Coronary artery bypass graft (CABG) surgery with endoscopic vessel harvesting (EVH)

A coronary artery bypass graft (CABG), also known as a heart bypass, or coronary bypass, is a type of surgery used to treat coronary heart disease. It works by diverting blood away from narrowed or blocked arteries that supply your heart. The blood supply is diverted to a new blood vessel taken from another part of your body (a graft). Coronary artery bypass graft surgery allows blood and oxygen to reach your heart more effectively and can relieve angina symptoms and reduce your risk of having a heart attack.

A coronary artery bypass graft is carried out under general anaesthetic, which means you’ll be asleep during the surgery. The operation takes between three and six hours.

During traditional coronary artery bypass surgery, a blood vessel is taken (harvested) from another part of your body, usually your chest, leg, or arm, to be used as a graft. The graft is then attached to your coronary artery above and below the narrowed area or blockage. The number of grafts used depends on how many of your coronary blood vessels are blocked or narrowed, and you may have a single, double, triple, or quadruple bypass.

Ross Hall Hospital is the only hospital in Scotland to offer an innovative new technique known as endoscopic vessel harvesting (EVH). This technique allows the grafts to be harvested using keyhole surgical techniques. During the surgery, a camera is inserted through a small incision below your knee and your surgery is performed using specially designed instruments guided by images on a monitor.

Coronary artery bypass graft surgery is performed by an incision made on your chest and your sternum (breastbone) is gently opened to allow your surgeon access to your heart.

While your surgeon is operating on your heart, we will frequently use a heart-lung bypass machine to keep blood pumping through your body, while your heart is rendered motionless by a special solution called cardioplegia. At the end of the procedure, your consultant will gradually withdraw support from the heart-lung machine, allowing your heart to resume its normal pumping function. Once the procedure is over, your breastbone is reunited, and the incision is closed.

CABG surgery is used to treat a condition called coronary heart disease. Coronary heart disease occurs when a build-up of fatty substances in your coronary arteries (the blood vessels that supply your heart) causes them to become blocked or narrowed, reducing, or stopping the heart’s blood supply. Narrowing of your coronary arteries can lead to symptoms of angina. The sudden closing of your arteries can lead to a heart attack, which can be life threatening. Having coronary heart disease doesn’t always lead to a heart attack, but it increases your risk. If your consultant feels you are at high risk of having a heart attack, they may recommend coronary artery bypass graft surgery.

Coronary artery bypass graft surgery aims to eliminate symptoms of angina, lower your risk of a heart attack, and lower your risk of sudden death from coronary artery disease. These are the three clear benefits of bypass surgery.

Endoscopic vessel harvesting (EVD) has many benefits over traditional techniques used to harvest the blood vessels that are used as a graft during the surgery. These include:

• A much smaller incision in your leg
• Faster recovery from surgery
• Less pain and discomfort after surgery

“CABG surgery is performed using a keyhole technique. This means we make much smaller incisions, leading to a faster recovery with much less pain and discomfort. There is also much less chance of wound infection, as compared with traditional open vessel harvesting techniques.”

Mr Fraser Sutherland, Consultant Cardiac Surgeon, Ross Hall Hospital