Coronary artery bypass grafting, CABG

Coronary artery bypass grafting (CABG) is a type of heart surgery used for treatment of coronary artery disease where blocked or narrowed coronary arteries are bypassed by another vein or artery. The artery used as a bypass is usually taken from the chest (left internal mammary artery, LIMA), veins are taken from legs (vein saphena magna, VSM).

The mainstay of coronary artery disease treatment is medication but in some cases invasive procedure – revascularization – is necessary to restore sufficient blood supply to the heart and thus prevent angina and reduce risk of heart attack. Revascularization can be carried out as a catheter procedure (PCI, percutaneous coronary intervention, also called angioplasty usually including stenting) or surgically as a CABG. Both options have their pros and cons and your consultant will be able to advise on the best strategy in your case.

The procedure

CABG is carried out as an open heart surgery by cardiac surgeon under general anaesthesia. The narrowed segment of diseased coronary artery is bypassed with a arterial or veinous graft taken from other part of the body, usually from the inner side of the left side of the chest wall and from legs. Depending on the extent of the coronary artery disease, the surgeon will attach one or more grafts, in most cases 2-4 grafts.

Recovery

Recovery following CABG depends on many factors including patient’s age, fitness, heart’s pumping function, associated diseases, extent of the operation and presence or absence of complications. Most patients leave hospital less than week after the surgery and after several weeks can resume their job and all normal activities.

Prognosis

CABG is a time proven procedure with perioperative mortality rate about 1-2% and additional risk of complications including heart attack and stroke which needs to be considered in the context of symptoms and risks if the indicated surgery is not carried out.

Most patients get significant and long lasting relief from angina and their risk of heart attack is reduced. However, CABG is a palliative procedure rather than a cure for coronary artery disease. The disease may progress and native coronary arteries or grafts can get again narrowed and blocked with recurrence of angina, particularly if the operation is not followed by a change in lifestyle, improved control of risk factors and correct medication.