1. Your cardiologist can consider coronary bypass surgery in patients following Coronary Angiogram in the following conditions such as Angina, Heart Attack, New or increasing chest pain (unstable angina) and A heart valve problem that requires surgery
2. In most cases, Coronary Angioplasty (STENT implantation) can be performed, but for some types of blockages, coronary bypass surgery may be the best option.
3. You have more than one diseased coronary artery and the heart's main pumping chamber — the left ventricle — isn't functioning well.
4. Your left main coronary artery which supplies most of the heart is severely narrowed or blocked.
5. You have an artery blockage for which Coronary Angioplasty isn't appropriate, you've had a previous angioplasty or stent placement that hasn't been successful, or you've had stent placement, but the artery has narrowed again (restenosis).
6. Coronary bypass surgery may also be performed in emergency situations, such as a heart attack, if your doctor sees that you're not responding to other treatments.

As with any invasive procedures, there are some risks associated with the procedures. Although risks are there but the benefits of performing, CABG is important. The Potential complications include:

1. Bleeding
2. Irregularities of Heart Rhythm (arrhythmias)
3. Chest wound infection
4. Kidney Problems
5. Stroke
6. Heart Attack, if a blood clot breaks loose soon after surgery

Your risk of developing complications is generally low, but depends on your health prior to CABG.

Your risk of complications is higher if the operation is done as an emergency or if you have other medical conditions, such as emphysema, kidney disease, diabetes or blocked arteries in your legs (peripheral artery disease, or PAD).

1. Before your operation, your doctor will review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs including blood pressure and pulse. They will review the images of the coronary arteries obtained via coronary angiogram.
2. The doctor will obtain verbal and written consent ( after explaining procedure and potential complications)
3. You will be asked not to drink or eat anything for at least 4-6 hours before the surgery
4. The Anesthesia specialist will come and discuss about the anesthesia.
5. An IV line is inserted into a vein in your arm for IV fluids and other medications

1. For the surgery, you will be transferred to the operation theater/room.
2. After general anesthesia has started, a breathing tube is inserted through your mouth. This tube attaches to a ventilator, which breathes for you during and immediately after the surgery.
3. Coronary bypass surgery generally takes between 3-6 hours and requires general anesthesia. The number of bypasses required depends on the location and severity of blockages in your heart.
4. Most CABG surgeries are done through a long incision in the chest along the breastbone while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery OR without a heart-lung machine (called off-pump coronary bypass surgery).
5. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over to circulate blood to the body.
6. The surgeon takes a section of healthy blood vessel, often from inside the chest wall (the internal mammary artery) or from the lower leg (veins),or wrist ( radial artery) and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.

Your surgeon may use if you are having coronary bypass surgery:

1. On-pump coronary bypass surgery: This requires Heart-lung machine
2. Off-pump or beating-heart bypass surgery: This surgery is performed whilst the heart is still beating. This type of surgery is challenging and, it's not an option for everyone.
3. Minimally invasive surgery: . In this procedure, a surgery is performed through a smaller incision in the chest, often with the use of robotics and video imaging. This type of surgery is challenging and, it's not an option for everyone.

Coronary bypass surgery is a major operation. Patient usually spend a day or two in the intensive care unit and 4-5 days in surgical ward.

Your breathing tube will remain in your throat until you are awake and able to breathe on your own.

You will be seen by physiotherapist who will help in introducing exercises and breathing.

1. You may see some bruise at the puncture site (wrist or groin) which will improve itself. If you feel some discomfort, you can use paracetamol or other simple painkillers.
2. You may be referred to cardiac rehabilitation
3. It may take some time to go back to complete everyday tasks, or even walk a short distance
4. If you experience Fever, Rapid heart rate, New or worsened pain around your chest wound, Reddening around your chest wound, bleeding, or other discharge from your chest wound, CALL your doctor as these may be due to wound infection.

1. You can return to work in about six to 12 weeks.
2. In most cases, begin exercising and resume sexual activity after four to six weeks
3. Driving private vehicle after 4-6 weeks
4. Wait at least six weeks before riding a bicycle or lifting things because your breastbone needs time to heal.
5. Air travel after 4-6 weeks (longer if they have had pulmonary complications)

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