Coronary bypass is a surgical procedure used 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.” It 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. Your physician will determine which is best for you, based on your medical history and current condition.
Types of Surgery
Conventional Heart Bypass Surgery
Conventional heart bypass surgery is often referred to as “open heart surgery.” A surgeon will make an eight 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, 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 candidates whose health would make the use of a heart-lung machine risky, according to the National Institutes of Health (NIH). 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, sometimes called “MICS” or “minimally invasive cardiac surgery,” is 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 three to five inches long, up to two 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.
Triple Bypass Surgery
In a triple bypass procedure, a surgeon will divert three separate arteries that all have blockages. A triple coronary bypass may be performed using either conventional or minimally invasive techniques. 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 laproscopically, using precision-guided tools and a video monitor to clearly see where the blockage is located.
Preparation for a planned coronary bypass operation includes a series of pre-admittance testing. The testing will 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 testing such as an angiogram may be required and you might be told to stop certain medications before the procedure. Most patients 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 suffers a heart attack. In this case, minimal preparation is needed before heading into emergency surgery.
Risks and Complications
The risks of any medical procedure, including bypass surgery, include infection, blood loss, the formation of blood clots, and significant scarring. Additional complications associated with bypass surgery may include:
- irregular heart beat
- heart attack
- memory loss or temporary cognitive impairment
- kidney failure
The healthier you are prior to surgery, the less likely you are to develop complications, according to the Mayo Clinic. Chronic conditions such as kidney disease, diabetes, or respiratory distress may cause prolonged healing or other complications detailed above.
Recovery and Outlook
Coronary bypass surgery is highly successful in most patients. According to University of Southern California’s Keck School of Medicine, grafts retain effectiveness for between 10 and 12 years in many cases. However, it’s important to remember that the operation doesn’t remove the damaged portion of your artery or repair other areas where plaque accumulates. Overall recovery also depends on adopting a healthy lifestyle to keep the remaining arteries clear.
Recovery from a heart bypass begins in the intensive care unit, 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 your 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.
Full recovery from a coronary bypass can be measured in months rather than weeks. 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 home care by a spouse, parent, or friend, as 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 to assess your physical and emotional health and discuss any issues around 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 post-surgery. However, your overall health and the type of surgery performed will greatly determine this.
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
Coronary bypass surgery is an option for some, but not for everyone who suffers from heart disease-related blockages. People with ill health might not be strong enough to withstand bypass surgery and may need to consider other forms of treatment. Discuss your options with your doctor.
You might be able to alleviate some of the symptoms of heart disease through medications or less risky procedures, like a balloon angioplasty (an intervention where a balloon-like device is inserted into the affected blood vessel and filled with air to clear the blockage). Sometimes a stent (a mesh tube filled with medication) is implanted into the area to keep the artery from becoming clogged again. Non-invasive alternatives to bypass and angioplasty may include taking medications that dilate your blood vessels to allow more blood to pass through.
Any type of surgical procedure is costly, and coronary bypass procedures are no exception. Minimally invasive techniques used to bypass damaged arteries are 25 percent less expensive on average than conventional open heart surgery. Minimally invasive bypass procedures cut down on cost through a shorter recovery time in the hospital and a lower rate of infection. As you bleed less during minimally invasive surgery, you also may save on anti-clotting medications and blood products.