Coronary Artery Bypass Grafting (CABG)

Coronary artery bypass surgery or coronary artery bypass grafting (CABG) is a surgical procedure that is performed to treat the narrowed arteries that supply blood to the heart. This procedure bypasses the blocked arteries thereby increasing the blood flow to the heart muscle.

Coronary artery bypass surgery is performed for 2 reasons: to relieve symptoms of CAD such as angina and to improve survival when there are severe or multiple blockages in the heart arteries. It is performed as an urgent procedure following a heart attack or as an elective procedure when the medical treatments such as blood-thinning drugs and medicines which relax the arteries, slow the heart rate, and reduce chest pain have failed to relieve symptoms of coronary artery disease (CAD).

Procedural details

Coronary artery bypass surgery is performed either through open surgery via an incision in the sternal bone.

During the procedure, a healthy blood vessel (graft) is taken from a part of your body such as leg (long saphenous vein), arm (radial artery), or chest (internal thoracic artery). The heart is temporarily stopped while the grafts are constructed. During this time a heart-lung machine performs the work of your heart and lungs by supplying oxygen to the blood, removing carbon dioxide and keeping blood flowing.

If the artery graft is taken from leg or arm, one end of the graft is attached to the aorta and the other end is attached to coronary artery beyond the blockage using fine sutures. Now the blood bypasses the blocked and narrowed area and reaches the heart freely.

If the internal thoracic artery is used, your surgeon will redirect the thoracic artery by detaching one end of it and re-attaching it below the blocked part of the coronary artery.

After the surgery is complete, your heart will be restarted, the heart lung machine is removed and the incision will be closed with absorbable sutures. The sternum bone is put back together using stainless steel wires that remain in place as the bone heals. They are inert, do not set off metal detectors and are MRI compatible after 6-8 weeks.

Risks and complications

The risks and complications of CABG procedure are higher if it is done as an emergency procedure or in the presence of certain conditions such as kidney disease, diabetes, blocked artery in your legs, and lung disease.

The possible complications associated with CABG include:

  • Bleeding
  • Heart rhythm irregularities
  • Heart attack
  • Stroke
  • Infection of the wound
  • Nerve and blood vessel damage
  • Blood clots
  • Recurrent chest pain

Post-operative guidelines and prevention of CAD

After the CABG surgery, you need to follow a few post-operative instructions which include:

  • Physical activity such as lifting heavy things, strenuous exercises and driving should be avoided for first few weeks after surgery to allow the sternum to heal
  • Medications may be prescribed to reduce chest pain and prevent blood clots
  • Your doctor may recommend you to wear compression stockings around the calf muscles while recovering
  • You may have to contact your doctor if you observe redness, swelling, irregular heartbeats, palpitations, chest pain, difficulty in breathing or weakness

You can manage or prevent the progression of CAD by lifestyle modifications which include

  • Regular Exercise
  • Consume a healthy diet low in salt and cholesterol
  • Avoid smoking and alcohol intake
  • Losing weight if you are obese
  • Controlling diabetes and high blood pressure.
  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital