-pump surgery or beating-heart surgery).

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

What will happen to me after the operation?

You will spend a night or two in the intensive treatment unit (ITU) or cardiac recovery ward and then around four to seven ⁽⁴⁾ days in hospital.

If the CABG operation and your recovery proceed normally, you should be able to walk to the toilet about two days after the operation, walk upstairs after five or six days and return home soon afterwards ⁽⁵⁾.

You must have someone to pick you up from the hospital and take you home after a CABG operation, or you can arrange this with your hospital care team.

Returning home

You should have someone stay with you during your first few weeks at home. If that is not possible, talk to your medical team or your GP and see if extra care can be provided. Even if you do not need this, you should let your GP know once you are home from hospital.

A CABG is a big operation, so you need to be realistic about how you will feel when you come out of hospital. Total recovery times vary from person to person.

Factors likely to influence recovery are:

• Age
• Severity of your heart disease
• Whether you smoke or not
• Whether you are overweight or not

What will recovery feel like?

Many people feel very tired for the first three months (this can go on for six months).

Your breastbone takes a long time to heal, so you may feel pain in your chest, back and neck. Talk to your doctor or nurse if this is a problem. You may need painkillers until the discomfort wears off.

If you've had a vein taken from your leg to use in the CABG, the area around the scar on your leg may feel numb or swollen.

You may also notice that you have an irregular heartbeat, which is considered a normal after-effect of the operation. If you are worried, talk to the medical team while you are in hospital, or mention it to your GP if you are at home. They'll assess the situation and decide whether you need any further treatment.

You may find it difficult to concentrate and your short-term memory may not be great. You may also feel quite emotional - anxiety and depression are quite common after CABG surgery. Again, discuss your concerns with your GP ⁽⁶⁾.

A CABG is carried out mainly to improve control of angina symptoms; it does not unblock or widen narrowed arteries. If you have already had a heart attack, your doctor will want you to continue taking your prescribed medication, such as statins, aspirin and beta-blockers.

The main complication of any surgery is infection. Signs that the wound has become infected include an increase in body temperature (higher than 38 degrees), new or worsened pain around the operation site, with reddening, bleeding or other discharge.

What is a cardiac rehabilitation programme?

You will probably be asked to attend a cardiac rehabilitation programme about four to six weeks after your operation. It will include exercise, healthy eating and relaxation techniques and is designed to get you back to normal as quickly as possible.

What are the risks and benefits of a heart bypass operation?

A CABG operation, as with any major surgery, does involve some risk. How much will depend on your age, how severe your heart disease is, whether you smoke, eat healthily and take any exercise, and whether you have any other conditions that affect your health.

CABG carries a risk of heart attack, stroke, kidney failure and irregular heartbeat, during and after the operation. However, for many people the risk is low and the benefits are considerable.

CABG surgery can reduce the risk of heart attack in the future, even if you have already had one or have a condition called left main stem disease or narrowing in all three main coronary arteries. It can also remove the pain of angina. It can also improve energy levels and help you get more out of life.

Infolinks:

• British Heart Foundation
• The Healthcare Commission