Coronary Artery Bypass Graft Surgery

Risks

Coronary artery bypass graft surgery (CABG) is one of several significant advances in managing cardiovascular disease (CVD). It’s used to treat heart attacks or severe chest pain (angina) caused by blockages in the arteries that supply blood to the heart muscle.

The surgery carries many benefits, including some particularly for patients who have the most severe CVD. The operation can save your life if you’re having a heart attack or are at high risk of having one. If you have ongoing angina and shortness of breath from diseased heart arteries, an elective CABG is highly effective at eliminating or reducing discomfort. Essentially, CABG can give you your life back.

Because CABG is an open-heart procedure requiring general anesthesia and, in many cases, the heart is stopped during the operation, the surgery carries risks. The good news is that recent decades have seen a steep drop in serious complications with the majority of people who undergo CABG.

The risk of serious complications is higher for emergency coronary bypass surgeries, such as for patients who are having a heart attack, when compared to elective surgery for the treatment of angina and other symptoms. Additionally, you may be at a higher risk if you:

• Are over age 70
• Are female (assigned female at birth, or AFAB)
• Have already had heart surgery
• Have other severe conditions such as diabetes, peripheral artery disease (PAD), kidney disease, or lung disease

While significant complications from CABG are uncommon today, your care team will try to guard against them and treat them if they develop. They may include the following:

• Risk of bleeding from the site of the attached graft and other sources – Some patients will require blood transfusions after the surgery. Rarely, bleeding will be severe enough to require additional surgery.
• Heart rhythm problems – Atrial fibrillation (Afib), a condition in which the upper chambers of the heart quiver rather than beat properly, is a more common complication of CABG and can contribute to blood clots that form in the heart and can travel to other parts of the body. Other forms of heart rhythm problems are also possible, though less common.
• Blood clots – If blood clots form, they can cause a heart attack, stroke, or lung problems.
• Infection at the incision site where the chest was opened for surgery – This complication is extremely rare, occurring in only about 1% of coronary bypass patients.
• Post-pericardiotomy syndrome – This condition occurs in some patients from a few days to six months after the surgery. The symptoms are fever and chest pain.
• Kidney (renal) failure – CABG may damage the functioning of a patient’s kidneys, though this is most often temporary.
• Memory loss or difficulty thinking – Many patients report difficulty thinking after having CABG. This problem typically improves in six months to a year. Researchers are not sure what causes this, though one theory is that the use of a heart-lung machine to allow surgery on the heart dislodges tiny bits of fatty buildup in an artery that can travel to the brain. Studies have been inconclusive about whether surgeries on a beating heart and without the heart-lung machine reduce this complication.
• Reactions to anesthesia – As with any surgery performed while the patient is “asleep,” patients may react to the anesthesia, including difficulty breathing.
• Death – In-hospital death is very rare after CABG. It’s typically caused by a heart attack or stroke.

If you’re considering coronary bypass surgery on an elective basis to treat your heart disease, please discuss any concerns you have about balancing the benefits and risks of the surgery with your cardiac surgeon.