Bypass Surgery

Details of Bypass Surgery

Before surgery

Patients who are good candidates for bypass surgery meet with members of the specialized team who will assist in their care. Patients receive specific instructions to help prepare for the surgery, including information about eating, drinking and taking medications. Patients meet with their cardiologist, heart surgeon, anesthesiologist and nurse clinician, and are encouraged to ask questions about the surgery and their experience at Mayo Clinic.

In nonurgent cases, patients are usually admitted to hospital on the morning of surgery.

Before surgery:

• An echocardiogram (ultrasound of the heart) is done to evaluate the structure and function of the heart.
• Cardiac catheterization may be done to check for coronary artery disease or other cardiovascular disease that could complicate surgery. It is routinely done for patients over 40 years old.
• Other basic diagnostic tests, including blood tests, an electrocardiogram and a chest x-ray, are required.

The need for more specialized tests, such as an electrophysiology study (EP), is determined on an individual basis.

During surgery

Bypass surgery generally takes between three and six hours and requires general anesthesia. Often, three or four coronary arteries are bypassed during surgery, and sometimes as many as six or seven bypasses may be done.

Most coronary bypass operations are still done conventionally — a chest incision is made and the sternum (breastbone) is divided so that the rib cage can be opened to expose the heart. Although the procedure is called open-heart surgery, surgeons don't actually open the heart. They work on the heart's exterior.

Typically a heart-lung machine (cardiopulmonary bypass pump) is used. This machine takes over the function of the heart and lungs during surgery. It allows the surgeon to place replacement grafts that provide detours for blood flow around blocked coronary arteries. In bypass surgery, this pause in heart function allows the surgeon to make the delicate maneuvers that are necessary.

Blood vessel grafts are obtained from other arteries and veins in the body. Typically an artery in the chest (the internal thoracic artery or internal mammary artery) is used. It's diverted from the chest wall, and one end is attached to a diseased coronary artery beyond the blockage.

Once the procedure is completed, the heart is restarted. When the surgical team is satisfied that the heart is beating strongly again, the heart-lung machine is disconnected. The chest incisions are then closed (sutured).

The sternum will knit back together in six to eight weeks and will be just as strong once the healing process is complete.

Immediately following surgery

After surgery, patients generally are moved to the intensive care unit (ICU) for up to two days. When patients awake from general anesthesia, they are groggy and somewhat disoriented. Every effort is made to minimize pain from the incision. Pain medication is available and patients are encouraged to take it as needed.

While in the intensive care unit, a patient breathes with the assistance of a ventilator. The breathing tube is usually removed within two to four hours after surgery. Intravenous (IV) fluids maintain hydration. One or more temporary drainage tubes exit the chest cavity to drain any excess blood or fluid that may build up after surgery. Patients may require blood transfusions during or after the operation.

The length of stay in the ICU depends on the complexity of the surgical procedure. When patients no longer requires the ICU's special facilities, they are moved to a monitored hospital unit.

Within 24 hours of surgery, most patients are out of bed, and they are able to walk within one or two days. Over the next few days, patients usually regain sufficient strength to be discharged within five to seven days after surgery.

After leaving the hospital

In most instances, recovery is rapid. Most patients are able to drive in about three weeks. Sexual activity can be resumed in three to four weeks. The main limitation to activity is healing of the sternum which may take up to 12 weeks.

Following conventional bypass surgery, a patient can expect a recovery period of about six to 12 weeks. People who do more sedentary work often return to work after six weeks. It may be 12 weeks or more before patients can return to more-physically-demanding jobs.

Most people who have bypass surgery are able to resume normal activities, and over 90 percent have a substantial lessening of angina. However, new blockages may occur and may require a second bypass, angioplasty or other procedure, or a change in medication. The risk can be reduced by discontinuing smoking, eating a healthy diet, taking prescribed medications and getting regular physical activity.

Full energy levels usually start to return in about three months. Most patients can expect to feel more tired than usual and their stamina may not yet be completely normal. After six months, most patients are back to normal.

Nearly all patients benefit from cardiac rehabilitation after surgery. Rehabilitation usually focuses on lifestyle changes, including diet and exercise as well as psychological issues. These programs are tailored to each person because individual circumstances vary and different people go into surgery at different levels of health.

Follow-up care

Generally, patients return to their local physician a week after being discharged from the hospital and are examined to ensure that they are healing properly. The Mayo Clinic staff works with patients, their local primary care physician and local cardiologist to assist with a full and smooth recovery following surgery.

Bypass surgery plays an important role in treating coronary artery disease, but it isn't a cure. Surgery can improve symptoms and even prolong life when the left main coronary artery or multiple vessels are bypassed, but it doesn't get rid of the disease. Patients must manage the disease with exercise, proper diet, and other lifestyle changes recommended by their physician.

Patients should be seen at regular intervals by their local physician to monitor the control of risk factors, particularly cholesterol, blood pressure, and diabetes, and at least annually by their cardiologist to monitor their coronary artery disease.