Heart Bypass Surgery (CABG): Procedure, Side Effects, Benefits

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Dr. Aman Priya Khanna
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Medically Reviewed by Dr. Aman Priya Khanna Written by Kirti V

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CABG surgery is a treatment to restore blood flow to specific parts of your heart. A blockage in an artery can stop the flow of blood, which can result in heart attacks or heart attack-like symptoms. 

This procedure may benefit the heart function when someone has had a heart attack or is at a greater risk of experiencing one in the near future. It is commonly referred to as Coronary Artery Bypass Graft or heart bypass surgery. 

Surgery Name CABG Surgery
Alternative Name Coronary Artery Bypass Graft, Heart Bypass surgery
Disease Treated Coronary Artery Disease (CAD), Angina, Silent myocardial ischemia
Benefits of the Surgery Reduced risk of heart attack, Improved blood flow in the heart and its function
Treated by Cardiac surgeon

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What is CABG Surgery?

Coronary Artery Bypass Graft Surgery, or CABG, is a surgical procedure to treat narrowed or blocked coronary arteries that supplies blood to the heart muscle. 

CABG surgery improves blood flow to the heart by bypassing the blocked or narrowed areas of the coronary arteries with a healthy blood vessel taken from another part of the body.

Anatomy and Physiology of the Human Heart

The heart is a muscular organ which is located in the thoracic cavity, behind the breastbone and slightly to the left. It pumps blood throughout the body. It is divided into four chambers. 

The anatomy of the heart includes the following structures:

  1. Atria: It is the upper chambers of the heart. The right and left atrium receive blood from the body and lungs.
  2. Ventricles: It is the lower chambers of the heart. The right ventricle and the left ventricle pump blood to the lungs and the body, respectively.
  3. Valves: There are four valves which control the flow of blood through the chambers of the heart.
  4. Coronary Arteries: They are blood vessels that supply the heart muscle with oxygen-rich blood.
  5. Cardiac Muscle: The heart muscle, also known as the myocardium, contracts to pump blood through the heart.
  6. Veins and Arteries: The blood vessels that carry blood to and from the heart.
  7. Electrical System: It is composed of the sinoatrial (SA) node and the atrioventricular (AV) node, controls the heart's rhythm and ensures that the chambers contract correctly.

Who needs CABG Surgery?

CABG surgery is recommended for patients with severe coronary artery disease (CAD) caused by plaque buildup in the coronary arteries. This buildup, known as atherosclerosis, can block or narrow the coronary arteries, reducing blood flow to the heart muscle. Conditions treated using CABG Surgery are:

  1. Angina: Chest pain or discomfort caused by blocked or narrowed coronary arteries.
  2. Myocardial infarction (heart attack): Damage or death of a portion of the heart muscle caused by blocked blood flow to the heart.
  3. Heart failure: It is caused by narrowed or blocked coronary arteries. Due to this, the heart cannot pump blood adequately to the body.
  4. Left Ventricular Dysfunction: Reduced pumping ability of the left ventricle, one of the four chambers of the heart, caused by narrowed or blocked coronary artery.
  5. Cardiomyopathy: It makes the heart muscle harder to pump blood.

Who needs CABG Surgery?

Patients who may need CABG surgery have one or more of the following:

  1. Angina (chest pain) that medications can't treat
  2. A previous heart attack
  3. Significant blockages in multiple coronary arteries
  4. Heart damage or weakness that limits the ability of the heart to pump blood effectively
  5. Blockages that cannot be treated with angioplasty

How is CABG Surgery Performed?

