Coronary artery bypass graft (CABG)

When a coronary artery is found to be significantly narrowed, it can often be expanded using a balloon (dilatation) and a stent may also be put in place. If multiple coronary arteries are narrowed or if the site of the narrowing is difficult to access, the best option may be to bypass the coronary arteries, which is called Coronary Artery Bypass Grafting (CABG).

Risks

The risks of complications from a coronary artery bypass are highly specific to each individual. Your age, past medical history, family history and general physical condition are all important. The surgical technique that is used and the length of the operation also have a significant impact on any complications. The risks will be discussed with you by the cardiac surgeon before the operation.

Before your treatment

Before your heart operation an assessment will be carried out including all your relevant medical information:

• Past medical history,
• Tests (electrocardiogram, echocardiogram etc.),
• Laboratory results,
• List of your medications,
• Etc.

All this is discussed at a multidisciplinary heart team meeting with cardiologists, electrophysiologists and cardiac surgeons. In many cases there is a discussion between referring cardiologists and the patient’s GP.

If it is decided that a heart operation is the best option for you, a preoperative consultation with the anaesthetist is scheduled. The date of the operation and the admission date are scheduled together with you and your surgeon.

The operation

In a classic coronary artery bypass operation the breastbone is opened (sternotomy). For selected patients one or more bypasses can be carried out via a small incision on the left side of your chest. In these minimally invasive procedures a robot or camera is used to release the venous grafts on the inside of the rib cage.

A coronary artery bypass graft or CABG is always carried out under general anaesthetic. The operation can be carried out with or without assistance from a heart-lung machine.

Types of bypass or graft

A graft is used to bypass the narrowed coronary arteries. A graft is a piece of vein or artery taken from another place in the body. Depending on your age and other risk factors that you have, such as limited lung function or diabetes, arterial grafts are used as much as possible. These are taken from the rib cage or (usually) the left arm. If necessary, a venous graft may be taken from your leg.

After the treatment

Immediately after the operation you will be monitored in the Intensive Care department. The main functions of your body will be monitored carefully and supported if necessary. The length of your stay in Intensive Care depends entirely on your condition.

Under ideal conditions you will be transferred to the ward after one to two days following the operation. You will continue to be monitored there and will start cardiac rehabilitation.