Coronary Bypass Surgery and Alternatives
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Coronary Bypass Surgery and Alternative Treatments

What Is a Coronary Bypass?

Coronary bypass is a surgery that’s done to restore blood flow to your heart muscle. People who require bypass surgery have partial or total blockages of the arteries, which is one of the primary symptoms of heart disease.

A coronary bypass is also referred to as “heart bypass surgery” or a “coronary artery graft.” During this surgery, your doctor diverts the blood flow around the blockage to ensure that your heart receives the oxygen and nutrients it needs. Several types of coronary bypass procedures exist. For example, your surgeon will divert three separate arteries that all have blockages if you’re having triple bypass surgery. Your doctor can determine which one is best for you based on your medical history and current condition.

What Are the Types of Coronary Bypass?

 Type 1

Coronary bypass surgery, including triple bypass, may be performed using either conventional or minimally invasive techniques:

Conventional Heart Bypass Surgery

Conventional heart bypass surgery is often referred to as “open-heart surgery.” Your surgeon will make an 8- to 10-inch incision in your chest and separate your sternum to perform the bypass. A section of vein will be taken from your leg, chest, or groin area to form a graft near the diseased artery. The graft is the new route through which blood will flow to your heart, bypassing the damaged sections of blood vessels.

You may be put on a heart-lung machine, which is a device that keeps you alive while your heart is temporarily stopped to perform the surgery. Your doctor may alternatively choose to perform an off-pump procedure while your heart is still beating. This type of open-heart surgery is ideal for people whose health would make the use of a heart-lung machine risky. The surgery can take as long as six hours to complete, and your surgeon may repair more than one artery.

Minimally Invasive Bypass Surgery

A minimally invasive bypass is sometimes called minimally invasive cardiac surgery (MICS). It’s performed using a series of keyhole incisions rather than one long incision down the middle of your chest. The smaller incisions are made along your ribs and measure approximately 3 to 5 inches long and up to 2 inches wide. MICS is performed while your heart continues to beat, using the same type of graft as conventional surgery. The recovery period is significantly shorter, and the risks and complications are lower than those associated with open-heart bypass.

Cardiac surgeons throughout the United States are beginning to use robotics to provide the least invasive experience possible. The first closed-chest, robotics-assisted coronary bypass was performed in 1999 by University of California, Davis surgeon, Dr. W. Douglas Boyd. The robotic-powered instruments allow for surgery to be completed laparoscopically, using precision-guided tools and a video monitor to see clearly where the blockage is located.

How Do I Prepare for a Coronary Bypass?

Diagnosis

Preparation for a planned coronary bypass operation includes a series of tests. These tests will help your doctor assess your heart function, pinpoint the location of the blockage, and measure other factors such as cholesterol, blood pressure, and glucose levels.

Blood tests and imaging tests such as an angiogram may be required, and you might be told to stop certain medications before the procedure. Most people aren’t allowed to eat or drink anything for at least eight hours before surgery. A coronary bypass can also be a type of emergency treatment after a person with heart disease has a heart attack. In this case, minimal preparation is needed before heading into emergency surgery.

Costs

Any surgical procedure is costly, and coronary bypass procedures are no exception. Minimally invasive techniques used to bypass damaged arteries are often less expensive than conventional open-heart surgery.

Minimally invasive bypass procedures cost less because they require a shorter recovery time in the hospital and are associated with a lower rate of infection. Most people bleed less during a minimally invasive surgery, so you also may save on anticlotting medications and blood products.

Are There Alternatives to Coronary Bypass Surgery?

Treatment

Coronary bypass surgery isn’t an option for everyone with heart disease. Some people may have health conditions that make the surgery too risky.

You might be able to alleviate some of the symptoms of heart disease through medications or less risky procedures, like a balloon angioplasty. During a balloon angioplasty, your doctor will insert a balloon-like device into the affected blood vessel and fill it with air to clear the blockage.

Your doctor may insert a stent, which is a mesh tube filled with medication, into the area to keep the artery from becoming clogged again. Noninvasive alternatives to bypass and angioplasty may include taking medications that dilate your blood vessels to allow more blood to pass through.

Discuss your options with your doctor.

What Are the Risks and Complications of Coronary Bypass Surgery?

Risk Factors

The risks of any medical procedure, including bypass surgery, are:

  • an infection
  • blood loss
  • the formation of blood clots
  • significant scarring

Additional complications associated with bypass surgery may include:

  • an irregular heart beat
  • a heart attack
  • a stroke
  • memory loss
  • temporary cognitive impairment
  • kidney failure

The healthier you are before surgery, the less likely you are to develop complications. Chronic conditions such as kidney disease, diabetes, or respiratory distress may cause prolonged healing or other complications detailed above.

What Is the Outlook for People Who Have Coronary Bypass Surgery?

Outlook

Coronary bypass surgery is highly successful for most people. For many people, grafts are effective for 10 to 12 years. During this surgery, your doctor doesn’t remove the damaged portion of your artery or repair other areas where plaque accumulates. Therefore, overall recovery also depends on adopting a healthy lifestyle to keep the remaining arteries clear.

Recovering from Coronary Bypass Surgery

Results/Exams

Recovery from a heart bypass begins in the intensive care unit (ICU), where your vital signs, oxygen levels, and blood pressure will be monitored continuously. You can expect fatigue and significant pain and tenderness at the incision sites.

As your recovery progresses, you’ll be released from the ICU to gain strength and heal in the cardiac unit or an ordinary hospital room. The length of your stay will vary according to the type of procedure and the rate of your recovery. You may remain in the hospital for up to a week if you undergo a conventional heart bypass. Or, you could go home as soon as three days after a minimally invasive bypass procedure.

You might not feel completely healed, rested, and like yourself until three months after surgery. Similar to the length of your hospital stay, recovery from a conventional bypass takes longer than minimally invasive measures. You may require care by a spouse, parent, or friend because even walking short distances can be difficult during the first month after your bypass.

Schedule follow-up appointments according to your surgeon’s recovery schedule. During these appointments, your doctor can assess your physical and emotional health and you can discuss any issues with returning to work or school. You may be able to drive, resume normal activities (including sex), and lead a normal life within three to eight weeks after your surgery. However, your overall health and the type of surgery performed will greatly determine how long this takes.

Lifestyle Changes

The recovery period is an excellent time to review your lifestyle choices and create a healthy living plan to help keep your heart functioning as well as possible. Some things to consider during this time include:

  • quitting smoking
  • finding an outlet for relieving stress
  • learning about heart-healthy nutrition
  • beginning a daily exercise plan when you’re able

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