Coronary artery bypass graft surgery (CABG, pronounced “cabbage”) is the most commonly performed type of heart surgery. In the year 2003 there were 467,000 bypass surgeries performed in the United States, and 26% of these were performed on women.
During bypass surgery, a healthy artery or vein is removed from another part of your body and used to re-route blood flow around a blocked or narrowed coronary artery. The healthy vein or artery is called a bypass graft. One end is sewn to the aorta (the largest artery that comes out of your heart) and the other end is attached to the coronary artery just below the blockage. A vein in the leg (the saphenous vein) or an artery in the chest (the internal mammary artery) is usually used to create the bypass graft. More rarely, an artery from the arm or the stomach may be used. Removing these healthy vessels is harmless since there are many other arteries and veins that can take over for them.
Heart Before Bypass
Heart After Bypass
Who should have bypass surgery?
Most patients with coronary artery disease do not require surgery. Bypass surgery is usually reserved for women with severe blockages in two or more arteries. Women with narrowings in only one coronary artery are usually treated with balloon angioplasty or stents. If you have other conditions, such as diabetes, bypass surgery may be the best treatment option. You may require one, two, three, or more bypass grafts depending on how many arteries are blocked.
Bypass surgery may be recommended if you have blockages in several arteries of the heart, a severe narrowing in the largest coronary artery (on the left side of the heart), severe chest pain, or blockages that have not responded to other treatments (such as medication or balloon angioplasty). Your doctor will recommend bypass surgery based on your symptoms and the results of diagnostic tests including cardiac catheterization.
What are the risks associated with bypass surgery?
As with any medical procedure, bypass surgery is associated with certain risks. However, these risks are usually outweighed by the fact that bypass surgery can lengthen life and greatly improve quality of life by alleviating symptoms such as chest pain and shortness of breath. Complications that may occur during or after bypass surgery include bleeding, infection, high blood pressure, abnormal heart rhythms (arrhythmias), and breathing difficulties. These complications are relatively rare, usually not serious, and resolve within a few weeks. However, more serious complications such as heart attack, stroke, or death can occur.
Bypass surgery has become safer as techniques improve. One database of more than 1 million bypass patients found that the death rate fell from 3.9% in 1990 to 3.0% in 1999. This was despite the fact that the average patient undergoing surgery in 1999 was older and sicker than the average patient in 1990.2
Women with certain conditions such as high blood pressure, diabetes, obesity, or peripheral vascular disease (blockages in arteries outside the heart, usually the legs) are at increased risk for complications after bypass surgery. If you have already had bypass surgery, you are also at higher risk, and the risk of surgery is generally higher for women over 70 years of age.