Coronary Artery Bypass Graft (CABG)

Coronary artery bypass graft surgery, commonly referred to as heart bypass surgery or CABG, is a major heart procedure used to improve blood flow to the heart.

Coronary artery bypass surgery is primarily used to treat severe coronary artery disease, where the coronary arteries—the vessels that supply blood to the heart muscle—become narrowed or blocked. This is often due to a build-up of fatty deposits called plaques, which can lead to chest pain (angina), shortness of breath, and other symptoms.

In severe cases, coronary artery disease can result in heart attacks.

How CABG works

During CABG surgery, healthy blood vessels are taken from another part of your body – often from the leg or chest – and are used to create a new pathway around the blocked or narrowed coronary arteries. This allows oxygen-rich blood to flow more freely to the heart muscle.

The surgery is typically performed under general anesthesia and can take several hours.

In open surgery, surgeons make an incision down the chest, then use a heart-lung machine to maintain circulation while they work on the heart. In some cases, the surgery might be performed “off-pump,” meaning the heart continues to beat on its own. For some people, physicians at WashU Medicine may be able to offer a minimally invasive endoscopic CABG procedure that does not require a large cut like in open surgery.

When CABG is used

CABG is generally recommended when:

• Multiple coronary arteries are significantly blocked.
• The main artery supplying blood to the left side of the heart is severely narrowed or blocked.
• Non-surgical treatments, such as medication or angioplasty with stent placement, have
• not been effective.
• The patient has diabetes and multiple blockages.

Recovery and what to expect after CABG

Recovery from CABG surgery typically involves a hospital stay of about a week, followed by a period of gradual recovery at home. Most people can return to normal activities within a few months. Your healthcare team will provide specific guidance on activity levels, medications, and follow-up appointments.

After surgery, patients often need to make lifestyle changes to enhance the long-term success of the procedure. This includes adopting a healthy diet, quitting smoking, getting regular exercise, and managing conditions like high blood pressure and diabetes.

Risks and considerations

As with any major surgery, CABG carries some risks. Possible complications can include infection, bleeding, heart rhythm problems, stroke, and, in rare cases, heart attack. It’s crucial to discuss these risks with your healthcare provider to determine if CABG is the right option for you.

Cardiac surgeons at WashU Medicine take active steps to reduce major complications and optimize outcomes including:

• An active program of physical rehabilitation starting the first day after surgery
• Encouragement of smoking cessation
• Evidence-supported use of medications such as aspirin within 48 hours of surgery; statin drugs to control cholesterol; and long-term use of beta-blockers (drugs that slow heart rate and lower high blood pressure) and ACE inhibitors (drugs that also control blood pressure)