Heart bypass surgery, also known as coronary artery bypass surgery, aims to replace damaged arteries in the heart. A surgeon uses blood vessels from another area of the body to repair the damaged arteries.
This surgery is used when the coronary arteries become blocked or damaged. The coronary arteries supply the heart’s muscles with oxygenated blood. If they are blocked or the flow of blood is restricted, the heart can’t function properly. This can lead to heart failure. According to the Centers for Disease Control (CDC), doctors perform 395,000 such surgeries in the United States each year.
When plaque, which is a material in the blood, builds up on the walls of the arteries, there’s less blood flow to the heart muscle. Since the heart is not receiving adequate blood, the muscle is more likely to tire and fail. This type of damage most often affects the left ventricle, the heart’s primary pump.
Doctors recommend heart bypass surgery if your coronary arteries become so narrowed or blocked that you run a high risk of a fatal heart attack. This condition is called coronary artery disease, or atherosclerosis. Bypass surgery is performed when the blockage is too severe to be managed with medication or other treatment.
Prior to the surgery, a team of physicians, along with a cardiologist, will identify whether or not you can safely undergo open-heart surgery. Some medical conditions can complicate surgery or eliminate it as a possibility altogether.
Conditions that can cause complications include:
- kidney disease
- peripheral artery disease
Tell your doctor about these issues along with family history, prescription and over-the-counter medications before any surgery is scheduled. In general, outcomes are better for planned surgery than emergency surgery.
As with any “open heart” surgery, heart bypass surgery does carry significant risks. However, recent technology advancements have helped improve the procedure, making the likelihood of success much higher.
There are some possible complications that can arise after surgery, including:
- blood clots
- chest pain
- kidney failure
- low-grade fever
- temporary or permanent memory loss
- heart attack or stroke
In the past decade, an increasing number of alternatives to heart bypass surgery have become available.
Balloon angioplasty is the most common doctor-recommended alternative to heart bypass surgery. During this treatment, a tube is threaded through the clogged artery, and a small balloon is inflated to widen the artery. The doctor then removes the tube and the balloon. In most cases, they leave behind a small metal scaffold called a stent that will keep the artery from contracting back to its original size. According to the American Heart Association, balloon angioplasty is not as effective as heart bypass surgery, but it's far less risky.
Enhanced External Counterpulsation (EECP)
EECP was approved by the Food and Drug Administration in 2003 as an alternative to heart bypass surgery, and some studies are very positive about its effectiveness. It’s an outpatient treatment that is administered daily for a period of one to two hours each day over the course of seven weeks.
EECP involves compressing blood vessels in the lower limbs to increase blood flow to the heart. Through this compression technique, extra blood flow is delivered to the heart with every heartbeat. Over time, some blood vessels may develop extra “branches” that will deliver blood to the heart, a sort of “natural bypass.”
There are some medications you may consider trying before resorting to heart bypass surgery or any of the other above methods. So-called “beta blocker” drugs can relieve stable angina. Cholesterol-reducing drugs can slow the buildup of plaque in arteries. Most doctors agree that a daily dose of “baby” (low-dose) aspirin can go a long way to prevent heart attacks in high-risk individuals.
Diet and Lifestyle Changes
Of course, the ultimate preventative measure is a “heart-healthy” lifestyle, as prescribed by the American Heart Association. A diet high in omega-3 fatty acids that avoids saturated and trans fats will enable the heart to best serve the body.
If your doctor recommends heart bypass surgery, they’ll give you complete instructions on how to prepare. If the surgery is scheduled in advance and not an emergency procedure, you’ll most likely have several pre-operative appointments where you’ll be asked about your health and family history.
You’ll also undergo several tests. These tests will help your doctor get an accurate picture of your overall health. Tests may include:
- blood samples
- chest X-ray
Here are some ways your doctor may ask you to prepare for surgery:
- Stop any medication that affects how your blood clots. Many pain relievers and heart medications affect clotting. You shouldn’t stop these drugs on your own, but only if your doctor tells you to do so.
- Quit smoking. It’s bad for your heart and increases healing time.
- Contact your doctor if you experience symptoms of a cold or flu. Heart infections can become very serious.
- Prepare your home, and make arrangements for your weeklong hospital stay.
- Wash your body with a special soap the day before the procedure. This reduces the risk of infection.
- Fast, which includes no drinking water, beginning at midnight before your surgery.
- Take any and all medications your doctor gives you.
Before the Surgery
Prior to surgery, you’ll change into a hospital gown and be given an IV. Through this IV, you’ll receive medication, fluids, and anesthesia. When the anesthesia begins working, you’ll fall into a deep, painless sleep.
Your surgeon will start by making an incision in the middle of your chest. Your ribcage will be spread apart to expose your heart. Alternatively, your surgeon may opt for minimally invasive surgery. This involves smaller cuts and specialized, miniaturized instruments.
You will be hooked up to a heart-lung machine. It will circulate oxygenated blood through your body while your surgeon operates on your heart. Some procedures may be performed “off-pump,” meaning that connecting you to the heart-lung machine may not be necessary.
Your doctor will remove a healthy blood vessel from inside your chest wall or leg. This will be implanted to replace the blocked or damaged artery. When your surgeon is done, the heart-lung machine will be removed. The function of the bypass will be checked. Once it is working properly, you’ll be stitched up, bandaged, and taken to the intensive care unit for monitoring.
When you wake up from heart bypass surgery, there will be a tube in your mouth. You may also feel pain or have side effects from the procedure, including:
- short-term memory loss
- trouble keeping track of time
You can expect to be in the intensive care unit for one or two days. There, your vital signs will be closely monitored. Once you are stable, you will be moved to another room. Be prepared to stay in the hospital for seven days.
Before you leave the hospital, your medical team will give you complete instructions on how to care for yourself. These could include:
- caring for the incision wound(s)
- getting plenty of rest
- refraining from physical activity
Even without any complications, recovery from heart bypass surgery can take between six and 12 weeks. That is the minimum amount of time it takes for the breastbone to heal. Anyone that undergoes heart bypass surgery should avoid all heavy exertion, limiting physical activity as much as possible and being careful not to lift objects over 10 pounds. Those recovering should also avoid driving until they receive approval from their doctor.
Most likely, your physician will recommend a program of cardiac rehabilitation. This will involve a regimen of carefully monitored physical activity, with occasional stress tests to see how the heart is healing.
Notify your doctor of any lasting pain or discomfort during your follow-up appointments. You should also call your doctor if you have:
- fever over 100.4°F
- increasing pain in your chest
- rapid heart rate
- redness or discharge around the incision
The Mayo Clinic is optimistic about bypass surgery outcomes. They state that after a successful heart bypass surgery, symptoms like shortness of breath, chest tightness and high blood pressure should be improved.
A bypass can fix a blocked artery, but you may need to change some habits to prevent future heart disease. The best surgery outcomes are observed in individuals that take this lifestyle changes seriously. But studies show that, following bypass surgery, while most patients are interested in resuming their pre-surgery lives, very few take a genuine interest in making lifestyle improvements that would prevent future coronary events. Talk to your doctor about dietary and other lifestyle changes to follow after surgery.