Coronary artery bypass grafts (CABG)
This operation involves creating a 'new' pathway for blood to flow through called a 'graft'; it lets blood flow around the narrowed part of an artery. A bypass graft will allow more blood to reach the part of your heart muscle where there was a reduced supply before.
This procedure is performed while you are asleep under a general anaesthetic. The surgeon makes an incision down the middle of your chest and will carefully divide your breastbone (sternum) to reach the heart.
Some patients may only need a single graft although, more commonly, two, three or four grafts are needed. Arteries from the chest, called the 'internal mammary arteries', or from the arm, called 'radial arteries', may be used to create the graft.
Sometimes a combination of these arteries, together with a vein from the leg, is used to create the graft. All these veins and arteries can be removed without any damaging effect on your circulation. In the case of someone with varicose veins, grafts can be made from arteries or veins found elsewhere in the body.
After the procedure has been completed the surgeon will join the breastbone back together using stainless steel wires and the incision in your chest will be sewn up using dissolvable stitches.
'On pump' surgery
CABG surgery has been performed for many years using a special heart and lung bypass machine. This machine takes over the work of the heart and lungs and means that oxygen-rich blood can continue to flow around the body while the heart itself is repaired.
'Off pump' surgery
You may also hear ‘off pump’ surgery called the ‘octopus procedure’. It is a technique where CABG surgery is performed without using a heart and lung bypass machine. This technique involves attaching the grafts while the rest of the heart continues working as normal.
The actual procedure of artery grafting is carried out in the same way as standard CABG and so recovery afterwards is very similar. Your surgeon will discuss with you which procedure he/she thinks is best, taking into consideration your health and medical condition. During this time you will have the chance to ask any questions you may have.
MIDCAB/MINICAB bypass surgery
If your condition means that you only need one bypass graft to the artery at the front of your heart, an operation called 'MIDCAB' or 'MINICAB' may be performed.
Unlike a CABG procedure where the chest is fully opened up to perform the operation, a MIDCAB or MINICAB operation only involves a small incision usually under the left breast area of your chest. This is carried out under a general anaesthetic.
Patients who have these types of procedures tend to spend a shorter time in the Intensive Therapy Unit (ITU) and a shorter time in hospital overall before going home. The rehabilitation team, physiotherapists, doctors and nurses on the ward will give you advice before you are discharged home.
After coronary artery bypass surgery
Coronary artery bypass grafting is very effective for the vast majority of people. The aim of the operation is to let you return to your normal lifestyle. For example, you should be able to return to work and continue to do everything you did before you became unwell.
Within a few months some people actually take up new hobbies and lead a more active life than they did before.
Occasionally angina can return even though the diseased arteries have been bypassed. This could be due to a narrowing in one or more of the grafts or due to the development of coronary artery disease in an artery that was not affected before. It is possible to reduce the risk of this happening by adopting a healthier lifestyle.
Before you are discharged from hospital the rehabilitation nurse will discuss 'risk factors' with you and your family and will give you appropriate advice about: