Why would I need coronary artery bypass surgery?

Coronary artery bypass surgery (CABG) is a surgical procedure used to treat blockages in the coronary arteries. The operation improves blood flow and oxygen supply to the heart and it bypasses or diverts blood around the narrowed parts of the major arteries. Cardiac surgeon Mr Shahzad Raja explains more about coronary artery surgery and answers commonly asked questions about the procedure.

How is coronary artery bypass surgery done? Is it a major surgery?

Coronary artery bypass surgery is a major operation, it’s one of the biggest operations that you may require in your lifetime. The operation involves taking a blood vessel from a part of the body, be it the chest, leg or arm and attaching it to the coronary artery of the heart, above and below the narrowed segment of the artery. This new blood vessel, taken from another part of the body is known as a graft. There are different types of grafts, broadly divided into arterial or venous grafts.

The operation is carried out under general anaesthetic, which means that you will be unconscious or sleeping during the operation. The procedure usually takes between three and four hours. The number of bypasses needed will depend on how many coronary blood vessels are narrowed, as well as the severity of the narrowing.

Is CABG safe?

CABG is one of the most commonly performed heart operations. Despite it being a big operation, it’s very safe, with the standard risk for a reasonably fit and otherwise well patient as low as 1-2%. There are, however, some minor and major complications associated with coronary bypass surgery. It’s important to reiterate that these complications don’t happen every day to everyone and, if they do occur, they are easily treatable. Common complications associated with bypass surgery include; an irregular heartbeat, wound infection, bleeding, stroke and heart attack.

Do your ribs have to be broken during the surgery to get to the heart?

There are different ways in which this operation can be done. The most common way to approach the heart is by splitting the breastbone, this is called a median sternotomy. The majority of operations, especially when a triple or quadruple bypass is needed are done using this approach.

If just a single bypass is needed, then the surgery usually involves entering the chest between the ribs, this is called a minimally invasive coronary bypass, where the ribs are stretched, but they are not broken.

How long will my chest hurt after the operation?

The pain threshold varies from individual to individual, however, most patients will receive strong painkillers for the first 24 hours to treat the pain associated with the incision. The intensity of the pain reduces with every passing day. Generally, most patients will require simple paracetamol or a combination of codeine and paracetamol from the third day after the operation onwards. Pain is usually manageable with paracetamol when the patient is discharged from the hospital.

What happens after being discharged from hospital?

Most patients will experience a significant improvement in symptoms such as angina and breathlessness after their operation. The risk of heart attack is also considerably low after the operation. Most people stay in hospital for up to seven days after the operation. Recovery takes time and everyone recovers at a different pace.

Generally, you will be able to sit in a chair one day after the operation, walk after 48 hours and go up and down stairs five to six days after the surgery. When you go home, it’s expected that you walk around and do deep breathing exercises to get yourself back on track. You should be able to return to normal activities like working and driving after about six weeks. Most people make a complete recovery within three months.

How should I sleep after the operation?

Patients are advised to sleep on their back, using one or two pillows to prop them up for the first four to six weeks. It’s generally advised not to lie on your side, as this can affect the healing of the breast bone. In exceptional circumstances you might be able to lie on your side, but with the support of a pillow. Overall, CABG is a generally safe procedure with a low risk of complications.

If you wish to know more about coronary bypass artery surgery, get in touch with Mr Shahzad Raja for more information.