Heart bypass surgery is a procedure to treat coronary heart disease.
There are various types, including multiple bypass and minimally invasive.

The medical name for heart bypass surgery is coronary artery bypass graft (CABG). The procedure involves removing a blood vessel from the chest, arms, or legs and using it to create a detour or bypass around the blockage in the coronary artery that feeds the heart. This allows blood to reach the heart again.

Heart bypass surgery is a relatively safe and effective procedure that reduces the risk of heart attack and death. The procedure might also ease symptoms of coronary artery disease, such as chest pain.

Heart bypass surgery is a complicated procedure that involves a significant amount of preparation and recovery time. Read on to learn more.

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Doctors typically have a range of options to treat a blockage. Doctors may try to resolve the issue with medications and less-invasive procedures, such as a stent, but this is not always the case.

Heart bypass surgery is the preferred treatment method in cases of complex vessel disease, if a person requires multiple bypasses, or if they have other underlying health conditions such as diabetes.

The stages of an open bypass procedure are:

  1. General anesthesia: After preparing for the surgery, an anesthesiologist will administer a general anesthetic to put the person to sleep and place a breathing tube into the person’s windpipe.
  2. Harvesting of graft vessels: Surgeons will remove target vessels from the person’s leg, arm, or chest.
  3. Incision and opening: The surgeon will make an incision in the center of the chest and separate the person’s sternum to access the heart. They will temporarily stop the heart from beating at this point.
  4. Cardiopulmonary bypass: Doctors may place a person on a cardiopulmonary bypass. This involves connecting the person to a machine that takes over their heart and lung processes. Not all surgeries require the use of this bypass.
  5. Grafting: Surgeons will attach the new graft vessels to either side of the blockages to divert blood flow.
  6. Restoring blood flow: Doctors will remove the cardiopulmonary bypass if necessary and then check that blood is flowing through the grafted vessel correctly.
  7. Closure: After checking blood flow through the graft, the surgeons will fix the sternum with metal wires and sew up the incision site. The person will move to an intensive care unit for recovery.

The procedure typically takes 3–6 hours, but this can vary depending on how many grafts a person requires.

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There are different types of bypass surgery.

Multiple bypass surgery

When a surgeon only has to bypass a single blocked artery, this is a single bypass operation. If more than one artery has a blockage, multiple bypasses will be necessary. Surgeons may also perform:

  • Double bypass surgery: If there are blockages in two arteries, then two grafts will be necessary.
  • Triple bypass surgery: If there are three blockages, then three bypass grafts are necessary.
  • Quadruple bypass surgery: If four coronary arteries contain blockages, then four grafts are necessary to bypass them.
  • Quintuple bypass surgery: This involves all five major arteries feeding the heart and requires five bypass grafts.

Minimally invasive

Surgeons can perform heart bypass surgery without fully opening a person’s chest. They can make small incisions in a person’s side, between ribs. They then insert small cameras and surgical instruments to carry out the bypass surgery. Surgeons may perform this with or without robotic assistance.

Minimally invasive heart surgery typically has a shorter recovery time. The procedures can produce results that are as positive as open surgery.

On-pump and off-pump

Heart bypass surgery is typically an open-heart surgery, which means the surgeon cuts the chest open to reach the heart. The surgeon can then perform the surgery “on-pump” or “off-pump.”

On-pump surgery involves using a heart-lung machine that circulates blood and performs the gas-exchange function of the lungs. The machine allows doctors to stop the heart, which makes the operation easier.

Off-pump surgery, also called “beating heart surgery,” takes place while the heart is still beating, but does not use the heart-lung machine.

Before heart bypass surgery, people should:

  • stop smoking immediately, if applicable
  • discuss with the surgeon which medications to continue or discontinue
  • arrange for someone to stay with them after returning home
  • avoid eating or drinking after midnight on the night before surgery
  • follow any other instructions provided by the doctor or care team

A person undergoing a planned heart bypass operation will have an opportunity to discuss the procedure with their doctor before the operation. The care team will explain the surgery, set arrival times, and help complete paperwork.

They will undergo tests before the surgery, including an electrocardiogram (EKG), chest X-ray, and blood tests. Before the operation, nurses insert an IV into the person’s arm. The IV will allow fluids and medication to enter the body as needed.

A member of the healthcare team might also shave the areas where a surgeon will make their incisions.

Risks and potential complications vary for each person. This will depend on the type of procedure performed, personal health, and personal risk factors.

Potential complications of a heart bypass include:

Factors that may increase the risk of complications include:

Heart bypass surgeries are a serious procedure but relatively safe. Outcomes of heart bypass surgery are typically positive. The procedure can reduce symptoms of arterial blockages and improve quality of life.

After waking up, a person will have a tube that helps them to breathe. It will feel strange and uncomfortable, but it is necessary. Usually, a doctor will remove the tube after 24 hours.

There will also be tubes and drains in the chest, as well as external monitors on the skin. The healthcare team will monitor the output from these devices and remove them when appropriate. They will also monitor blood pressure.

On average, a person will remain in the hospital for about a week after surgery. It is typical to experience soreness and night sweats, and there is likely to be some fluid in the lungs, so people should expect coughing.

People usually start to eat and move around soon after the doctor has removed the breathing tube.

Common post-surgery medications typically include platelet inhibitors, which help prevent blood clots.

Physical therapy and cardiac rehabilitation may also be necessary for recovery.

Complications are possible but unusual. Assuming there are no complications, most people can expect a better quality of life quite soon after surgery.

Heart disease continues to be a top health problem in the United States. There are many options for treating heart disease. For hundreds of thousands of people each year, heart bypass surgery is the best choice to address blocked arteries.

Heart bypass surgery is safe and effective and can help people regain the quality of life they experienced before they developed a heart condition.