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Heart attack

Coronary Artery Bypass Surgery

Coronary artery bypass surgery may be needed for some people who have had heart attacks. 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.

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.
 

He felt devastated when he was told that he needed bypass surgery one week after his heart attack.

He felt devastated when he was told that he needed bypass surgery one week after his heart attack.

Age at interview: 71
Sex: Male
Age at diagnosis: 65
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The few days I spent in [the local hospital], they explained lots of things about heart attacks and said that 'because of the readings they were getting, they felt it was a heart attack, but if it settled down then I would go through a normal convalescent period and things would be fine,' and you think that's going to be alright. You think, 'yeah, I'll get fit again.' 

But then when you're taken to [the specialist hospital] and you actually see on the screen the effects of what's going on and then somebody says, 'we're requesting surgical intervention immediately,' it is a shock of some magnitude. Yeah, I knew that, yeah, yeah I knew that there was something seriously wrong with a fundamental part of your anatomy and they'd got to do something about it. 

The nurse then that was on the ward, she was just terrific. She was so comforting and sympathetic and I, I think I was in tears, not from a weakness point of view but sheer frustration and aggression. This can't be me, I haven't spent my life playing sport, all my life, and enjoying good health to have to have people hack me open and put this thing that's gone wrong, right. 

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.
 

Her doctors disagreed about whether she should have bypass surgery at her age.

Her doctors disagreed about whether she should have bypass surgery at her age.

Age at interview: 84
Sex: Female
Age at diagnosis: 81
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Well I had several nasty attacks in the hospital but they said well perhaps it would be wiser to just let things go for a while and see what happened. This went on for about six weeks and then I had a really nasty one and 

Is this another heart attack?

I ended up in intensive care and then I ended up being taken to [the specialist] hospital where the same thing happened again. You're too old to be operated on. 

We might lose you on the table and we don't want to do that so we'll see how it goes. Well this went on for another six weeks and then the doctors came and said, 'I think you better go home because it's too risky to operate on you, you know your chest is not all that good.' 

So one of the, one of the surgeons he said, 'I could do it', but he said, 'we all have to agree." So I said, 'Well what chance would I have?' He said, 'Well I consider you would have a 50/50 chance.' So I said, 'Alright you do 50 and I'll do the other 50.' But he said, 'It's not so easy as that.' 

He said, 'we've got to be perfectly sure that you're strong enough to go to the theatre and go through the operation.' So I said, 'Well I'm sure I'll be alright, I'm sure I will.' He said, 'I'm sure you will but I'm the only one.' 

Well this went on for some time and one of the doctors came and said to me 'Well we're sending you home tomorrow because we don't think we can do anymore. You'll be given treatment and looked after but we're sending you home.' 

So they were getting me ready in the morning, had my breakfast, got up, went to the bathroom and had another heart attack. Right out, that's it. 

Well along comes the surgeon who said he thought he could do it against the advice of all the others but he got the vote that day. And I was taken down to the operating theatre and operated on and it was a success. 

You see I could quite understand they don't want to lose a patient, it's not good for them to lose a patient and if the chances are 50/50, I think they'd rather take their 50 on their side and have you die at home than on their table. 

That is fair enough, but then from the patient's point of view, who hasn't got much chance anyway, she would rather take the chance on the other side of the 50 and go ahead. 

 

He felt well informed before he signed the consent form for bypass surgery two weeks after his...

He felt well informed before he signed the consent form for bypass surgery two weeks after his...

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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The surgeon, I think he was a very good communicator. He came and sat on the side of the bed, explained everything he was going to do. After the operation he came back and he explained everything he had done. 

And also he explained what's going to happen to me in the next few days because when he was talking to me, there's pipes sticking in my mouth and in my groin, all over the place. 

And he explained that progressively they was going to remove all the different pipes, and the purpose for them and everything else, and I thought it was marvellous that a surgeon would take the time out to explain everything he was going to do, or had done, in the next few days. And I was very, very impressed with this surgeon, I've got to be truthful. 

So the only person that was really good, as far as I was concerned, was the surgeon and he didn't mince his words, you know, he spat it straight out. 

He called a spade, a spade and I loved that, I knew exactly where I stood. I knew the risk from living and dying on the operation or from a stroke and everything else and that's the way I like it, I knew exactly where I stood. I knew the odds were against me but I went for it. 

 

He asked the surgeon how many bypass operations he had done before he consented to surgery.

He asked the surgeon how many bypass operations he had done before he consented to surgery.

Age at interview: 77
Sex: Male
Age at diagnosis: 69
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I'm telling you this because one of the things that the surgeon told us was that the, one of the things that I wanted to know from the surgeon was how many of these things had he done. Was he, sort of, did he know what he was doing and he told me, this was September, he told me by that time he had done about 140 bypass operations that year. 

