Heart attack

Coronary Artery Bypass Surgery

Currently in the UK, treatments used most frequently for heart attack are thrombolytic (clot buster) drugs, other medication, or primary angioplasty (see 'Initial treatments in the ambulance and hospital' and 'Medication & side effects'). Occasionally, in a small proportion of heart attacks, coronary artery bypass surgery may be needed.

Coronary artery bypass surgery, also known as Coronary Artery Bypass Graft (CABG, pronounced "cabbage") is a type of surgery that improves blood flow to the heart. It diverts blood around narrowed or clogged parts of the major arteries (blood vessels), to improve blood flow and oxygen supply to the heart. 
 
“Every year, 28,000 Coronary Artery Bypass Graft surgeries are performed in the UK. Nearly 80% of those who need to have the operation are men over 60 years old.” (NHS Choices)
 
Here, people talk about successful outcomes from their bypass surgery. Some had their surgery a few days after their heart attack. Others had the operation several months later. Sab avoided a heart attack just because during a consultation for a lung condition he had a series of tests done, including an angiogram. It showed that his artery was so bad that it would be dangerous to put a stent in and doctors decided to do a triple bypass instead. One man described how he felt when he was told during his angiogram that he would need bypass surgery immediately.
One woman in her eighties explained how some of the doctors advised against bypass surgery, and why she wanted to go ahead with it. One man reported how the surgeon described the operation to him before he asked him to sign the consent form for bypass surgery. Another man wanted to know how many bypass operations the cardiac surgeon had done before he signed the consent form and what things might go wrong.
What CABG surgery involves
CABG operation involves the use of a piece of a vein from the leg or artery from the chest or wrist. The surgeon attaches this to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft.
 
Once all the graft vessels have been taken, the surgeon will make a cut (incision) down the middle of the breastbone (sternum) to access the heart through the ribcage. During the procedure, the blood is re-routed to a heart-lung bypass machine. This takes over from the heart and lungs, pumping blood and oxygen through the body. The heart will be temporarily stopped using medication while the surgeon attaches the new grafts to divert the blood supply around the blocked artery. After the grafts have been attached, the heart will be started again using controlled electric shocks. The sternum will then be stitched up using wires and the skin on the chest sewn up using dissolvable stitches. Surgeons are also performing a new surgical technique OPCAB (Off Pump Coronary Artery Bypass) which is a variation of CABG which involves operating on the beating heart rather than bypassing it with the heart lung machine (NHS Choices).
 
CABG surgery usually lasts three-to-six hours. However, some people need more than one bypass and so it may take longer depending on how many blood vessels are being grafted (NHS Choices).
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Feelings
The prospect of bypass surgery can be frightening. One man said he had been terrified before his operation but that other patients and the nurses on the ward had helped to calm his fears. Another who felt well informed about the surgery, said he felt a little apprehensive, but relaxed.
One man, whose operation was done at short notice because of a cancellation, said that he didn't have time to be anxious because everything happened so quickly. Another had to have his operation delayed for a week because the surgeons had been unaware he was taking the blood thinning drug clopidogrel.

Some people mentioned that the first few days after the operation were difficult, but that they soon recovered.

Many were surprised how weak they felt. Some people lost weight during their stay in hospital. One man who had worried about having a urinary catheter said that it was only in for two days and it didn't affect him. Many were encouraged by the way the nurses got them out of bed and walking a few days after their operation. One man had felt encouraged by seeing ex-bypass patients exercising in the gym. Another describes the 'black' day he had been warned he could have soon after his operation.

Pain relief is given during and after the operation and some said that they had less pain than they had expected. Many had more discomfort in their leg, where the vein had been removed, than they did in their chest (see 'Recovery from coronary artery bypass surgery').

Another recalled that it was painful when the chest drains were removed and he had experienced complications. But others said that having the drains removed had been fine.

Most people can leave hospital a week after coronary bypass surgery and continue with their recovery at home (see 'Recovery from coronary artery bypass surgery'). A small proportion of people may have more serious side effects from the surgery such as having a stroke or going into heart failure and in extreme cases a few people may die in surgery.

 
Last reviewed April 2013.
Last updated April 2013.

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