Before going ahead with coronary artery bypass graft surgery, there are certain questions you need to ask. If in doubt, consider getting a second opinion.
Make sure you fully understand the procedure; don’t be afraid to ask questions. It's imperative your doctor explains the common risks and benefits, as well as those particular to your circumstances. Knowing all the relevant information is part of informed clinical consent.
Once you and your surgeon have decided that coronary artery bypass surgery is the most appropriate intervention for your coronary artery disease, there are a number of other important questions you’ll need answered.
Questions for your surgeon
Which artery or vein will be used for a graft? The common option is the internal thoracic artery (also called the internal mammary artery), which runs along the inside of your chest wall close to your heart, because it’s robust and reduces risk of later heart attack.This artery is normally chosen when grafting the heart’s left anterior descending artery. The radial artery in the arm may also be used. Where further grafts are needed leg veins are occasionally used.
How many coronary arteries will be grafted? Multiple grafts may be needed depending on the number of coronary arteries affected. Typically three or four grafts are performed.
Will a heart/lung machine be used? This enables your heart to stop beating, making the surgery easier to perform. However, sometimes bypass surgery is done on the beating heart instead. This is known as off-pump surgery and it’s becoming more common. Off-pump surgery is technically more difficult but may be used for single grafts.
Will a minimally-invasive procedure be used? This may be done for largely cosmetic reasons.
More questions for your surgeon
- How urgent is this procedure?
- For the type of coronary artery disease I have, and my other health issues, is this the best intervention?
- What happens during and after surgery?
- What is the potential benefit to me if I have this surgery?
- How will the surgery affect the way I feel?
- What might be the consequences if I don’t have the surgery?
- Is there anything I can do to improve the outcome of the surgery?
- Will I need a blood transfusion?
- What are the potential complications of the surgery in my case?
- What type of sedation and/or anaesthesia will I receive during the procedure?
- What are my risks of dying from this surgery?
- Am I likely to live longer if I have this surgery?
- How long will I be in hospital after the procedure?
- What medications will I have to take afterwards, and for how long?
- What should I expect during the weeks after surgery?
- How long before I can go back to work?
- Will I need to undertake a rehabilitation program?
- If I have a pacemaker in place, how will it affect the procedure?
- What are the likely out-of-pocket medical expenses? (Your doctor should be able to give you a breakdown of any costs you'll incur – this is known as ‘Informed Financial Consent’). Learn about the costs
- Will there be additional fees for an assistant surgeon or for imaging. If so, what will they be?
- How should I prepare for surgery?
- Should I donate my own blood several weeks beforehand to be re-transfused during surgery?
- Will I have a choice of anaesthetist?
- Will I be able to meet with the anaesthetist before the day of surgery?
- Will there be an additional fee for the anaesthetist? If so, what will it be?
- How many coronary artery bypass graft surgeries do you perform each year?
- What percentage of patients are satisfied with the results of the coronary artery bypass graft procedures you perform?
- What is your complication rate for this procedure? (20-30% is normal)
- What sort of result can I expect from the procedure?
- What limitations will there be to my activities? When can I drive, resume sports, sexual activities, etc.?
- Follow-up appointments (Write down any questions or concerns you want to discuss with your surgeon)
Tell your surgeon if you have any skin lesions, sores, cuts, a raised temperature, or kidney problems, as you'll need to be treated before surgery.
Most medication should be taken as usual, but some may interfere with the operation. Your surgeon will let you know which medication (if any) you should stop. This could include:
- NSAIDs (including aspirin)
- Blood thinners (warfarin, heparin eliquis, xarelto, pradaxa)
- Pain medication
Don’t forget to mention any complementary or herbal remedies you’re taking, as these can have interactions and side effects too.
Questions for your anaesthetist
- What type of anaesthesia are you planning to use for my surgery?
- Will you be prescribing a pre-med? (A medication given before the anaesthetic to prevent nausea, reduce stomach acid or help you relax)
- How will my pain be managed after the surgery? (The anaesthetist is responsible for this)
Print out this page to take to your appointment with the surgeon and anaesthetist