Before your coronary artery bypass graft (CABG) your surgeon will discuss every aspect of the procedure with you. This will give you the opportunity to ask any questions to make sure you understand it fully.
You will be advised to stop smoking. This is because smoking increases your chances of a serious chest infection and also slows down the time your wounds will take to heal. Smoking can also increase your risk of blood clots.
Because the procedure is performed using a general anaesthetic, you must not eat or drink for at least six hours before the operation. Sometimes you may be able to have occasional sips of water until two hours before the operation.
During the operation
CABG surgery usually lasts three to six hours. However, it may take longer depending on how many blood vessel grafts are being performed.
To begin with your surgeon will take healthy blood vessels from either your chest, leg or arm.
Because most operations involve several new grafts being carried out, it's likely at least one of the grafts will be taken from your chest. The blood vessels taken from your chest are called internal mammary arteries. Surgeons prefer to use at least one of these because they do not narrow over time, unlike the blood vessels taken from your leg or arm.
Once all the new grafts have been harvested, your surgeon will then make a cut (incision) down the middle of your breastbone (sternum). This is so they can access your heart through your ribcage.
During the procedure your blood will be re-routed to a heart-lung bypass machine. This takes over from your heart and lungs, pumping blood and oxygen throughout your body.
Your heart will be temporarily stopped using medication, while your surgeon attaches the new grafts to divert the blood supply around the blocked artery.
After the grafts have been attached your heart will be started again using controlled electrical shocks.
Your sternum will then be stitched up using wires, and the skin on your chest stitched up using dissolvable stitches.
Variations of CABG
Off-pump coronary artery bypass surgery (OPCAB)
More surgeons are now performing off-pump coronary artery bypass surgery (OPCAB). This is simply a variation of the CABG procedure.
A CABG is often described as on-pump surgery as it uses the heart-lung bypass machine to pump blood and oxygen around your body during the procedure. During the off-pump surgery (OPCAB) your heart is still beating while the new blood vessel grafts are attached. According to the National Institute for Health and Clinical Excellence (NICE), this procedure works as well as coronary artery bypass using a pump. Around 20% of heart bypasses are performed off-pump.
The benefits of a OPCAB are:
- it often takes less time to perform than a CABG,
- it reduces your chance of bleeding during the surgery,
- it is less likely that you will develop post-operative complications, such as an irregular heart beat or chest infection, and
- your stay in hospital is usually shorter.
Because the OPCAB is performed while the heart is still beating, it is not recommended for everyone.
Minimally invasive surgery (keyhole surgery)
This latest development in heart bypass surgery is a variation of the CABG procedure. It is done without stopping the heart.
Minimally invasive surgery involves a small incision being made between your ribs in order to pass an instrument through. This enables your surgeon to see inside your chest using a video monitor, while carrying out repairs on your blood vessels.
The procedure is only available in a few centres in the UK. It's usually only suitable for people with just one affected coronary artery.
