Coronary Artery Bypass Surgery

What is coronary artery bypass surgery?

Coronary artery bypass surgery (CABG) is a procedure that diverts the flow of blood around a blocked or partially blocked artery in your heart. The diversion aims to improve blood flow to your heart muscle.

During the surgery performed by a cardiothoracic surgeon, a healthy blood vessel is taken from either your chest, arm, or leg and used as a connector to other arteries in your heart, forming a diversion that bypasses the blockage.

With the blockage circumvented, the increased blood flow to your heart should allow you to feel less breathlessness and chest pain. In some patients, there is improved heart function and reduced risk of dying from heart disease.

When should I see a specialist for coronary artery bypass surgery?

You can see a specialist for your heart condition. You and your specialist can decide whether coronary bypass surgery or another artery-opening procedure, such as coronary angioplasty or coronary stent implantation, is right for you.

You can consider coronary bypass surgery if:

· Your chest pain is severe and is due to several narrowed arteries such that your heart is unable to get sufficient oxygen even at rest.
· You have more than one blocked (or partially blocked) coronary arteries and the left ventricle (the heart’s main pumping chamber that circulates blood to the rest of the body) is not functioning well
· Your left coronary artery which supplies most of the blood to the left ventricle is narrowed or blocked.
· You have had previous angioplasty or stent implantation that were not successful or the artery has narrowed again.

Did you know?

A Singapore study published in 2016 examined different factors in patients with coronary artery disease that contribute towards their physical health. Improving patients’ depression and promoting their ability to maintain function and control symptoms may be helpful in improving their physical health and quality of life¹.

What are the risks of coronary artery bypass surgery?

Coronary artery bypass surgery is an open-heart surgery. While the risk of developing complications is generally low, the likelihood is dependent on your health prior to surgery. Possible complications include
· Bleeding
· Heart rhythm irregularities (arrhythmias)
· Infections of the chest wound
· Stroke
· Kidney problems
· Heart attack, if a blood clot breaks loose soon after surgery

How should I prepare for my appointment?

As the cardiologist will ask you for your past medical and family history, be prepared with the following information:

● Current symptoms that you are experiencing including those that seem unrelated
● Current or previous medical conditions including any treatments such as diabetes or stroke
● Results of previous laboratory tests such cholesterol tests
● List of medications, vitamins or supplements currently being consumed.
● Be prepared to discuss your diet and your smoking and exercise habits. If you don’t already follow a diet or exercise routine, discuss getting started with one.

If possible, bring someone along with you to help remember what the doctor tells you.

To enable you to decide on whether you would want a coronary bypass graft surgery, you may wish to ask the cardiologist the following questions:

● How many arteries are blocked?
● What is the extent of the blockages?
● What are the signs that I need to go to a hospital or seek treatment right away?
● Are there any alternatives to the treatments suggested?
● I have other health conditions. How do I manage them together?

What can I expect during coronary artery bypass surgery?

Coronary artery bypass surgery is done under general anesthesia and can take between three and six hours depending on the location and severity of blockages.

The surgeon will access the heart through a long incision down the centre of the chest. The ribs are spread open to expose the heart which is then temporarily stopped. A heart-lung machine takes over to circulate the blood around the body. The surgeon will take a section of a healthy blood vessel from the chest or leg, and attach it above and below the blockage to divert the blood around the narrowed artery.

As this is a major operation, you should expect to stay in an intensive care unit where your vital signs are closely monitored. You should be discharged within a week or so depending on your condition. The recovery period is about 6 to 12 weeks.

How do I maintain my health after coronary artery bypass surgery?

Coronary artery bypass surgery improves blood supply to the heart, but it does not cure coronary artery disease. Lifestyle changes such as those listed below are encouraged for good results in the long term:

● Exercising regularly
● Curbing your smoking habit
● Eating healthily
● Maintaining a healthy weight

Your specialist will likely recommend that you undertake a cardiac rehabilitation program, comprising exercise and education, to treat your heart disease.

1. Wang W, Jiang Y, Lee C-H. Independent predictors of physical health in community-dwelling patients with coronary heart disease in Singapore. Health Qual Life Outcomes. 2016;14(1):113. doi:10.1186/s12955-016-0514-7.