So that was you know, quite reassuring. And I also asked him what the prognosis was and he told me that 95% of all cases of, who have bypass surgery are successful, and 5% are not. So you've got a 1 in 20, is it? yes 1 in 20 chance that something might go wrong and I said what can go wrong. 

He said mostly what can go wrong is that you get some kind of sepsis and we can fix that. So I thought the odds were pretty good, bearing in mind that my cardiologist said I've got to have this done, not much choice.

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.
 
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.
 

Sab talks about how he felt and looked like following his CABG surgery.

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Sab talks about how he felt and looked like following his CABG surgery.

Age at interview: 65
Sex: Male
Age at diagnosis: 64
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I was still under Intensive Care so and then one; I had, the one thing that really was irritating, I had an oxygen in my nose and making… the mask I had with wire… loads of wire from here, here – chest and you don't do nothing, you just lie there, you're almost as good as dead. There's no part of the body you can move. Unbelievable pain, unbearable pain , you can't breathe properly, you can't turn, you just sit still, there's no sleep for three days but you want to close your eyes to sleep but they made no difference and the experience I had, I forgot it and tell is that the dreams that you hallucinate, hallucinations. 
 
And that was a scary part and being on your own in this private room, nobody else then, no visitors and you're looking round and you can't understand, you can't move, you can't really shout, you can press a button for a nurse if you want to and you even shout, "Why is that happening, what's wrong?" and it just feels that you're not in the room. Every day the room looked different so I was thought I was in a different room again – how did I get here? And then, those, for two days was like that and it was so scary to shut the eyes and it was so scary to open the eyes so you didn't know what, which, you know dimension you were in and how do you get out of here. Night time I opened the room and thinking, 'Am I asleep or am I awake?' and it was so difficult. But the support from nurses and the people in charge, it was so brilliant, they were there to make sure that, reassure you that you are alright. And day and night were just the same, there was, you know, you couldn't, it was nothing to look forward to whether it was daytime or night time so those were the first two days. 
 
And the pain was so, you couldn't move, yeah I was petrified of moving. Only the hand that could move and press the button. And then what… I think about two, two days later then you get up and you drag these things with you to go to toilet and the first time they took a tube out, out of m what do they call it, the willy? And you can pee naturally. That was a lovely feeling, you can feel something that you're doing on your own and the first feeling that you have. So I didn't want to get out of the toilet, I was like ‘I’m staying here now’ and then you drag yourself back. 
 
And so that was a horrendous experience and once I started walking and I was, after three days I was walking up and down the hallway to get yourself fit and I then got better, then I had, one of the male nurse give me a shower which was brilliant and from then on the things got better and better then I was eating a little bit more, drinking a lot, I drank so much water. I remember my first day when I realised I was awake that they said the more water I drink the quicker, better I will get. 

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.
 

He was terrified before bypass surgery but other patients on the ward helped to calm his fears.

He was terrified before bypass surgery but other patients on the ward helped to calm his fears.

Age at interview: 72
Sex: Male
Age at diagnosis: 49
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The unknown, the thought of having your chest sliced open, your ribs cut open and your ribs expanded, your heart being handled, being on a life support machine and there's always a chance even with the best surgeons in the world that you may not come out of it. That really frightened me. Not the thought of coming out of it because I knew if I didn't come out of it, I knew nothing about it. 

I was literally shaking, my nerves did get the better of me all of the time, whilst I was in. I did calm down, it was rather funny at the time. They transferred me in to a side ward with three young lads in because they thought I would cheer them up. I think the reverse happened, but it was great. There was a 14 year old with a lung problem who eventually had to get it cut out. 

There was another young lad with a concave chest, which they were going to take his ribs out and reverse them; a procedure they had never done at the hospital before and there was another chap who was quite an early age to be having bypasses. 

So we were mixed bag, we settled each other down and the nurses helped. The nurses were quite young, a lot of training nurses, which was surprising. But we were a good mix and we helped each other out and we helped each other to get over their fears, a) before the surgery and b) after. 

 

He felt a bit apprehensive but relatively relaxed before his bypass surgery, one month after his...

He felt a bit apprehensive but relatively relaxed before his bypass surgery, one month after his...

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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Again I was relatively relaxed. Clearly one is a little bit apprehensive but I wasn't really because I knew it was for my own benefit, for my own good. I asked about the risk of these operations and so on and I was told that I was fit, healthy and if I had one, that was the time to have one. 

So I knew that there wasn't much risk of anything happening. I knew I was in a good hospital and I felt relatively 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.
 

His bypass operation was delayed for a week because he was still taking clopidogrel.

His bypass operation was delayed for a week because he was still taking clopidogrel.