The entire procedure may take anywhere between 3-6 hours or sometimes more. Patient vitals are monitored during the entire procedure. The procedure starts with the following:

  1. A urinary catheter is inserted.
  2. CABG surgery is done under general anaesthesia given intravenously.
  3. A breathing tube attached to a ventilator is inserted through the mouth. The ventilator breathes for the patient during and immediately after the surgery. 
  4. The surgical site is cleaned with an antiseptic solution.
  5. The surgeon will proceed with either one of the above based on your condition. CABG surgery procedure may be done in either of the following:
    1. On-pump procedure
    2. Off-pump procedure

On-pump & Off-pump CABG Surgery:

1. The surgeon will access the blood vessel to be used for the grafts by making an incision in either the leg(s) or wrist. After the removal of the blood vessel, the incision is closed. 

2. An incision is made from below Adam’s apple to just above the navel (i.e. incision from just below the neck till slightly above the belly button).

3. The sternum (breastbone is cut in half lengthwise, and halves are separated to expose the heart.

4. In the case of On-pump CABG Surgery: The heart is placed on a heart-lung bypass machine that pumps blood like an artificial heart. The heart is stopped temporarily by injecting a cold solution. 

In the case of Off-pump CABG Surgery: The heart is not stopped. Instead, a unique instrument is used to stabilize the area around the artery to be bypassed.

5. One end of the graft is sewn over a tiny opening made in the aorta, and the other end over a tiny space made just below the block. (If the internal mammary artery is used as a graft, the lower end of the artery is cut and sewn below the blockage. 

6. Depending on the number of arteries blocked, more than one bypass graft may be done. 

7. Grafts are checked as blood runs through them.

8. In the case of On-pump CABG Surgery: Blood circulating through the bypass machine is let into the heart. The heart may restart on its own, or a mild electric shock may be used to restart it. Temporary wires may be put in for pacing the heart.

9. The sternum is stitched with small wires.

10. To drain fluids from around the heart, tubes are inserted into the chest.

11. A tube is placed into the stomach through the mouth or nose to drain stomach fluids. 

12. To cover the surgical site, a sterile bandage is used.

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What to Expect Before and On the Day of CABG Surgery

Prior to the CABG surgery, the surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before CABG Surgery

  1. Medical history (current and past drug prescriptions, smoking/alcohol habits, lifestyle habits, presence of other concurrent health conditions, surgical history), complete physical exam, necessary blood tests and other diagnostic tests are prescribed to determine the type of CABG procedure to be done
  2. In case of elective surgery, the patient is admitted to the hospital a day prior to the scheduled procedure and provided with a unique identification number.
  3. No food or drink is allowed 8 hours before the procedure
  4. You may carry spare clothing, toiletries, comfortable slippers/shoes to the hospital. 
  5. It is recommended to leave all the jewellery and other accessories at home before getting admitted to the hospital. 

On the Day of the CABG Surgery

  1. A unique identification number as a wristband is assigned after admission 
  2. A consent form granting permission to the surgeon to do the procedure and not holding the hospital or surgeon and their team liable for complications (including death) is sought from the patient. 
  3. The patient is helped to change into a hospital gown, and all jewellery and accessories are removed. 
  4. Hair near the genital area (for urinary catheter) and the surgical site may be trimmed if required.
  5. Vitals are monitored

What to Expect after CABG Surgery?

CABG surgery usually takes 3-6 hours. The patient can go home within a couple of days after the procedure. The patient may expect the following after the surgery:

The recovery process at the hospital

  1. Monitoring: The vital signs will be closely monitored to ensure that they are stable and that the surgery was successful.
  2. Pain management: Pain and discomfort are common after CABG surgery. Medication will be prescribed to manage pain, prevent infection, and lower the risk of blood clots.
  3. Drainage: Patients may have a tube placed to remove any excess fluid from the chest area.
  4. Breathing exercises: Deep breathing exercises would be taught to help clear the lungs and prevent pneumonia.
  5. Discharge planning: Patients will receive discharge instructions and information on post-operative care, including follow-up appointments, medications, and lifestyle changes.

