Heart/Bypass Surgery
Coronary artery bypass surgery
is a heart operation. It uses blood vessels to go around or “bypass” clogged coronary (heart) arteries so blood can flow through the new vessels to the heart muscle the way it should. This information sheet provides answers to the following questions regarding coronary bypass surgery:
- How is it done?
- What is surgery like?
- What about after surgery?
- What happens when I leave ICU?
Coronary Artery Bypass Surgery
Also called: Bypass surgery, CABG
If you have coronary artery disease (CAD), the arteries that supply blood and oxygen to the heart muscle become hardened and narrowed. If lifestyle changes and medicines don't help, your doctor may recommend coronary artery bypass surgery.
The surgery uses a piece of a vein from the leg or artery from the chest or wrist. The surgeon attaches this to the coronary artery above and below the narrowed area or blockage. This allows blood to bypass the blockage. Some people need more than one bypass.
You may need bypass surgery for various reasons. Another procedure for CAD, angliplasty, may not have widened the artery enough. In some cases, the angioplasty tube can't reach the blockage.
A bypass also can close again. This happens in more than 10 percent of bypass surgeries, usually after 10 or more years.
Why is this surgery done?
The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.
If you are suffering chest pain or other symptoms that may indicate a cardiovascular problem, your doctor will likely want you to undergo an angiogram (cardiac catheterization) to see if your coronary arteries are blocked by plaque. A blockage can cause a decrease in the supply of blood and oxygen to the heart and over time can lead to debilitating chest pain or a heart attack.
If angioplasty proves unsuccessful, the position of the blockage is too difficult to access by angioplasty, or you have severe blockages in multiple major vessels, your doctor may recommend that you undergo coronary artery bypass graft (CABG) surgery.
What happens during bypass surgery?
Bypass surgery is a major operation that usually lasts between two and six hours. Pre-operative medications are often administered by mouth, muscular or subcutaneous injection, or IV. You will receive general anesthesia and be completely asleep.
During bypass surgery, the chest bone is separated, and the ribs are spread apart to allow visible and physical access to the heart. In most instances, blood circulation and breathing functions will be taken over by a heart-lung machine.
Surgeons take a segment of a healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery.
- An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area.
- A piece of a long vein in your leg may be taken. One end is sewn onto the large artery leaving your heart—the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area.
- Either way, blood can use this new path to flow freely to the heart muscle.
A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked.
Cardiopulmonary bypass with a pump oxygenator (heart-lung machine) is used for most coronary bypass graft operations. This means that besides the surgeon, cardiac anesthesiologist and surgical nurse, a competent perfusionist (blood flow specialist) is required.
During the past several years, more surgeons have started performing off-pump coronary artery bypass surgery (OPCAB). In it, the heart continues beating while the bypass graft is sewn in place. In some patients, OPCAB may reduce intraoperative bleeding (and the need for blood transfusion), renal complications and postoperative neurological deficits (problems after surgery).
What is a graft?
A graft is a blood vessel that has been created to bypass a blocked artery. It is usually taken from the internal mammary artery in the chest, the saphenous veins from the leg, or in rare instances from the radial artery in the arm. The graft is attached above and below the area in the artery where there is a blockage, so that the blood can use the new, unblocked path to flow freely to the heart.
Typically, traditional bypass surgery takes between two and six hours, depending on the number of bypasses to be performed. Minimally invasive bypass surgery usually takes two to three hours.
The overall hospital stay, including both the CICU and a regular hospital room, is generally between five and six days if you undergo a traditional bypass surgery. You could be in the hospital for less time – three to four days – following minimally invasive surgery.