Heart bypass surgery (Coronary artery bypass grafting (CABG))
A major heart operation that uses a blood vessel from your chest, leg or arm to carry blood around narrowed coronary arteries, easing angina and lowering the risk of a heart attack.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A bypass reroutes blood around narrowed heart arteries to ease angina and, for many people, lower heart-attack risk.
- It treats today's blockages but does not cure coronary heart disease, so medicines and lifestyle changes continue for life.
- This is major surgery: most people spend about a week in hospital and take 2–3 months to feel fully recovered.
- For some people, stents or medicines are a reasonable alternative, so it is worth asking how the heart team reached their recommendation.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Often gives lasting relief from angina and breathlessness on effort
Your disease is limited and better treated with stents or medicines alone.
You are looked after in intensive care or a high-dependency unit, with close monitoring, drains and lines, which are removed as you stabilise.
A named contact and clear out-of-hours route for chest pain, breathlessness or wound problems.
You are looked after in intensive care or a high-dependency unit, with close monitoring, drains and lines, which...
You move to a ward, start getting up and walking, and begin gentle breathing and movement exercises. Most people...
Tiredness is normal and the chest wound feels tight or sore. Avoid heavy lifting, pushing and pulling to protect...
Energy improves and many people return to light work and most normal activities. Cardiac rehabilitation builds...
What is heart bypass surgery (CABG)?
Coronary artery bypass surgery, often called a heart bypass or CABG, is an operation for coronary heart disease, where the arteries supplying the heart muscle have become narrowed by fatty deposits. The surgeon takes a healthy blood vessel from your chest, leg or arm and uses it to create a new route, a 'bypass', that carries blood around the narrowed section.
It is usually done to relieve angina (chest tightness or breathlessness on effort) and, in many people, to lower the future risk of a heart attack. The number of bypasses depends on how many arteries are affected, which is where terms like 'double' or 'triple' bypass come from.
A bypass treats the arteries that are blocked now. It does not stop coronary heart disease coming back, so medicines, not smoking, exercise and managing blood pressure, cholesterol and diabetes remain important for life.
This is major open-heart surgery with a serious recovery, not a quick fix. For some people, stents (angioplasty) or medicines alone may be a better or safer option, and a heart team will weigh this up with you.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Bypass surgery vs stents (angioplasty)
| Point | Bypass (CABG) | Stents (PCI) |
|---|---|---|
| What it involves | Open-heart surgery under general anaesthetic | Catheter through wrist or groin, usually awake |
| Best suited to | Several arteries affected, diabetes, complex disease | One or two discrete narrowings |
| Recovery | Longer; weeks to months | Shorter; often days |
| Durability | Often more durable for complex disease | May need repeat procedures more often |
The right choice depends on your pattern of disease, diabetes, heart function and your own priorities. A cardiologist and surgeon (heart team) should decide this with you.
Preparing for your surgery
- Meet the operating surgeon and the anaesthetist, who will explain the operation, the risks for you personally and what to expect afterwards.
- Expect tests beforehand, such as blood tests, an ECG, an echocardiogram and a coronary angiogram, to map the narrowings.
- Tell the team about all medicines and supplements; some blood thinners and diabetes medicines need adjusting before surgery.
- Stop smoking as far ahead as possible, as it lowers the risk of wound, lung and graft problems.
- Sort out practical help at home for several weeks, including someone to drive you and help with shopping and chores.
- Ask about dental checks beforehand, as treating dental infection first lowers the risk of valve and bloodstream infection.
- Plan for cardiac rehabilitation after the operation, and ask how it will be arranged.
What happens
The operation is done under general anaesthetic, so you are fully asleep. Most often the surgeon reaches the heart through a cut down the centre of the chest, dividing the breastbone (a sternotomy).
In a standard on-pump bypass, a heart-lung machine takes over the work of your heart and lungs and the heart is stopped so the surgeon can sew the grafts precisely. In an off-pump bypass, the heart keeps beating. The new grafts are joined above and below each narrowing to carry blood past it.
The breastbone is closed with wires that stay in permanently, and the skin is closed with stitches or clips. The operation usually takes several hours. You wake up in intensive care or a high-dependency unit, often with a breathing tube for a short while, drains, and lines for fluids and monitoring.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your disease is limited and better treated with stents or medicines alone.
- You are too frail or unwell for the strain of open-heart surgery, so a less invasive option is safer.
- Severely impaired heart, lung or kidney function makes the risks outweigh the likely benefit.
- You would not be able to take the medicines needed afterwards to keep the grafts open.
Delay surgery if…
- You have an active infection, including dental or chest infection, that should be treated first.
- Your angina is stable and there is time to optimise medicines and risk factors before deciding.
- Important results are missing, such as up-to-date heart-function or angiogram findings.
- Blood thinners or other medicines need safe adjustment before surgery.
- You need time to stop smoking, which lowers wound, lung and graft complications.
Alternatives to discuss
- Coronary angioplasty with stents (PCI) for suitable patterns of disease.
- Medicines alone (optimal medical therapy) to control angina and risk factors.