The recovery process after hospital discharge

  1. Rest and relaxation: Patients will need to rest and avoid strenuous activities for several weeks after surgery to allow the body to heal properly.
  2. Medications: Patients will continue to take medications as prescribed by their surgeon to manage pain, prevent infection, and lower the risk of blood clots.
  3. Physical activity: Patients will be encouraged to slowly increase their physical activity as they recover. They will be advised to start with light walking and gradually increase their activity level as they feel ready.
  4. Diet: Patients will be advised to eat a healthy diet that is low in saturated fat and cholesterol to promote healing and reduce the risk of further cardiac issues.
  5. Lifestyle changes: Patients will be advised to make lifestyle changes such as quitting smoking, reducing stress, and exercising regularly to reduce the risk of further cardiac issues.

First follow-up appointment

  1. Medical evaluation: The surgeon will perform a medical evaluation, including a physical examination and review of the patient's vital signs.
  2. Discussion of recovery: The surgeon will discuss the patient's recovery process and answer any questions the patient may have.
  3. Review of medication regimen: The surgeon will review the patient's medication regimen and make any necessary adjustments.
  4. Review of activity level: The surgeon will assess the patient's activity level and provide guidance on increasing physical activity as the patient recovers.
  5. Review of incision site: The surgeon will examine the incision site to ensure that it is healing properly.
  6. Review of lab results: The surgeon will review any lab results, such as blood tests, that were performed during the recovery process.

Benefits of CABG Surgery

Coronary Artery Bypass Graft surgery provides several benefits for patients with severe coronary artery disease (CAD), including:

  1. Improved blood flow to the heart: Bypassing the blocked or narrowed areas of the coronary arteries with a healthy blood vessel improves blood flow to the heart muscle, reducing symptoms such as chest pain (angina) and shortness of breath.
  2. Reduced risk of heart attack: Bypassing the blocked coronary artery reduces the risk of a heart attack by improving blood flow to the heart muscle.
  3. Relief of angina: CABG can relieve angina by improving blood flow to the heart muscle and reducing chest pain and discomfort.
  4. Improved heart function: It can improve heart function by increasing blood flow to the heart muscle, which can help to reduce the risk of heart failure.
  5. Long-term benefits: CABG has been shown to provide long-term benefits, with studies showing that patients who have had the surgery have a lower risk of dying from heart disease.
  6. Reduced need for medication: After coronary artery bypass surgery, many patients can reduce or stop taking medications for angina, high blood pressure, and other cardiac issues.

Risks and Complications of CABG Surgery

Complications and risks associated with CABG surgery are generally higher in comorbidities (i.e. presence of one or more additional medical conditions) such as diabetes, kidney disease, emphysema and others. Other risks include:

  1. Bleeding during or after the bypass surgery
  2. Blood clots that may cause heart attack, lung problems, or stroke
  3. Infection at the incision site
  4. Pneumonia
  5. Breathing problems
  6. Kidney failure
  7. Abnormal heart rhythms
  8. Failure of the graft

Risks of Delayed CABG Surgery

the delay in the surgery may be a result of the patient's overall health and the complexity of the surgery. In these cases, the delay is done in order to minimize the risks and to ensure the best outcome. If CABG surgery is delayed, the following risks can occur:

  1. Progression of disease: The blockages in the coronary artery may become more severe over time, leading to more damage to the heart muscle, and making the surgery more complex and risky.
  2. Increased symptoms: The patient's symptoms of chest pain (angina), shortness of breath, and fatigue may become more severe as the blockages in the coronary artery become more severe.
  3. Increased risk of heart attack: The risk of a heart attack increases as the blockages in the coronary artery become more severe.
  4. Reduced quality of life: The patient's quality of life may be reduced as the symptoms of CAD become more severe.
  5. Greater risk of death: The risk of death from CAD may increase as the blockages in the coronary artery become more severe.

