What is coronary artery bypass surgery?
artery bypass graft surgery (also called CABG or "cabbage") helps improve blood
flow to the heart in people with severe
coronary artery disease. The surgeon connects, or
grafts, a healthy artery or vein from another part of your body to the blocked
coronary artery. The grafted blood vessel goes around (bypasses) the blocked
part of the artery. This provides a new pathway for blood to your heart.
The goals of bypass surgery are to:
- Relieve chest pain (angina) and
other symptoms of coronary artery disease.
- Improve your quality
- Increase your heart’s ability to pump blood.
- Improve your chances of living a longer life.
your chances of having a heart attack.
Bypass surgery does a good job of treating coronary
artery disease, but it is not a cure. Bypass surgery doesn't change the way
arteries harden or narrow because of heart disease. And even after surgery, you
can still get new blockages. These can occur in the new blood vessels that
bypass the blocked arteries, as well as in the original coronary arteries.
What happens during and after bypass surgery?
anesthesia before the surgery that will make you
sleep. In most cases, bypass surgery is open-chest surgery. During the surgery,
your chest will be open and your heart exposed. The surgeon makes a large cut,
or incision, in your chest. He or she then cuts through your breastbone and
spreads apart your rib cage.
The surgeon removes a healthy blood
vessel-often from the leg-and attaches (grafts) it to the blocked artery. The
new blood vessel bypasses the blocked artery to increase blood flow to the
heart. You may need just one bypass graft, or you may need more. Some people
have as many as two, three, or even four (double, triple, or quadruple bypass
surgery). How many grafts you need depends on how many arteries are blocked and
When the surgery is complete, the doctor will use wire to
put your rib cage back together and stitches to close the incision. The surgery
can take 3 to 6 hours.
You will stay in the hospital at least 3
to 5 days after the surgery. It can take 4 to 6 weeks to recover at home. Most
people are able to return to work within 1 to 2 months after surgery.
See a slideshow on
bypass surgery to see how it is done.
How do you know if you need bypass surgery?
everyone with coronary artery disease needs bypass surgery. Some people can be
angioplasty with stents or medical therapy, which
involves making lifestyle changes and taking medicines, or both. Your doctor is
likely to recommend bypass surgery only if you will benefit from it and if
those benefits are greater than the risks.
Your doctor may advise
bypass surgery if:
- Your left main heart artery is very
- All three arteries of the heart are blocked or the amount
of blood flowing through them is very low.
- Your doctor thinks that
bypass surgery will be more successful than angioplasty with stents.
- You also need surgery to repair or replace a heart valve damaged
heart valve disease.
- You have
diabetes and two or more blocked
- Your heart is having trouble pumping. This is called a
If only two of your arteries are blocked and neither of
these is the left main artery, your choice may not be as clear. Talk with your
doctor about the best treatment for you. This may depend on your age, your
health, and how much your chest pain is affecting your quality of life.
What are the risks of bypass surgery?
surgery has been done for more than 30 years. In the United States, it is done
more often than any other major surgery. But it has some serious risks.
The risks of bypass surgery include:
- Death. Out of 100 people who have bypass
surgery, 2 of them will have a serious complication that leads to death, while
98 of them will not.1
- Heart attack. Out
of 100 people who have bypass surgery, 5 will have a heart attack, and 95 will
- Stroke. Out of 100 people who have
the surgery, 1 to 5 will have a stroke, and 95 to 99 of them will not.3
- Too much bleeding, leading to the need for a
transfusion. This happens in 30 out of 100 people who have the surgery.4 This means that 70 out of 100 people don't have bleeding
Other risks include return of angina, problems tied to
anesthesia, and infections at the site of the chest incision.
Some people also have memory loss and trouble thinking clearly. These
problems are most common in older people and tend to improve several months
The chances of having a serious problem with
bypass surgery are higher if you are older than 70. Your risk is also higher if
you have other problems such as diabetes, kidney disease, lung disease, or
peripheral arterial disease. It's important to talk
with your doctor to find out how your health affects your risk.
How well does bypass surgery work?
reduces angina and other symptoms of coronary artery disease. About 95 out of
100 people who have the surgery get relief from chest pain right away, while 5
out of 100 do not.3
More than 80 people
out of 100 are still free of chest pain 5 years after surgery.3 People who have bypass surgery tend to have longer relief
from repeat heart problems compared to other treatments.
surgery can increase your chances of living a longer life. More than 90 people
out of 100 who have a bypass are still alive 5 years after surgery.3
How long a bypass lasts depends on how long the
blood vessel grafts stay open. Most bypass grafts that are done with arteries
stay open for 10 years or more. That makes it less likely that you will need a
repeat surgery during that time.5
success of bypass surgery also depends on you. If you smoke and don't quit, you
won't get the most benefit from bypass surgery. You may need to make some other
big changes, like eating right and getting regular exercise. These changes will
help your bypass grafts last and stay open longer. They will also give you the
best chance of living a longer, healthier life.
If you are taking
medicines for angina, to lower cholesterol, or to control blood pressure, it’s
also important to take these every day. Along with lifestyle changes, these
medicines can help you get the most benefit from bypass surgery.
Bypass surgery is not a cure for heart disease. That's why all of these
things-eating right, not smoking, getting exercise, and taking medicines-are so
important. Without them, you raise your risk of getting new blockages and
needing another surgery.
Are there other treatment choices?
for you and your doctor to talk about are:
- Angioplasty with stents. Angioplasty has
fewer risks in some patients, and recovery is quicker than with surgery. But
there is a greater chance that the artery will narrow again within 1 year. This
means that you may need another angioplasty or bypass surgery to reopen it. For
at least a year after angioplasty with stents, you may need to take medicine to
reduce the risk of blood clots.
- Medicines and lifestyle changes. This is sometimes called
medical therapy. This may be a choice for you if your chest pain is not
affecting your quality of life. But in order to be successful, you'll need to
follow a strict program of medicines and lifestyle changes, including eating
right, getting regular exercise, and not smoking.
Bypass surgery offers more relief from chest pain and
other symptoms and the chance at a longer life compared with making lifestyle
changes and taking medicines alone.6
Bypass surgery and angioplasty with stents have similar results in terms of
improving your chances of living a longer life.7 But
bypass surgery will help keep your arteries open longer. It’s also a better
choice if your coronary arteries are narrow or if the amount of blood flowing
through them is very low.
If you have diabetes, bypass surgery is
almost always better than angioplasty. Bypass surgery lowers the risk of death
and heart attack in people with diabetes compared to angioplasty with stents.
Bypass surgery can also help you live longer than angioplasty with stents if
you have a decreased ejection fraction.
Ask your doctor what you
can expect to happen if you have bypass surgery, compared with having other
kinds of treatment like medical therapy or angioplasty with stents. Your doctor
should be able to tell you why bypass surgery would be a good choice. Sometimes
it helps to see another doctor to get a second opinion.
information on angioplasty, see:
- Should I have angioplasty?
If you need more information, see the topic
Coronary Artery Disease.