Bypass surgery

What is bypass surgery?

If you have one or more blocked coronary arteries, your heart may not be getting enough blood or oxygen. If a less invasive procedure, like balloon angioplasty, isn't likely to open your arteries - your doctor may recommend bypass surgery. During bypass surgery, your doctor creates new pathways to route blood around blocked vessels.

A bypass is an open-heart surgery that requires general anesthesia. The full name for a bypass is coronary artery bypass graft (or CABG, pronounced "cabbage")

Where are the new vessels from?

During bypass surgery, your doctor takes (harvest) a piece of a healthy blood vessel- often from your chest, arm, or leg. This harvested vessel becomes the new path for blood flow around the blocked artery. Doctors usually choose from among these three options when taking vessels for bypass:

  • Internal mammary artery- which runs inside the chest wall
  • Radial artery- which runs from the elbow to the wrist
  • Saphenous vein- which runs the length of the leg

It's okay to remove pieces of these bloods vessels for bypass because other vessels take over for them. Doctors more often choose arteries, rather than veins for grafts.  Veins sewn-or "grafted" to heart arteries sometimes clog up again. Arteries are less likely to do so.

How is surgery done?

Traditional bypass surgery begins with an incision in your breastbone (sternum). With the traditional form of bypass surgery, your doctor needs to operate on a completely still heart. So you receive medications to stop your heart. A heart-lung machine then does the job of both your heart and your lungs.

  • It adds oxygen to your blood- as your lungs would do
  • It pumps the blood back into, and throughout your body- as your heart would do

Your doctor sews (grafts) one end of the healthy blood vessel just below the blocked artery. The other end of the health vessel is then sewn about the blocked artery. Blood flows through the new vessel around the blocked area. The "detour" is a bypass graft. After bypass surgery, your blood flows freely through your coronary arteries. So bypass surgery can lower your risk of a heart attack.

A single bypass detours around one blocked artery. A double bypass detours around two blockages, and so on.

Newer types of bypass

In addition to traditional bypass, some less intrusive kinds of bypass now exist. Neither of these two types of surgery uses the heart-lung machine. Your doctor can tell you whether either of these less invasive surgeries might work for you.

Minimally invasive bypass surgery- this requires a smaller incision near your ribs instead of the large incision by your breastbone.

Off-pump bypass surgery- a tool holds part of your heart still while the doctor operates. The rest of your heart beats as usual during this type of surgery.

Bypass surgery outside the heart:

Coronary bypass surgery is the most common type of vessel bypass. But blood vessels outside the heart-peripheral vessels- can also become blocked. This is called a peripheral vascular disease (PVD), or peripheral artery disease. A bypass is sometimes needed to treat PVD.

The blood vessels in the leg are the peripheral vessels that most often get blocked.  For bypass surgery on the leg arteries, the healthy vessel is either from the leg or artificial vessel. Peripheral artery bypass requires general anesthesia. However, because it is not a heart surgery, the heart-lung machine is not needed.

What can I expect?

Usually you are told not to eat or drink anything for a number of hours before the procedure. You lie on an exam table, and an intravenous (IV) line is put into your arm. The IV delivers fluid and medication that makes you unconscious during the surgery. After the surgery, you may spend a few days in the intensive care unit (ICU). That's to make sure your heart is pumping normally and your chest is healing normally. You are usually out of the hospital within a week. You may have pain at the incision site for several weeks, but medication is provided for the pain. At home, recovery often takes 4-6 weeks.

After your bypass surgery, your doctor may recommend cardiac rehabilitation. This involves a team of healthcare experts who work with you to help you recover. To avoid future heart related problems, the team:

  • Shows you the best exercises for you
  • Suggest new eating habits
  • Orders medication to reduce your symptoms
  • Helps you regain or learn new lifestyles and coping skills
  • Counsels you on making lifestyle changes