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Heart bypass surgery
Definition
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart.
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Alternative Names
Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery
Description
Before your surgery you will get general anesthesia. You will be asleep (unconscious) and pain-free during surgery.
Once you are unconscious, the heart surgeon will make an 8 - 10-inch surgical cut in the middle of your chest. Your breastbone will be separated to create an opening. This allows your surgeon to see your heart and aorta, the main blood vessel leading from the heart to the rest of your body.
Most people who have coronary bypass surgery are connected to a heart-lung bypass machine, or bypass pump.
- Your heart is stopped while you are connected to this machine.
- This machine does the work of your heart while your heart is stopped for the surgery. The machine adds oxygen to your blood, and moves blood through your body.
A newer type of bypass surgery does not use the heart-lung bypass machine. The bypass is made while your heart is still beating. This is called off-pump coronary artery bypass, or OPCAB. This procedure may be used if you could have problems while on the heart-lung machine.
During bypass surgery, the doctor takes a vein or artery from another part of your body and uses it to make a detour (or graft) around the blocked area in your artery.
- Your doctor may use a vein, called the saphenous vein, from your leg. To reach this vein, a surgical cut will be made along the inside of your leg, between your ankle and groin. One end of the graft will be sewn to your coronary artery. The other end will be sewn to an opening made in your aorta.
- A blood vessel in your chest, called the internal mammary artery (IMA), can also be used as the graft. One end of this artery is already connected to your aorta. The other end is attached to your coronary artery.
- Other arteries can also be used for grafts in bypass surgery. The most common one is the radial artery in your wrist.
After the graft has been created, your breastbone will be closed with wires. These wires stay inside you. The surgical cut will be closed with stitches.
This surgery can take 4 to 6 hours. After the surgery, you will be taken to the intensive care unit.
Why the Procedure Is Performed
Your doctor may recommend this procedure if you have a blockage in one or more of your coronary arteries. Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.
When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease, or coronary artery disease (CAD). It can cause chest pain (angina).
Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have first tried to treat you with medicines. You may have also tried exercise and diet changes, or angioplasty with stenting.
Coronary artery disease is different from person to person. The way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It is not right for everyone.
Other procedures that may be used:
- Angioplasty and stent placement
- Heart bypass surgery - minimally invasive
Risks
Risks for any surgery include:
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Infection, including in the lungs, urinary tract, and chest
- Blood loss
Possible risks from having coronary bypass surgery include:
- Chest wound infection, which is more likely to happen if you are obese, have diabetes, or have already had this surgery
- Heart attack or stroke
- Heart rhythm problems
- Kidney or lung failure
- Low fever and chest pain, together called post-pericardiotomy syndrome, which can last up to 6 months
- Memory loss, loss of mental clarity, or "fuzzy thinking"
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.
During the days before your surgery:
- For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include aspirin, ibuprofen (such as Advil and Motrin), naproxen (such as Aleve and Naprosyn), and other similar drugs. If you are taking clopidogrel (Plavix), talk with your surgeon about when to stop taking it.
- Ask your doctor which drugs you should still take on the day of the surgery.
- If you smoke, try to stop. Ask your doctor for help.
- Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness.
- Prepare your home so you can move around easily when you return from the hospital.
The day before your surgery:
- Shower and shampoo well.
- You may be asked to wash your whole body below your neck with a special soap. Scrub your chest two or three times with this soap.
On the day of the surgery:
- You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
- Take any medications that your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After the operation, you will spend 3 to 7 days in the hospital. You will spend the first night in an intensive care unit (ICU). You will probably be moved to a regular or transitional care room within 24 hours.
Two to three tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.
You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV) lines for fluids. You will be attached to machines that monitor your pulse, temperature, and breathing. Nurses will watch your monitors constantly.
You will be encouraged to restart some activities and may begin a cardiac rehab program within a few days.
It takes 4 to 6 weeks to start feeling better after surgery. Your health care providers will tell you how to take care of yourself at home after the surgery.
Outlook (Prognosis)
Recovery from surgery takes time. You may not see the full benefits of your surgery for 3 to 6 months. In most people who have heart bypass surgery, the grafts stay open and work well for many years.
This surgery does not prevent the coronary artery blockage from coming back. You can do many things to slow this process down, including:
- Not smoking
- Eating a heart-healthy diet
- Getting regular exercise
- Treating high blood pressure
- Controlling high blood sugar (if you have diabetes) and high cholesterol
You may be more likely to have problems with your blood vessels if you have kidney disease or continue to smoke.
References
Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.
Gopaldas RR, Chu D, Bakaeen FD. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 60.
Morrow DA, Boden WE. Stable ischemic heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 57.
Greenhalgh J, Hockenhull J, Rao N, Dundar Y, Dickson RC, Bagust A. Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Database of Syst Rev. 2010:5:CD004587. DOI: 10.1002/14651858.CD004587.pub2.
Moller CH, Penninga L, Wettersley J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database of Syst Rev. 2012:3:CD007224. DOI: 10.1002/14651858.CD007224.pub2.
Reviewed By: Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
