People who have certain conditions may benefit from CABG, such as those who have obstructive coronary artery disease, a type of ischemic heart disease. Obstructive coronary artery disease occurs when plaque builds up in the coronary arteries that supply the heart with oxygen-rich blood.
Your heart care team will work with you to decide if CABG is right for you. Your team includes your heart doctor, called a cardiologist, and a cardiothoracic surgeon, who specializes in heart, lung, and chest surgeries.
During an emergency, such as a heart attack or sudden cardiac arrest, CABG or another procedure may be performed with consent from a heart care team. If it is not an emergency, the team will evaluate your symptoms, medical history, the severity of your condition, your overall health, and how treatment will help you. The team will also consider your preferences after discussing the risks and benefits of CABG with you and your family.
The heart care team may recommend CABG to relieve symptoms and to improve your chance of living longer. Surgery is not always the best option for everyone. Depending on your overall health and other conditions, your care team may recommend an alternative procedure called percutaneous coronary intervention (PCI), which may include placing a stent. This procedure is also known as coronary angioplasty.
CABG may be recommended when you have:
Your doctor may use diagnostic tests or procedures before CABG to determine how serious your ischemic heart disease is and where the coronary arteries are narrowed. If you need CABG, talk to your doctor about how to prepare for the procedure.
Tests and procedures may include the following:
CABG may be planned ahead of time, or it may be performed in an emergency situation, such as after a heart attack that leads to severe heart failure. If your surgery is scheduled, talk to your doctor about what to expect and how to prepare, such as:
Your doctor will also discuss treatment options with you, including the risks and possible complications during and after surgery. Ask your doctor any questions you have so you can make the best decision about your treatment.
During CABG, a surgical team will take one or more blood vessels from another part of your body and connect it to the blocked artery in your heart. CABG may be performed in one of three ways. In traditional CABG, the chest is cut open and a machine pumps your blood. In “off-pump” CABG, the chest is opened, but a machine for pumping blood is not used. With minimally invasive CABG methods, only small cuts are made in the chest, and a machine is not used.
Your surgical team will include a cardiothoracic surgeon, who will work on your heart. An anesthesiologist will give you medicine to make you sleep before the surgery, connect you to a breathing machine, and monitor your vital signs throughout the procedure. A perfusionist will manage the heart-lung pump, and nurses and other surgeons may help throughout the surgery.
Traditional CABG is the most common type of CABG surgery. This surgery takes about three to six hours, depending on how many arteries need to be bypassed. Learn more about how to prepare before surgery.
You will be given an intravenous (IV) line for fluids and medicines that will make you sleep before the surgery. You will be connected to a ventilator to support your breathing. The surgeon makes a cut down the middle of the chest, through the breastbone. The bone is split and the rib cage separated so the surgeon can reach the heart.
You will receive medicines to temporarily stop your heart from beating. This makes it easier for the surgeon to connect the healthy blood vessels, called grafts, into the coronary arteries. This requires a heart-lung bypass machine, which adds oxygen to your blood and pumps it throughout your body during surgery while your heart is not beating.
The surgeon will then take an artery or a vein from your leg, arm, stomach, or chest. The graft is connected to the blocked coronary artery. The new blood vessel bypasses the blocked portion to create a new path for blood flow to the heart muscle. The number of grafts depends on how many coronary arteries need to be bypassed.
When the grafting is finished, the surgeon will restart the heart and restore blood flow. The heart usually starts beating on its own, but sometimes mild shocks are used to start it. Surgeons will sew the breastbone back together with a wire.
Sometimes CABG can be done without stopping the heart and using a heart-lung bypass machine. This is called off-pump CABG because the heart-lung bypass machine, or pump, is not used. The heart is steadied with a mechanical device. It is more difficult for surgeons because the heart is beating, and surgeons do not have easy access to blood vessels. However, it may be safer for certain people, such as those who have a higher risk of complications from using a heart-lung bypass machine. These include older adults and people who have ventricular dysfunction, diabetes, kidney disease, and chronic lung disease. This type of surgery is also sometimes called beating-heart bypass grafting.
Sometimes, CABG surgery may not be done as open heart surgery. There are less-invasive methods, including:
After CABG surgery, you will need time to recover. There are also potential complications from surgery.
You will stay in the hospital for about one week. You may stay longer if you had other procedures done as well or if you have a complication. You will stay in an intensive care unit (ICU) for a day or two, where medical staff may do the following:
After you leave the hospital, you will need to continue taking medicines. Some common side effects from surgery, which should go away in four to six weeks, include the following:
After you leave the hospital, you will need about six to 12 weeks to recover completely. People who undergo minimally invasive CABG need less time to recover than for traditional CABG.
All surgeries have risks. The risk is generally higher for certain people, such as those who get CABG in an emergency situation, have plaque in other arteries throughout the body, or have other medical conditions, such as major heart failure, or lung or kidney disease. Potentially serious complications may include:
CABG is a treatment but not a cure for ischemic heart disease. It is important to work with your doctor after CABG to help you stay healthy. This may include taking medicines prescribed by your doctor, making healthy lifestyle changes, getting regular medical checkups, and participating in cardiac rehabilitation.
Your doctor will likely discuss medicines with you shortly after your surgery. Some of them are important to start right away. You may need to take them for up to one year or even continuously throughout your life. These medicines may include:
After surgery and after recovery, your doctor will want to schedule checkups to look for common complications of CABG or further problems from ischemic heart disease.
Even if you do not experience any signs or symptoms, you may need testing about five years after CABG surgery, or sooner if you have new symptoms or have other risk factors. You may take a stress test with an electrocardiogram or echocardiogram, or other heart and lung imaging. If you have symptoms such as chest pain, especially before or during the stress test, your doctor will likely recommend coronary angiography to check on the graft and other arteries.
Your doctor will discuss heart-healthy lifestyle habits and changes that are important to maintaining your health and controlling risk factors, such as hypertension and diabetes. These include:
Your doctor may refer you to cardiac rehabilitation to improve your heart health after a heart-related procedure or heart condition. Cardiac rehabilitation helps you maintain or adopt heart-healthy lifestyle practices to lower your risk for cardiovascular diseases. This program includes exercise training, education on heart-healthy living, and counseling to reduce stress and help you return to an active life. These rehabilitation programs are supervised by doctors and are usually offered in hospitals or community facilities.
Your doctor will likely ask if you have had any changes in your mood or other aspects of your well-being. It is important to be treated for depression to increase your chance of full recovery.
If you have symptoms of depression, your doctor may refer you to a mental health specialist. Treatment may include counseling and medicine.
Complications can occur quickly or years after CABG. One possible complication is that the graft will become blocked with plaque and limit or stop blood flow to the heart. If your graft stops working, this may cause a heart attack or other problem with your heart, and you may need additional surgery or PCI.
If you think that you are or someone else is having the following symptoms, call 9-1-1 right away. Every minute matters.
Learn about the following ways the NHLBI continues to translate current research into improved health for people who need coronary artery bypass grafting. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
Learn about some of our pioneering research contributions that have improved clinical care.
In support of our mission, we are committed to advancing research on coronary artery bypass grafting, in part through the following ways.
Learn about exciting research areas the NHLBI is exploring that involve CABG.
We lead or sponsor many studies on coronary artery bypass surgery and heart disease treatments. See if you or someone you know is eligible to participate in our clinical trials.
After reading our Coronary Artery Bypass Grafting Health Topic, you may be interested in additional information found in the following resources.