- Cardiac rehabilitation and lifestyle change, alongside any treatment.
- Watchful management with close monitoring if symptoms are mild and stable.
- A second opinion or formal heart-team review if the best option is unclear.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Often gives lasting relief from angina and breathlessness on effort
- Can lower the risk of a future heart attack, especially with complex or multi-vessel disease
- Can improve survival for certain patterns of disease, such as left main or three-vessel disease
- Artery grafts, particularly the internal mammary artery, tend to stay open for many years
- May allow some people to reduce reliance on frequent angina medicines
Risks & complications
- Tiredness, low mood and poor appetite for several weeks
- Pain, numbness or tingling around the chest and graft (leg or arm) wounds
- An irregular heartbeat (often atrial fibrillation) in the first days, which usually settles
- Temporary problems with memory and concentration
- Wound or chest infection, sometimes affecting the breastbone
- Bleeding needing a return to theatre or a blood transfusion
- A temporary effect on kidney function, more likely if kidneys were already impaired
- Fluid around the heart or lungs needing drainage
- A graft narrowing or blocking over time
- Stroke during or soon after the operation
- Heart attack around the time of surgery
- Death — uncommon for planned isolated bypass, but a real risk that rises with age, frailty and other illness
The biggest risks to weigh are stroke, bleeding, kidney strain and, rarely, death, and these rise with age, diabetes, poor heart or kidney function, lung disease and previous strokes. Ask the surgeon for your own estimated risk (teams often use a score such as EuroSCORE II), and ask why surgery is being recommended over stents or medicines in your case.
Published figures to discuss
Risk after bypass surgery varies a great deal between people, depending on age, diabetes, heart and kidney function, lung disease and previous strokes, so a single figure can be misleading. UK outcomes are audited nationally and are published by hospital and surgeon. The ranges below reflect typical reported figures for planned isolated bypass; your personal risk should be estimated for you, often using a score such as EuroSCORE II.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Stroke around the time of surgery | Roughly 1–2% on average, but higher with older age, prior stroke or diffuse arterial disease | Reported ranges across studies span about 1–5%; ask for your individual estimate. | Predictors and outcomes of post-CABG stroke — PMCncbi.nlm.nih.govPublished figure |
| Atrial fibrillation (irregular heartbeat) after surgery | Often around 20–40% after isolated CABG | Usually temporary and treatable, but can prolong the hospital stay and may need anticoagulation in selected patients. | Predictors and outcomes of post-CABG stroke — PMCncbi.nlm.nih.govPublished figure |
| Death from a planned isolated bypass | About 0.4–1.0% in recent UK audit/series for elective or isolated CABG; higher for urgent, emergency or combined operations | SCTS/NICOR data report excellent UK elective CABG outcomes, but your personal risk depends on age, heart function, kidneys, lungs, diabetes and frailty. | Predictors and outcomes of post-CABG stroke — PMCncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from a bypass is gradual. The breastbone needs time to heal like any broken bone, so most people feel tired and limited for several weeks and take 2–3 months to feel themselves again.
- Feeling drained, emotional or tearful for the first few weeks
- A tight, sore or numb feeling along the chest wound and the leg or arm where a vessel was taken
- Disturbed sleep and a poor appetite at first
- Clicking or aching in the breastbone that eases as it heals
- Swelling in the leg used for a vein graft, helped by elevation and gentle walking
Aftercare
- Take all heart medicines exactly as prescribed, including blood thinners, statins and blood-pressure medicines.
- Keep wounds clean and dry, and watch for signs of infection such as increasing redness, heat or discharge.
- Build up walking a little each day rather than resting completely.
- Avoid heavy lifting, pushing and pulling for about 3 months to let the breastbone heal.
- Do not drive until your team and the driving-licence rules say it is safe (usually at least 4 weeks). These rules are set by the DVLA in England, Scotland and Wales, and by the DVA in Northern Ireland.
- Attend cardiac rehabilitation, which is a key part of safe recovery.
- Stop smoking, eat well and keep follow-up appointments to protect the new grafts.
- Someone to drive you home and stay for the first days
- A supply of your prescribed medicines and a clear list
- Comfortable loose clothing that does not press on the chest wound
- A cushion to hold against the chest when coughing
- Help arranged with shopping, cooking and chores for several weeks
- Cardiac rehabilitation start date noted
- Clinic and out-of-hours contact numbers saved
Scars and how they heal
You will have a scar down the centre of the chest where the breastbone was opened, plus a scar on the leg, arm or chest wall where the graft vessel was taken. Scars are firm and pink at first and usually fade over many months. Keeping them out of strong sun while healing helps them settle.
⚠ Get urgent help if…
- Chest pain like your original angina, or pain that does not settle
- Sudden breathlessness, or breathlessness that is getting worse
- Signs of stroke — face drooping, arm weakness or slurred speech — call 999 immediately
- A wound that is increasingly red, hot, swollen or leaking fluid, or a clicking, unstable breastbone
- Fever, feeling generally unwell, or a fast or very irregular heartbeat with dizziness
- A hot, swollen, painful calf, which can signal a clot
- Fainting or collapse
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A successful bypass usually eases angina and breathlessness on effort, often noticeably, and for many people lowers the risk of a future heart attack. Some patterns of disease, such as left main or three-vessel disease, also gain a survival benefit.
