Introduction
Coronary Artery Bypass Grafting (CABG), commonly known as bypass surgery, is a major surgical procedure used to treat severe coronary artery disease (CAD). CAD occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed or blocked by a buildup of fatty plaque (atherosclerosis). This restricts blood flow, leading to chest pain (angina), shortness of breath, and a high risk of a heart attack. CABG aims to restore normal blood flow to the heart muscle by creating a new path (a bypass) around the blocked or narrowed sections of the artery. It is a life-saving procedure that relieves symptoms, improves heart function, and significantly reduces the risk of future heart attacks.

Surgical procedure
CABG is an open-heart surgery performed under general anaesthesia and typically takes 3 to 6 hours.
First, the surgeon makes a long incision down the centre of the chest and cuts through the breastbone (sternum) to access the heart.
Simultaneously, another surgical team harvests a healthy blood vessel to use as the graft. This vessel is most commonly taken from the leg (saphenous vein), the chest wall (internal mammary artery), or the arm (radial artery).
In a traditional CABG, the patient is connected to a heart-lung bypass machine, which temporarily takes over the function of the heart and lungs, keeping oxygenated blood circulating through the body while the heart is stopped to allow the surgeon to operate on a still surface. (In some cases, “off-pump” or “beating heart” surgery is performed without the machine).
The surgeon attaches one end of the harvested graft vessel above the blockage and the other end below the blockage, effectively routing blood flow around the obstruction. This process is repeated for each blocked artery (e.g., a “triple bypass” means three blockages were bypassed).
Once the grafts are secure, the heart is restarted (if stopped), the bypass machine is disconnected, and the breastbone is wired back together. The chest incision is then sutured closed.

Surgical Risks
As a major open-heart surgery, CABG carries significant risks, which are higher for older patients or those with other serious medical conditions (like diabetes or kidney disease).

General Complications
Common post-operative issues during the initial recovery include:
– Significant pain and discomfort at the chest incision site and the graft harvest site.
– Fatigue and weakness, which can last for several weeks.
– Swelling in the leg if a vein was harvested from there.
– Temporary loss of appetite or changes in taste.
– Emotional changes, such as mood swings or depression, are very common following major heart surgery.

Rare but Serious Complications
Severe complications can be life-threatening:
– Bleeding during or after the operation, which may require a return to the operating theatre.
– Heart attack or stroke during or shortly after the procedure.
– Infections at the chest wound site (deep sternal wound infection) or within the chest cavity, which can be very serious.
– Arrhythmias: Irregular heartbeats, such as atrial fibrillation, are common and usually temporary, but may require medication.
– Kidney failure or lung complications (such as pneumonia).
– Cognitive decline: Some patients experience temporary or, in rare cases, long-term memory loss or difficulty thinking clearly (“pumphead”).

Pre-operative Preparation
– Extensive medical assessment: This includes an angiogram (to identify blockages), an echocardiogram, an electrocardiogram (ECG), chest X-rays and comprehensive blood tests.
– Medication Adjustments: Blood thinners must usually be stopped several days before surgery to prevent excessive bleeding.
– Lifestyle Changes: It is absolutely essential to give up smoking before surgery in order to reduce the risk of lung complications and promote healing.
– Fasting: Patients must fast from midnight on the night before the operation.

Post-operative Care
Immediately after surgery, patients are moved to the Intensive Care Unit (ICU) for 1 to 2 days, where they are closely monitored. Breathing tubes, pacing wires, and chest tubes (to drain fluid) will be in place initially. Once stable, patients are moved to a regular hospital room for another 3 to 5 days.

Wound Care
– Keep all incisions clean and dry. Inspect them daily for signs of infection (increased redness, swelling, warmth, or pus).
– A special supportive bra or chest harness may be provided to support the healing breastbone.
– Follow the specific instructions on how to care for the leg wound if a vein has been harvested.

Diet
A heart-healthy diet is essential. This means a diet low in saturated fats, cholesterol and sodium, and high in fruit, vegetables and whole grains. This diet helps prevent new blockages from forming in the grafts or other arteries.

Post-discharge Notes
Full recovery from CABG takes 6 to 12 weeks.
– Precautions regarding the sternum: You must protect your healing breastbone. Do not lift anything heavier than 5–10 pounds, avoid pushing or pulling heavy objects, and do not raise your arms above your head for 6 to 8 weeks.
– Cardiac Rehabilitation: Participation in a structured cardiac rehab programme is highly recommended to safely rebuild strength and establish heart-healthy habits.
– Do not drive until your doctor has given you the all-clear (usually 4 to 6 weeks).
– Contact your doctor immediately if you experience a fever, sudden shortness of breath, a rapid or irregular heartbeat, or worsening chest pain.