Age at interview: 66
Sex: Male
Age at diagnosis: 65
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I went in on the Thursday for the operation, I think it was the Friday, I may get it wrong on the days but it doesn't actually matter. And the surgery was just shutting for the evening and I said to him, 'oh by the way, I've still been taking the aspirin should I have stopped'. He said, 'oh no we can get over aspirin these days. We're so used to people taking aspirin when we operate, aspirin doesn't actually matter.'

He said, 'what else are you taking,' and I showed him and there was an aspirin replacement [clopidogrel], which I can't think of the name but I can find it if you wish. And he said, 'I can't operate on you if you take these, I can't stop you bleeding'. He said, 'I can if you're desperate,' but he said, 'but if you were my family I can't operate.' 

So it was a lesson to be learned really, I should have informed him or he should have asked me what things I was taking.

So he sent me home and said, 'come back in a week's time.' And in some ways it was a good thing because when I went in the first time I was very, very apprehensive, I knew he had a 98% success rate and I kept saying to myself I've got to be one of the 98 not the 2.  

I'm a quite positive person really and you know I felt I'm going to be a 98 not a 2 but I was very apprehensive when I went in on that Thursday and the build up a day or two days beforehand I was very apprehensive about the whole thing. Then he sent me home and I thought he knew what he was doing. 

Okay we made a mess of the fact of this tablets and I shouldn't really been taking them but I went through the following week quite happy and went in on the following Thursday night, I thought very relaxed, at least I felt relaxed and wasn't apprehensive. 

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

 

The first three days after bypass surgery were difficult but then he began to feel the benefits.

The first three days after bypass surgery were difficult but then he began to feel the benefits.

Age at interview: 72
Sex: Male
Age at diagnosis: 49
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In the hospital, as I said earlier, I saw it as three days trauma, for instance, making sure, the physiotherapist coming round, making sure your chest is clear. That's hard work getting the phlegm up from your chest at times. If you are able, within twelve hours you were sitting on the bedside. 

The second day you may be, may be walking. The third day you are certainly walking. The surgery itself on the chest wasn't so much a problem as actually the legs, where they take the vein out of that, in a lot of people, including myself, gave more problem than the chest.  

The chest was a shade wobbly at first because you realise they put it back together again, they pin it together. So until those pins become firmly implanted you've got a weeny, weeny bit of movement. Sometimes you don't notice it but it's there and that's where you need to be careful about it. 

You don't overdo things too much in that area to possibly knock things out of alignment or loosen a bit of wire, I don't really know but that was the thing that gave me concern and the leg. My right leg where they took the first vein out of for the first lot of bypasses, that's fine. My left leg, I still have to wear a stocking. Without the stocking, without the support on the leg, I've got problems there; I need that support. 

But gradually after the operation, once those first three days are over, it's magic. You really feel the benefits then after the third day. You're really feeling a lot better, well worth three days of a little trauma.

 

Describes his recovery from bypass surgery.

Describes his recovery from bypass surgery.

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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Well to go through the sequence of things; I was prepared for the operation and I was given an injection, which put me to sleep. I wakened up in intensive care. I didn't know I'd had the operation. I was in good care in intensive care for about a day and superb nursing where I was and it all went very smoothly. 

I did not realise I'd had the operation and of course when the pain killers wear off a bit, then you do feel discomfort, of course you do, it's a big operation. But I was in good care and one just has to persevere with these things, get over them and do what you can. I found myself exercising after about two days of the operation; doing toe rolls, flexing and things like that. So you can start right from the beginning getting yourself fit again.

Again I had a physiotherapist, the nurses were good and I just felt confident enough to start getting better quickly. So, yes I did. The problem in the early stages are you are a bit sore in your chest. 

They take a vein out your leg for the bypass and you feel a bit discomfort, course you do. It's difficult to get a comfortable position in bed, but you know it's going to get better and you just find positions where you are comfortable and be patient and just go for it.

 

Encouragement from family and the thought of his grandchildren helped Sab to cope with the first...

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Encouragement from family and the thought of his grandchildren helped Sab to cope with the first...