What a bypass cannot do is cure coronary heart disease or guarantee you will never have another problem. The grafts can narrow over time, and the underlying disease continues, so the long-term result depends heavily on medicines and lifestyle as well as the operation itself.
Bypass grafts can last many years, and artery grafts (especially the internal mammary artery) tend to stay open longest. Vein grafts are more likely to narrow over time. How long the benefit lasts depends on the grafts used, how well risk factors such as cholesterol, blood pressure, diabetes and smoking are controlled, and how the disease behaves in your other arteries.
Combining with other procedures
A bypass is sometimes combined with other heart surgery in the same operation, most often a heart valve repair or replacement, if a valve problem is found. Combining procedures increases the size and risk of the operation, so the heart team will discuss whether doing both at once is right for you.
Follow-up & long-term care
You will usually be reviewed in the weeks after surgery to check your wounds, medicines and recovery, with cardiac rehabilitation running alongside. Longer term, you will have regular checks of blood pressure, cholesterol and other risk factors, often shared between your cardiologist, GP and rehabilitation team.
- Lifelong heart-protecting medicines such as statins, blood-pressure medicines and usually an antiplatelet (for example aspirin)
- Regular checks of blood pressure, cholesterol and, if relevant, blood sugar
- Staying smoke-free, active and a healthy weight
- Prompt review if angina-type symptoms return, as a graft may have narrowed
Revision and secondary surgery reality
- Grafts, especially vein grafts, can narrow or block over the years, and angina-type symptoms may return.
- Repeat (redo) heart surgery is technically harder and carries higher risk than a first operation.
- Some later narrowings can be treated with stents rather than further surgery.
- Long-term results depend heavily on medicines and risk-factor control, not just the operation.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A named contact and clear out-of-hours route for chest pain, breathlessness or wound problems.
- A structured cardiac rehabilitation programme to rebuild fitness and confidence.
- Clear medicine instructions, including any blood thinners, with planned reviews.
- Wound checks and prompt management of any infection or unstable breastbone.
- Ongoing risk-factor management shared between cardiologist, GP and rehabilitation team.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon's and anaesthetist's fees
- Operating theatre, perfusion (heart-lung machine) and intensive-care time
- Number of grafts and the complexity of your disease
- Length of hospital and intensive-care stay, which is longer if complications occur
- Pre-operative tests such as angiogram, echocardiogram and blood tests
- Cardiac rehabilitation and follow-up appointments
- How any complications or readmissions are covered
- The surgeon's and anaesthetist's fees
- Theatre, perfusion and intensive-care charges
- Pre-operative tests and assessments
- Expected hospital length of stay and what extra days cost
- Cardiac rehabilitation and follow-up appointments
- What happens, and who pays, if you need a return to theatre, a longer stay or readmission
- Cancellation policy if the operation is postponed for medical reasons
On the NHS? Coronary bypass surgery is very commonly carried out on the NHS when clinically indicated; private care is mostly used for choice of surgeon, hospital or timing, not because the operation differs.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- No clear explanation of why bypass is preferred over stents or medicines for you.
- Risks of stroke, bleeding, kidney strain and death not spelled out as your personal estimate.
- No mention that the disease continues and lifelong medicines are needed afterwards.
- No written aftercare and warning-signs plan before you go home.
- Combined procedures (such as adding valve surgery) agreed without discussing the extra risk.
Marketing red flags
- Describing major open-heart surgery as 'routine', 'simple' or 'low risk' without your own figures.
- Promising a 'cure' for coronary heart disease rather than treatment of current blockages.
- Pushing a particular technique (such as off-pump or minimally invasive) as best for everyone.
- Downplaying the recovery time, breastbone healing or the importance of cardiac rehabilitation.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why are you recommending a bypass rather than stents or medicines in my case?
- How many grafts do I need, and which vessels (artery or vein) will you use?
- What is my personal estimated risk of stroke, bleeding and death for this operation?
- Will this be on-pump or off-pump, and why is that best for me?
- How will my recovery and cardiac rehabilitation be arranged?
- What symptoms should make me seek urgent help after I go home?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is a bypass available on the NHS?
Bypass or stents — which is better?
How long is the recovery?
Will I need to take medicines afterwards?
When can I drive again?
How risky is the operation?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Coronary artery bypass graft (CABG) British Heart Foundation — Coronary bypass surgery NICE NG185 — Acute coronary syndromes Society for Cardiothoracic Surgery (SCTS) — patient information Predictors and outcomes of post-CABG stroke — PMC SCTS Blue Book 2020 — UK adult cardiac surgery outcomes Postoperative atrial fibrillation after CABG — review (PMC) DVLA — Assessing fitness to drive DVA Northern Ireland — Telling DVA about a medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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