Coronary artery bypass surgery
Coronary artery bypass surgery creates a new path for blood to flow to the heart. A healthy blood vessel from another part of the body is used to redirect blood around a blocked area of an artery. Usually the blood vessel is taken from an artery in the chest, called the internal mammary artery. Sometimes it's taken from a leg vein, called the saphenus vein.
Coronary bypass surgery redirects blood around a section of a blocked or partially blocked artery in your heart. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it below and above the blocked arteries in your heart. With a new pathway, blood flow to the heart muscle improves.
Coronary bypass surgery doesn't cure the heart disease that caused the blockages, such as atherosclerosis or coronary artery disease. However, it can ease symptoms, such as chest pain and shortness of breath. For some people, this procedure can improve heart function and reduce the risk of dying of heart disease.
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Why it's done
Coronary bypass surgery is one treatment option if you have a blocked artery to your heart.
You and your doctor might consider it if:
- You have severe chest pain caused by narrowing of several arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest.
- You have more than one diseased coronary artery, and the heart's main pumping chamber — the left ventricle — isn't functioning well.
- Your left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
- You have an artery blockage that can't be treated with a procedure that involves temporarily inserting and inflating a tiny balloon to widen the artery (angioplasty).
- You've had a previous angioplasty or placement of a small wire mesh tube (stent) to hold the artery open that hasn't been successful. Or you've had a stent placement, but the artery has narrowed again.
Coronary bypass surgery might also be performed in emergency situations, such as a heart attack, if you're not responding to other treatments.
Even with coronary bypass surgery, you'll need to make lifestyle changes after surgery. Medications are prescribed routinely after coronary bypass surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart work as well as possible.
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Because coronary bypass surgery is an open-heart surgery, you might have complications during or after your procedure. Possible complications include:
- An irregular heart rhythm
- Infections of the chest wound
- Memory loss or trouble thinking clearly, which often improves within six to 12 months
- Kidney problems
- Heart attack, if a blood clot breaks loose soon after surgery
Your risk of developing complications is generally low, but it depends on your health before surgery. Your risk of complications is higher if the surgery is done as an emergency procedure or if you have other medical conditions, such as emphysema, kidney disease, diabetes or blocked arteries in your legs.
How you prepare
Your doctor will give you specific instructions about activity restrictions and changes in your diet or medications that you should make before surgery.
Make arrangements for assistance after your surgery. It will take about four to six weeks for you to recover to the point where you can resume driving, return to work and perform daily chores.
What you can expect
Before the procedure
If your coronary bypass surgery isn't performed as emergency surgery, you'll likely be admitted to the hospital the morning of the surgery.
During the procedure
Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. The number of bypasses you need depends on where in your heart and how severe your blockages are.
For general anesthesia, a breathing tube is inserted through your mouth. This tube attaches to a ventilator, which breathes for you during and immediately after the surgery.
Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung machine keeps blood and oxygen flowing through your body. This is called on-pump coronary bypass surgery.
The surgeon cuts down the center of the chest along the breastbone and spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped with medication and a heart-lung machine takes over to circulate blood to the body.
The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.
Other surgical techniques your surgeon might use include:
- Off-pump or beating-heart surgery. This procedure involves doing surgery on the beating heart using special equipment to stabilize the area of the heart the surgeon is working on. This type of surgery is challenging because the heart is still moving. It's not an option for everyone.
- Minimally invasive surgery. A surgeon performs coronary bypass through small incisions in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area. Variations of minimally invasive surgery might be called port-access or keyhole surgery.
After completing the graft, the surgeon will restore your heartbeat, disconnect you from the heart-lung machine and use wire to close your chest bone. The wire will remain in your body after the bone heals.
After the procedure
Expect to spend a day or two in the intensive care unit. The breathing tube will remain in your throat until you are awake and able to breathe on your own.
Cardiac rehabilitation often begins while you're still in the hospital. You'll be given an exercise and education program designed to help you recover. You'll continue with monitored programs in an outpatient setting until you can safely follow a home-based maintenance program.
Barring complications, you'll likely be discharged from the hospital within a week. You still might have difficulty doing everyday tasks or walking a short distance. If, after returning home, you have any of the following signs or symptoms, call your doctor:
- Rapid heart rate
- New or worsened pain around your chest wound
- Reddening around your chest wound or bleeding or other discharge from your chest wound
Expect a recovery period of about six to 12 weeks. If you have your doctor's OK, you can return to work, begin exercising and resume sexual activity after four to six weeks.
After surgery, most people feel better and might remain symptom-free for as long as 10 to 15 years. Over time, however, it's possible that other arteries or even the new graft used in the bypass will become clogged, requiring another bypass or angioplasty.
Your results and long-term outcome will depend in part on taking your medications to prevent blood clots, lower blood pressure, lower cholesterol and help control diabetes. It's also important to follow healthy-lifestyle recommendations, including these:
- Stop smoking.
- Follow a healthy-eating plan, such as the DASH diet.
- Achieve and maintain a healthy weight.
- Exercise regularly.
- Manage stress.
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Nov. 03, 2020