Heart bypass surgery

Heart bypass surgery, also called coronary artery bypass graft (CABG), gives blood a new route around a narrowed or blocked heart artery. The surgeon takes a healthy blood vessel from elsewhere in the body, usually the chest, leg or arm, and joins it above and below the blockage. Most people need three or four arteries bypassed, and some need one or two.

Bypass surgery treats coronary artery disease. It may be advised when medicines do not control angina (chest pain), when the risk of a heart attack is high, or when angioplasty with a stent is not suitable. It can also be done as an emergency after a severe heart attack. Surgery is recommended only when its risks are lower than the risks of leaving the blockage untreated.

You will have tests first, usually including an angiogram (an X-ray of the heart's arteries), and a talk with the surgical team.

You are given a general anaesthetic and are asleep throughout. The usual operation:

1. A long cut is made down the middle of the chest and the breastbone is divided. Keyhole surgery is sometimes possible.
2. Healthy blood vessels are taken from the chest, leg or arm.
3. The heart is usually stopped while a heart-lung machine keeps blood flowing. In off-pump surgery it keeps beating.
4. The vessels are joined beyond the blockages, and the heart is restarted.
5. The breastbone is closed with wires that usually stay in for good, and the skin with stitches that usually dissolve.

It takes 3 to 6 hours. You wake in intensive care with monitors and drain tubes, and may have a breathing tube until fully awake.

You spend a day or two in intensive care, then move to a ward; most people stay about a week. Physiotherapists help you walk from the day after surgery. Tiredness and poor appetite are common for weeks. At home, follow the advice on wound care. People are usually told not to drive for at least 4 weeks or lift heavy things for 3 months. Most people are back to most activities after about 6 weeks, and full recovery takes 2 to 3 months. Cardiac rehabilitation (exercise and support) is often offered.

Get urgent advice for a worsening, red or leaking wound, a fever or palpitations. Chest pain that does not go away, or weakness or a drooping face, needs emergency care.

Bypass surgery is a major operation. Risks include:

• Wound infection, usually treated with antibiotics
• Bleeding, which may need more surgery or a transfusion
• An irregular heartbeat, usually settling in a few days
• Kidney problems, more likely if the kidneys were already weak
• Memory problems, usually clearing within a few months
• A heart attack or stroke during or soon after the operation

Risk is higher after an emergency operation or with other serious illness. Ask the surgeon about your own risk.

The operation eases chest pain and breathlessness and lowers the risk of a heart attack. In most people the grafts work well for many years. It does not cure the disease, and blockages can return, so medicines, a heart-healthy diet, activity, no smoking and control of blood pressure, sugar and cholesterol matter. Regular check-ups may include an echocardiogram (an ultrasound scan of the heart) or a stress test.