Age at interview: 65
Sex: Male
Age at diagnosis: 64
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And after the operation and then I realised that now, you know, I mean you look at yourself and completely helpless, a wire coming out of everywhere, you know, and you can't get up and you can't sleep for three days, you don't want to eat, drink, nothing and you know there's no will to do that. So that was the hardest part, then thinking where do you go from there? Where's the next stop, you know, and people answer, convince you that you'll be fine and you don't believe that and because your body's torn to pieces and there's nothing, no strength and, or will. And you think why have I had this done, you know, what's the point of it all? I'm not going to get better. And then my family, my wife, to look at her face and you're thinking, 'I need to get better,' you know and I remember my father had the same, a triple bypass and I went to see him and he was fine and then I had a phone call from my brother saying he was very, very ill, he's back in hospital. So I went to see him again six weeks later and to see him he was from fourteen stone, he was, to about nine stone eight and he looked like a skeleton and he hadn't eaten for three weeks and I could see him and I'm thinking, 'If I don't eat I'm going to end up like him.' So I had to force myself to put something in my mouth and swallow with a tea or water just two spoons each day, that's all I had for three days and that's what really inspired me. I thought, 'I've got to live, I've got, you know, get better. If I don't eat now I'll probably never do it.' So that was one inspiration from him.
 
Then my daughter came from Canada and to see her face that you, and she's a very determined young lady, she said, "You've got to get better Dad, so get yourself up." I love my grandchildren, they want to chase you because I always fight with them and so I thought there was another one, I thought I've got to get better. So it was a brilliant, every day, felt a little bit better than the day before. For three days it was very, very difficult and then fourth day and you can see a light, like somebody had turned the lights on, it was more brighter and every day, every minute from then on it got brighter and brighter and I started walking and then I remember on Tuesday which is the fourth day and the doctor came to see me, he said, "You give me a bit of a fright, but you're OK now," he said, "I was worried, I was concerned but not worried." So and then he said, "How would you like to go home on Wednesday?" So I said, "Can I go home on Tuesday?" And he said, "Why Tuesday?" I said "Because my daughters going back to Canada on Wednesday so if I go home on Tuesday she'll know I'm better." So that's when I came home.

 

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.
 

Two days after his bypass surgery he was out of bed and walking a short way around the hospital.

Two days after his bypass surgery he was out of bed and walking a short way around the hospital.

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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I had the operation on the 27th November and on the 29th November, the operation was totally successful, I came round after a period of time and felt, you know it was nice to be alive so to speak, and I did feel good. Anyway on the 29th November, they got me out of bed and started walking me around the hospital, which really thrilled me. 

Then two days after that, they walked me a further distance around the hospital and I was really feeling good, and they gave me a badge to say I had walked the marathon around the hospital and I was virtually ready for discharge. On the 2nd December they discharged me. They put on a hospital car and they sent me home and from that day onwards, I've made very, very good progress.

 

He felt positive after seeing ex-bypass patients exercising in the gym before he left hospital.

He felt positive after seeing ex-bypass patients exercising in the gym before he left hospital.

Age at interview: 77
Sex: Male
Age at diagnosis: 69
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Before I was discharged the physiotherapist took me to the gym down stairs and in the gym there were a number of people doing various exercises and she said they were all ex-patients who had bypass operations and I was, you know, I was pretty impressed. You know, they were doing, they were jumping up and down and they were doing skipping, and they were doing a mild form of press-ups. 

A number of fairly strenuous looking things and I thought, oh well it must have been two or three years since they've had their bypass and I asked her about that and she said, turned to one of the chaps and she said 'How long ago have you had your bypass?' and he said, 'Oh, just six weeks ago now.' 

So that was, that was a real eye opener and again something very positive. And really from that moment on I felt, and my wife, we both felt very positive about the whole thing.  

 

Describes his 'black' day in hospital after his bypass operation.

Describes his 'black' day in hospital after his bypass operation.

Age at interview: 66
Sex: Male
Age at diagnosis: 65
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And things were doing nicely and the surgeon said, 'today will be a day that you will be dopey, you'll be alright' he said, 'but you will have a black day,' he said, 'you'll definitely have a black day during the period you are in here. I hope to get you out in six days,' but he said, 'everybody has a black day'. And the following day my black day appeared. 

Not much to me particularly but my heart rate I'm told went up to 180 pulses which I mean I could feel, feel I was racing away and on this monitor it was on 180 and going up and down slightly. 

And obviously they called, called the doctors in and the surgeon in and I said, 'what had happened?' and he said, 'well the person to blame is me', he said. 'I've had my hands on your heart and your heart didn't like it', he said. 'I've upset your heart', he said, 'and it's now showing up and it's doing this', he said. 'But we'll, we'll put in a drug.'  

So fortunately I'd still got this drip in so they put this drug in and it was, as I say a black day to me, partially I suppose but it was more of a black day to my wife really and she knew this black day was coming but she could see this figure of 180 not coming down and she spent several hours with me watching this figure until it eventually it did come down and that was the end of my black day really. And from then onwards, I had certain pains, but I never had a great deal of pain from the 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.

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 will need to stay in hospital for at least seven days after a CABG and then continue with their recovery at home which can take from 6 to 12 weeks (see 'Recovery from coronary artery bypass surgery') (NHS Choices 2015). 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 June 2017.
Last updated June 2017.
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