Cost of CABG Surgery

The cost of CABG surgery ranges from ₹140000 - ₹ 350000. The cost varies based on the following factors:

  1. Type of CABG surgery
  2. Age of the patient
  3. The medical condition of the patient
  4. The type of hospital facility availed - individual room or shared

Procedure Name

Cost Value
CABG  ₹140000 - ₹ 350000

Frequently Asked Questions (FAQ)

CABG surgery is a surgical procedure that creates an alternative route for blood to flow around a clogged or partially blocked artery in the heart.
The full form of CABG is Coronary Artery Bypass Graft.

CABG surgery is required for the following conditions:

  1. Severe Coronary Artery Disease (CAD)
  2. Angina (chest pain)
  3. A previous heart attack
  4. Significant blockages in multiple coronary arteries
  5. Heart damage or weakness that limits the ability of the heart to pump blood effectively
  6. Blockages that cannot be treated with angioplasty

Yes, CABG surgery is an open heart surgery performed under general anaesthesia. The doctor makes an incision in the chest and uses a healthy blood vessel to bypass the blocked or narrowed coronary artery, improving blood flow to the heart muscle.


CABG surgery is considered safe, with a high success rate. There are a few risks involved, which are generally low.


CABG surgery has a high success rate, with studies showing that more than 90% of patients experience significant improvement in symptoms and a reduced risk of heart attack and death. 


After CABG surgery, patients will receive post-operative care to ensure a smooth recovery. The following are some of the aspects of post-operative care:

  1. Timely medications
  2. Physical therapy
  3. Follow-up appointments
  4. Lifestyle changes like no smoking
  5. Diet with low saturated fat and cholesterol
  6. Cardiac rehabilitation
  7. Monitoring the vital signs

The advantages of CABG surgery include the following:

  1. Improved blood flow to the heart
  2. Reduced risk of heart attack
  3. Relief of angina
  4. Improved heart function
  5. Long-term benefits

The risks involved in CABG surgery include the following:

  1. Bleeding
  2. Infection at the incision site
  3. Blood clots
  4. Heart attack or stroke

If the patient has symptoms or complications that need immediate attention, the surgery should be performed as soon as possible. If CABG surgery is delayed, the following can happen:

  1. Progression of disease and symptoms
  2. Increased risk of heart attack
  3. Reduced quality of life
  4. Greater risk of death

The risk of dying from heart disease in the first year after CABG surgery is around 2-3%. Studies have shown that patients who have had CABG surgery have a lower risk of dying from heart disease than those who did not. People can live for more than 15 years, and then they can improve their life expectancy by inserting a stent. 


CABG surgery is an invasive procedure that may cause discomfort and pain. However, the pain level varies for each patient in response to pain sensitivity. Patients will receive medication to manage pain during and after the surgery and physical therapy to help them recover.


Yes, CABG or Coronary Artery Bypass Graft surgery is major surgery. It involves opening the chest and connecting a healthy blood vessel to bypass the blocked coronary artery. It is usually performed under general anaesthesia. The recovery can take several weeks.


CABG surgery typically takes between 3 to 6 hours. However, the duration may vary depending on the patient's overall health, the complexity of the surgery, and the number of bypasses that need to be performed.


Yes, most patients can return to normal activities after CABG surgery with the guidance of their healthcare team. Lifestyle changes such as a healthy diet, regular exercise, and medication will be needed to recover and prevent further cardiac issues successfully.


The length of stay in the ICU after CABG surgery can vary depending on the overall health of the patient, the complexity of the surgery, and any complications that may arise. Usually, patients may stay in the ICU for 1-2 days. However, some patients may stay longer if they have any complications.


The cost of CABG Surgery in India ranges from ₹140000 - ₹ 350000.


CABG surgery is covered under insurance. It's important to check with the insurance provider to understand the coverage and any out-of-pocket costs that may incur.

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Kirti V

Kirti V

B.A. English | M.A. English ( Magadh University, Bihar)

3 Years Experience

With 3 years of full-time experience as an SEO content writer, she has honed her skills to deliver captivating and persuasive writing that leaves a lasting impact. She is always ready to learn new things and expand...View More

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