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Coronary Artery Bypass Grafting

Coronary artery bypass grafting (also known as bypass surgery or “CABG”) is a treatment for coronary artery disease (ischaemic heart disease or also known as atherosclerosis) and is the most common cardiac surgical procedure in the UK and at LHCH. 

It is usually offered to patients who have coronary arteries that cannot be stented; who have all three main coronary arteries blocked; or those who have two coronary arteries blocked but other significant risk factors (such as diabetes or any reduction in the strength of the heart, called the left ventricular ejection fraction). 

The decision to offer surgery is based on European Guidelines that have used the latest research to determine which treatments will be best for patients in the long term. 

In a CABG procedure, blood vessels from elsewhere in the body are removed (or “harvested”) in order to reroute the blood around the heart. The blood vessels that are taken are chosen based on whether they can be removed without it causing major harm to the blood flow. The most common blood vessels harvested are the Left Internal Mammary Artery (LIMA) from the inside of the  chest, the radial artery from the arm and the long saphenous vein from the inside of the leg. 

The disease in the coronary arteries is not taken out, but rather the blood supply to the area of muscle beyond the blockage is “bypassed”, hence the name.
Because the disease is not removed (this has been tried previously and causes too much damage), it is important that the medications used to prevent further progression of atherosclerosis continue to be taken lifelong. 

Surgery is needed for coronary artery disease if you have the following:

  • three major coronary artery territories blocked
  • two major coronary artery territories blocked AND diabetes or reduced heart function 
  • coronary artery disease in the first part of the left anterior descending coronary artery not amenable to stenting 
  • any coronary artery disease that cannot be stented and is causing crippling symptoms 
  • less severe coronary artery disease but another reason for cardiac surgery (e.g. valve disease) 

Benefits of performing this surgery are: 

  • to improve symptoms (angina, shortness of breath or fatigue, where these were present before surgery)
  • to prolong life (in patients who have evidence of disease that may shorten life expectancy)