Coronary artery bypass

What is a coronary artery bypass?

A coronary artery bypass is an operation to improve the blood flow to your heart. Your heart is a muscle about the size of a fist. It has its own blood vessels called coronary arteries. These arteries bring the heart muscle the oxygen it needs to keep pumping blood round your body.

If these arteries have been narrowed by heart disease, your heart doesn't get enough oxygen. This can give you chest pain. In a bypass operation, a surgeon takes parts of healthy blood vessels from another part of your body (such as your leg) and uses them to take over from the narrowed arteries in your heart.

What happens during a coronary artery bypass?

Bypass surgery usually takes between three and six hours. You'll be given a general anaesthetic, so you'll be asleep during the operation.

At the start of the operation, the surgeon takes some healthy blood vessels from another part of your body. These will be used to take blood around (bypass) the narrow parts of the arteries in your heart. This is called a graft. Healthy blood vessels can be taken from:

• The leg (saphenous vein)
• Inside the chest (internal mammary artery)
• The arm (radial artery).

The number of blood vessels the surgeon needs to remove will depend on how many parts of your coronary arteries the surgeon needs to bypass. Some people only need one or two grafts, but most need three or four. Your surgeon will discuss how many grafts are needed before you have the operation.

To operate on your heart, the surgeon will usually make a cut down the middle of your breastbone and gently pull your ribs apart so your heart can be seen. The surgeon works on the surface of the heart where the blood vessels run. The surgeon usually needs to stop your heart so it doesn't keep beating while he or she is trying to sew the new blood vessels in place. A hear t-lung machine is used to pump blood round your body while your heart is stopped. Sometimes surgeons can do the operation without stopping your heart (they call this off-pump surgery). But the machine is always there in case you need it.

The surgeon will then sew the new blood vessel (the graft) to your coronary artery, bypassing the narrow part. One end of the healthy vessel will be sewn above the blockage, and the other end below. After the surgeon has stitched all the grafts in place, the heart-lung machine will be switched off and your heart will start beating again. The cut along your breastbone is then stitched up.

After the operation, you'll be taken to intensive care or a cardiac recovery ward, where nurses will keep a close eye on you overnight. Sometimes there is fluid left in your chest after the operation, and you'll have a tube put in your chest to drain it. The tube is usually taken out the next day. In one or two days you should be well enough to walk.

How can a coronary artery bypass operation help me?

If you have angina, having a coronary artery bypass can:

• Reduce your chest pain and stop you feeling so breathless. About 9 in 10 people have no angina after their operation.[2] Half the people who have bypass surgery still have no symptoms of angina five years later[3] [4] [5]
• Reduce the amount of tablets you need to take for angina. You may even be able to stop taking them altogether.[3] You may need to keep taking tablets for high blood pressure and high cholesterol. Taking aspirin will reduce the risk of your new, healthy blood vessels clogging up
• Generally make you feel better. You may be more able to go out and see friends or have hobbies.[3] [6] [7]

If you've had a heart attack, having a coronary artery bypass can:

• Help you live longer.[8] You're about 40 percent more likely to be alive in five years and 20 percent more likely to be alive in 10 years than you would be with just drug treatment.

However, you should know that bypass surgery can't cure your heart disease. It's possible to get new blockages. You can reduce this risk by stopping smoking, taking the tablets your doctor prescribes and exercising regularly.

What are the risks?

All operations have risks, and your surgeon will talk them through with you before you have a coronary artery bypass.

Anaesthetics can have side effects. For example, you may feel sick afterwards. You can also have an allergic reaction to the anaesthetic or get breathing or heart problems. This is serious, but also very rare. If you have any allergies, you must tell your doctor.

In the first few days after surgery, you may have these problems:

• Pain in your chest. It takes months for the breastbone to heal, and you may need to take painkillers for a few weeks after your operation. If you are in pain you should tell a doctor or nurse straight away. Don't put up with pain while you wait for your next scheduled dose of painkillers
• Pain where the su rgeon removed a blood vessel. So if a vein was removed from your leg, you may have pain and swelling there
• An i rregular heartbeat. It may feel as though your heart misses a beat, or beats too quickly. This can happen to about a third of people who have bypass surgery. It should settle down after a few days, but you may need tablets to make it beat regularly again[9] [10]
• A b lood trans fusion. Just under a third of people need a blood transfusion. About 5 in 100 people bleed so much that they need to go back into the operating theatre for the surgeon to stop it[11]
• Help with breathing. Around 1 in 20 people need to be put on a ventilator to breathe properly.[2] Even so, they can usually breathe on their own after 48 hours
• A h eart attack. You can have a heart attack during or just after the operation. This happens to about 1 in 100 people.[2] You'll need emergency treatment
• A stroke. You can have a stroke during or just after the operation. This happens to about 3 in 100 people.[2] A stroke could give you problems using one side of your body or difficulty speaking or swallowing.

In the weeks and months after surgery:

• Infection. There's a small chance that the wound in your chest will become infected and that you'll need to stay in hospital for a few extra days while you are given antibiotics. This happens to about 1 in 100 people.[12] There's also a chance that the place your new arteries were taken from could get infected. About 4 in 100 people get an infection in this wound, but only about 1 in 200 need treatment for it[13]
• Problems with your memory. Between 1 and 5 out of 100 people have problems with their memory. You may find you don't feel as sharp mentally as you did before the operation. But this usually gets better over the next six months
• A h eart attack. There's a small chance you could have a heart attack. About 7 in 100 people who have this type of surgery have a heart attack within 30 days.[8] But most of them get better
• A s troke. There's a small risk that you could have a stroke. This happens to about 1 or 2 people in 100.[2] [14] You may be more at risk of a stroke if you are 70 or older at the time of the operation. A stroke could give you problems using one side of your body, or difficulty speaking or swallowing
• Kidney problems. Bypass surgery can stop your kidneys working properly. They usually recover, but in rare cases you may need dialysis (where a machine does the work of your kidneys and gets rid of waste products in your blood)
• Dying from your operation. There's a small chance that you could die. About 3 in 100 people die within 30 days of having bypass surgery.[8]

Doctors can do things to reduce all of these risks. For example, you'll be given aspirin and drug treatment to lower your cholesterol, as these can help prevent the new arteries clogging up with fatty material.[1] This will reduce your risk of having a heart attack.

What will happen if I choose not to have the operation?

No one can say for certain what will happen if you don't have bypass surgery, but research shows that:

• If you have angina, you're more likely to have a heart attack. Every year, about 5 in 100 people with angina have a heart attack or die from heart disease[1]
• If you've just had a heart attack, you're at an increased risk of having another. Many things, including your age and your general health, affect this risk
• About half of people who have a heart attack die within a month [15]
• Within six years of having a first heart attack, about 20 in 100 men and 30 in 100 women will have another one [16]
• Of men between 40 and 60 who survive the first month after their heart attack, about 25 in 100 die within five years. This compares with about 10 in 100 men who haven't had a heart attack.[17] [18] [19]

What other treatments are there?

What can I expect after a heart bypass?

You should recover quickly. You'll usually be walking after two days and home within 10 days.[2] You'll need someone to collect you from hospital, as you shouldn't drive for at least four weeks after the operation.