What is Heart Bypass Surgery?
Heart bypass surgery, or coronary artery bypass graft (CABG) surgery, is used to improve blood flow to your heart.
Heart bypass surgery redirects blood around a section of a blocked or partially blocked artery in your heart to improve blood flow to your heart muscle. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it beyond the blocked arteries in your heart.
Although coronary bypass surgery doesn’t cure the heart disease that caused the blockages (atherosclerosis or coronary artery disease), 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
Why it’s done
Coronary bypass surgery is one 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 of the 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 for which temporarily inserting and inflating a tiny balloon to widen the artery (angioplasty) isn’t appropriate, 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 stent placement, but the artery has narrowed again (restenosis).
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 function as well as possible.
Before Heart Bypass Surgery
How do I prepare for heart bypass surgery?
If your doctor recommends heart bypass surgery, they’ll give you complete instructions on how to prepare.
If the surgery is scheduled in advance and isn’t an emergency procedure, you’ll most likely have several preoperative appointments where you’ll be asked about your health and family medical history.
You’ll also undergo several tests to help your doctor get an accurate picture of your health. These may include:
. Blood tests
. Chest X-ray
. Electrocardiogram (ECG or EKG)
. Angiogram
Dr. Mohammadreza Mirzaaghayan
Cardiac surgeon
Chief of cardiac surgery unit
Department of Surgery
Markaz Tebbi Kodakan
Tehran University of Medical Sciences
Tehran – Iran
Heart surgery tips
. Seek your doctor’s advice about any medication that affects how your blood clots. Many pain relievers and heart medications affect clotting, so you may have to stop taking them.
. Quit smoking. It’s bad for your heart and increases healing time.
. Tell your doctor if you have symptoms of a cold or flu. In particular, the flu can put further strain on the heart and can increase your chances of a heart attack or worsen heart failure. It can also cause myocarditis, pericarditis, or both. These are potentially serious heart infections.
. Prepare your home and make arrangements to stay in the hospital for several days.
. To reduce the risk of infection, wash your body with a special soap, like Hibiclens, the night before surgery. It’s made of chlorhexidine, which will help keep your body germ-free until surgery.
. Fast, which includes not drinking water, beginning at midnight before your surgery.
. Take all of the medications your doctor gives to you.
Risks and Complications
What are the risks of heart bypass surgery?
Because coronary bypass surgery is an open-heart surgery, you might have complications during or after your procedure. Possible complications include:
. Bleeding
. Heart rhythm irregularities (arrhythmias)
. Infections of the chest wound
. Memory loss or troubles with thinking clearly, which often improve within six to 12 months.
. Kidney problems
. Stroke
. 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 operation 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 (peripheral artery disease).
What are the long-term Side effects of bypass surgery?
After a successful heart bypass surgery, symptoms such as shortness of breath, chest tightness, and high blood pressure will likely improve.
A bypass can increase blood flow to the heart, but you may need to change some habits to prevent future heart disease.
The best surgery outcomes are observed in people who make healthy lifestyle changes. Talk to your doctor about dietary and other lifestyle changes to make after surgery.
During Heart Bypass Surgery
What are the different types of heart bypass surgery?
Your doctor will recommend a certain type of bypass surgery depending on how many of your arteries are blocked.
. Single bypass. Only one artery is blocked.
. Double bypass. Two arteries are blocked.
. Triple bypass. Three arteries are blocked.
. Quadruple bypass. Four arteries are blocked.
Your risk of having a heart attack, heart failure, or another cardiac issue depends on the number of arteries blocked. Blockage in more arteries also means that the surgery may take longer or become more complex.
During the procedure
How is heart bypass surgery performed?
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. He or she then 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 allows surgery to be done 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 Heart Bypass Surgery
Recovery
What’s it like to recover from heart bypass surgery?
When you wake up from heart bypass surgery, you’ll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:
. Pain at the incision site
. Pain with deep breaths
. Pain with coughing
You’ll likely be in the ICU for one to two days so your vital signs can be monitored. Once you’re stable, you’ll be moved to another room. Be prepared to stay in the hospital for several days.
Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:
. Caring for your incision wounds
. Getting plenty of rest
. Refraining from heavy lifting
Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. That’s the least amount of time it takes for your breastbone to heal.
During this time, you should avoid heavy exertion. Follow your doctor’s orders regarding physical activity. Also, you shouldn’t drive until you get approval from your doctor.
Your doctor will likely recommend cardiac rehabilitation. This will involve a regimen of carefully monitored physical activity and occasional stress tests to see how your heart is healing.
Tell your doctor about any lasting pain or discomfort during your follow-up appointments. You should also call your doctor if you experience:
. Fever over 100.4°F (38°C)
. Increasing pain in your chest
. Rapid heart rate
. Redness or discharge around the incision
Diet and lifestyle changes
The best preventive measure is a “heart-healthy” lifestyle, as prescribed by the American Heart Association (AHA). Eating a diet high in omega-3 fatty acids and low in saturated and trans fats helps your heart stay healthy.
Results
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 as directed, and following 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.
What medications will I take after heart bypass surgery?
Your doctor will give you medications to help manage your pain, such as ibuprofen (Advil) or acetaminophen (Tylenol). You may also receive a narcotic for extreme pain.
Your doctor will also give you medications to help you throughout your recovery process. These will include antiplatelet drugs and other drugs prescribed by your doctor.
Talk to your doctor about what medication plans are best for you. This is especially important if you have existing conditions such as diabetes or conditions affecting the stomach or liver.
| Type of drug | Function | Possible side effects |
| antiplatelet drugs, such as aspirin | help prevent the formation of blood clots | • stroke caused by bleeding rather than clotting • stomach ulcers • serious allergy-related issues if you’re allergic to aspirin |
| beta-blockers | block your body’s production of adrenaline and lower your blood pressure | • drowsiness • dizziness • weakness |
| nitrates | help reduce chest pain by opening up your arteries to let blood flow through more easily | • headaches |
| ACE inhibitors | prevent your body’s production of angiotensin II, a hormone that can make your blood pressure rise and cause your blood vessels to narrow | • headaches • dry cough • fatigue |
| lipid-lowering medicines, such as statins | can help lower LDL (bad) cholesterol and help prevent strokes or heart attacks | • headache
• liver damage |
Success rate
Heart bypass surgeries are serious but relatively safe.
Surgeons perform hundreds of thousands of heart bypass operations each year and many of those who have the surgery get relief from their symptoms without needing long-term medication.
The more severe the heart disease, the higher the risk of complications. However, the mortality rate is low, and according to one report, only 2–3 percent of people who undergo heart bypass surgery die as a result of the operation.
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