Coronary artery bypass surgery (CABG): who needs it and recovery

Heart bypass surgery is a major operation, and understanding it can make decisions and recovery easier. This article explains who may need coronary artery bypass grafting, how it works, what recovery involves and how to look after your heart afterwards, using information from the US National Heart, Lung, and Blood Institute (NHLBI).

1. Introduction

Coronary artery bypass grafting, known as CABG or heart bypass surgery, is an operation that improves blood flow to the heart. It is used when the coronary arteries, the vessels that supply the heart muscle, are narrowed or blocked ^[1]. Doctors may recommend it to lower the risk of a heart attack in people with coronary heart disease, or as an emergency treatment for a severe heart attack ^[1].

2. How the operation works

Surgeons take healthy blood vessels from elsewhere in the body and attach them above and below the blocked artery. This creates a new route for blood to reach the heart muscle. The vessels are usually arteries from the arm or chest, or veins from the leg ^[1]. In traditional open-heart surgery the heart is stopped and a heart-lung machine pumps blood during the operation, which is still the most common method. In some people, off-pump techniques that keep the heart beating may be possible ^[1].

3. Who may need CABG

A care team, usually a cardiologist (heart specialist) and a cardiothoracic surgeon (a surgeon for the heart and chest), decides whether CABG is right for each person. NHLBI notes that surgery is not always the best option for everyone ^[2]. NHLBI lists these situations in which a person may benefit ^[2]:

• Angina, which is chest pain from the heart, that medicines have not relieved, or a past cardiac arrest caused by an irregular heartbeat
• Diabetes
• A heart attack caused by coronary artery disease that a non-surgical procedure cannot adequately treat
• Several blocked coronary arteries, or a large amount of plaque in the left main coronary artery
• Serious heart failure that weakens the heart's pumping

For some people the team may suggest percutaneous coronary intervention (PCI) instead. This is a non-surgical procedure that opens the artery, using angioplasty and a stent, a small tube that holds the vessel open, to open and stretch the blood vessel ^[2].

4. Hospital stay and recovery

NHLBI says to expect a hospital stay of about a week, longer if there are other procedures or complications. The first day or two are usually spent in intensive care, where staff monitor heart rhythm and vital signs, and tubes drain fluid from the chest and bladder ^[3]. Compression stockings help protect against blood clots, and medicines are given for pain, clot prevention and cholesterol. Oxygen is given through nasal prongs or a mask ^[3].

Full recovery usually takes 6 to 12 weeks, and minimally invasive surgery generally has a shorter recovery ^[3]. Common short-term effects that usually settle within 4 to 6 weeks include ^[3]:

• Pain near the chest cut
• Constipation
• Itching
• Reduced appetite
• Mood changes or low mood
• Upper body muscle pain
• Sleep problems and tiredness
• Swelling where a vessel was taken

5. Medicines and follow-up

NHLBI says doctors tailor medicines for each person. Common groups include blood pressure medicines, medicines for heart rhythm, antiplatelet medicines, water tablets that remove extra fluid and statins that lower blood fats. Antiplatelet medicines can raise the risk of bleeding ^[3]. Keep taking prescribed medicines and attend follow-up visits, and do not stop any medicine without talking to your doctor.

Even without symptoms, you may need testing about 5 years after surgery, or sooner if new symptoms or risk factors appear, such as a stress test or heart scan ^[3].

6. Risks and complications

As with any operation, there are risks. NHLBI explains that grafts can become blocked by plaque, reducing or stopping blood flow. A failed graft can cause a heart attack or other heart problem and may need another operation or PCI.

7. Cardiac rehabilitation and healthy habits

Cardiac rehabilitation is a medically supervised programme of exercise training, heart-healthy education and counselling. It can be given in an outpatient clinic or a hospital rehabilitation centre, and a standard programme is 36 supervised sessions over 12 weeks ^[3]. NHLBI says it can improve quality of life and lower the chance of future heart problems or returning to hospital ^[3]. Heart-healthy habits advised include nutritious eating, a healthy weight, regular physical activity, stress management, good sleep and not smoking ^[3]. Tell your doctor about low mood, because treating depression can improve recovery ^[3]. NHLBI notes that serious risks of rehabilitation are rare but can include muscle or bone injury and dangerous heart rhythms ^[3].

It helps to prepare questions before surgery. You might ask the team why CABG is suggested rather than a non-surgical procedure, how long you are likely to stay in hospital, which medicines you will need afterwards and when you can return to normal activities. Having a family member or friend with you to listen and remember the answers can be useful. Recovery is different for each person, so follow the advice of your own care team and ask them about anything that worries you.

8. When to see a doctor

Know the warning signs of a heart attack and act at once if they appear. NHLBI stresses that every minute matters ^[3]. NHLBI says chest pain after surgery may need tests such as coronary angiography, so tell your care team about any new chest pain, and about low mood that does not lift ^[3]. Your team will advise on what needs urgent review.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

CABG improves blood flow to the heart by building new routes around blocked arteries. Whether it suits you is decided with your cardiologist and surgeon, who also compare it with other options. Recovery takes weeks, and long-term heart health depends on medicines, rehabilitation and healthy daily habits.