Sometimes, when an artery becomes narrow, blood struggles to get to the heart. This operation involves creating a graft, or a new pathway for the blood so it can start flowing back to the heart muscle again. 

How we do it

While you're asleep, or under general anaesthetic, we'll make an incision down the middle of your chest and carefully divide your breastbone (sternum), so we can get to your heart. 

We use:

  • internal mammary arteries - chest arteries
  • radial arteries - arteries from the arm
  • veins from the leg

To create the graft. Some patients will only need one graft but it's more common for people to need two, three or four. 

These veins and arteries can be removed without any damaging effect on your circulation. If you have varicose veins, grafts can be made from arteries or veins from other parts of the body. 

On pump/off pump surgery

On pump

CABG surgery has been done over the 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

Off pump (also known as the octopus procedure), is a technique where CABG surgery is done without using a heart and lung bypass machine. This technique involves attaching the grafts while the rest of the heart continues to work as normal. 

The surgery is done just like it would if it were a standard CABG, and the recovery afterwards is very similar. Your surgeon will consider your health and medical condition and then chat with you about which procedure is best for you. You'll also be able to ask them anything you like about the whole procedure. 

After the operation

After your bypass graft, the surgeon will rejoin the breastbone using stainless steel wires, and the incision in your chest will be sewn up using dissolvable stitches. 

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.

CABG risks

All medical procedures carry some risk, but it's important to remember that we wouldn't recommend any procedure if we didn't believe that the benefits outweighed any risk. the risks are different for every patient, so we'll discuss that with you before your surgery. 

The most common risks are:

Atrial fibrillation

If your heart starts to beat faster, in a more irregular way, we call this atrial fibrillation. It usually settles after a few days and rarely causes any major changes to how your heart works or your overall health. 


Some patients may need a further operation after surgery to control bleeding. 

Wound infection

This is more common in patients who have poorly-controlled diabetes, or other conditions that make them more vulnerable to infection. If you do get an infection, we can treat it with antibiotics. 

Renal (kidney) failure

For patients who already have kidney problems this is more common, but it can be treated with dialysis. 


When a blood clot develops and travels to the brain, it cuts off the oxygen supply and can cause a stroke. The risk of this happening is higher in patients who have already had a stroke, or transient ischaemic attacks (TIAs, also known as mini-strokes). To reduce the risk of a stroke, we will give you medications, both during and after the operation, to slow down the rate at which your blood clots. You may also have to wear special stockings after your operation because these have been shown to reduce the risk of clotting. 


The risk of not surviving the operation will be higher for patients who are very unwell before their surgery. your surgeon will discuss your risk with you at your consultation. 

CABG alternatives

There are no real alternatives to having a CABG procedure. Drugs can control the symptoms of your heart disease, but it will not solve the underlying problem. 

If you decide not to have CABG, symptoms such as angina and shortness of breath will get worse and more frequent. You will also increase your risk of having a heart attack. Patients with severe coronary artery disease may have a shorter life expectancy. 


Coronary artery disease is also known as 'ischaemic heart disease' and occurs when a fatty substance called 'atheroma' develops on the inside of an artery.


24-hour nurse advice line: 020 7352 8121 Bleep:7043
Cardiac homecare team:020 7351 8497
Princess Alexandra ward:020 7351 8516

Useful documents

After your heart operation - Royal Brompton Hospital - February 2022 (pdf, 2.17MB)