During a coronary artery bypass, the diseased sections of your coronary arteries are bypassed with healthy artery or vein grafts to increase blood flow to the heart muscle tissue. This procedure is also called coronary artery bypass grafting (CABG). Bypass typically requires open-chest surgery.
There are several newer, less invasive techniques for bypass surgery that can be used instead of open-chest surgery in some cases. In some procedures, the heart is slowed with medicine but is still beating during the procedure. For these types of surgery, a heart-lung bypass machine is not needed. (For open-chest surgery, a heart-lung machine is needed to circulate the blood and to add oxygen to it.) Other techniques use keyhole procedures or minimally invasive procedures instead of open-chest surgery. Keyhole procedures use several smaller openings in the chest and may or may not require a heart-lung machine. These techniques are still being studied and may not be available in all medical centers.
The material in this section will focus on traditional open-chest bypass surgery. View the slideshow on CABG surgery to see what happens during a bypass.
You'll receive anesthesia before the surgery that will make you sleep. In most cases, bypass surgery is open-chest surgery. During the surgery, your chest will be open and your heart exposed. The surgeon makes a large cut, or incision, in the middle or side of your chest. He or she may cut through your breastbone and spread apart your rib cage.
The surgeon removes a healthy blood vessel—often from the leg—and attaches (grafts) it to the blocked artery. The new blood vessel bypasses the blocked artery to increase blood flow to the heart. You may need just one bypass graft, or you may need more. Some people have as many as two, three, or even four (double, triple, or quadruple bypass surgery). How many grafts you need depends on how many arteries are blocked and where.
When the surgery is complete, the doctor may use wire to put your rib cage back together and stitches to close the incision. The surgery can take 3 to 6 hours. You will stay in the hospital at least 3 to 8 days after the surgery. It can take 4 to 6 weeks to recover at home. Most people are able to return to work within 1 to 2 months after surgery.
After surgery, there will be a short stay (1 to 2 days if there are no complications) in the intensive care unit (ICU). In the ICU, the person will likely have:
You will typically stay in the hospital from 3 to 8 days after open-chest bypass surgery. The amount of time you stay varies and will depend on your health before bypass surgery and whether complications develop from surgery.
After discharge, recovery at home takes 4 to 6 weeks. Recovery includes physical therapy, respiratory therapy, occupational therapy, and diet counseling. Exercise and driving may be resumed after about 2 to 3 weeks. People who are able to return to work can usually do so within 1 to 2 months, depending on the type of work they do. Some people find that they experience heightened emotions (such as a greater tendency to cry or otherwise show emotion in ways that are unusual compared with before the procedure) for up to a year following surgery.
After your surgery, your doctor may suggest that you attend a cardiac rehabilitation program. In cardiac rehab, a team of health professionals provides education and support to help you recover.
The rehab team can help you make new, healthy habits, such as eating right and getting more exercise.
Not everyone with coronary artery disease needs bypass surgery. Some people can be helped by angioplasty with stents. Others use medical therapy, which involves making lifestyle changes and taking medicines. Some people use both of those treatments. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks.
Your doctor may advise bypass surgery if:
Your choice may depend on the number of arteries that are blocked or which arteries are blocked. Talk with your doctor about the best treatment for you. The best treatment for you may also depend on your age, your health, and how much your angina is affecting your quality of life.
To help you make a decision, see the topic:
The success of bypass surgery also depends on you. If you smoke and don't quit, you won't get the most benefit from bypass surgery. You may need to make some other big changes, like eating right and getting regular exercise. These changes will help your bypass grafts last and stay open longer. They will also give you the best chance of living a longer, healthier life.
If you are taking medicines for angina, to lower cholesterol, or to control blood pressure, be sure to take these every day. Along with lifestyle changes, these medicines can help you get the most benefit from bypass surgery.
Bypass surgery is not a cure for heart disease. That's why all of these things—eating right, not smoking, getting exercise, and taking medicines—are so important. Without them, you raise your risk of getting new blockages and needing another surgery.
Bypass surgery has been done for more than 40 years. In the United States, it is one of the most common major surgeries. But it has some serious risks.
The risks of bypass surgery include:
Other risks include return of angina, problems from anesthesia, and infections at the site of the chest incision. Some people also have memory loss and trouble thinking clearly. These problems are most common in older people and tend to improve several months after surgery.
The chances of having a serious problem with bypass surgery are higher if you are older than 70. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Talk with your doctor to find out how your health affects your risk.
When bypass surgery is clearly needed, surgery improves symptoms and in some cases prolongs life. But in many situations, the reasons for doing bypass surgery instead of other treatments are less clear.
In each case, the cardiac surgeon or cardiologist should be able to clearly explain why bypass surgery is preferred over medicine or angioplasty. Sometimes, a second opinion can be helpful when it is not clear that surgery needs to be done.
Transmyocardial laser revascularization (TMR) is sometimes used along with bypass surgery. TMR uses a laser beam to improve blood flow to the heart and relieve angina. It is not common but may be done to reach areas of the heart where bypass grafting does not work as well. And it is not the right treatment for everyone.
- Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.
- Sabik JF, et al. (2011). Coronary bypass surgery. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1490–1503. New York: McGraw-Hill.
- Gray RJ, Sethna DH (2012). Medical management of the patient undergoing cardiac surgery. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1793–1810. Philadelphia: Saunders.
- Morris DC, et al. (2011). Management of the patient after cardiac surgery. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1504–1512. New York: McGraw-Hill.
- Tarakji KG, et al. (2011). Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA, 305(4): 381–390.
Other Works Consulted
- Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652–e735.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Primary Medical Reviewer||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
|Specialist Medical Reviewer||John A. McPherson, MD, FACC, FSCAI - Cardiology|
|Specialist Medical Reviewer||Robert A. Kloner, MD, PhD - Cardiology|
|Last Revised||May 15, 2012|
Last Revised: May 15, 2012
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