Heart bypass surgery, or coronary artery bypass surgery, is used to replace damaged arteries in your heart muscle. A surgeon uses blood vessels taken from another area of your body to repair the damaged arteries. Doctors performed 213,700 such surgeries in the United States in 2011.
This surgery is done when coronary arteries become blocked or damaged. These arteries supply your heart with oxygenated blood. If these arteries are blocked, or blood flow is restricted, the heart doesn’t work properly. This can lead to heart failure.
Your doctor will recommend a certain type of bypass surgery depending on how many of your arteries are blocked.
- single bypass: only one artery is blocked
- double bypass: two arteries are blocked
- triple bypass: three arteries are blocked
- quadruple bypass: four arteries are blocked
Your risk of having a heart attack, heart failure, or another cardiac issue depends on the number of arteries blocked. Blockage in more arteries also means that the surgery may take longer or become more complex.
When a material in your blood (plaque) builds up on your arterial walls, less blood flows to the heart muscle. The muscle is more likely to become exhausted and fail if it’s not receiving enough blood.
Any damage this creates most often affects the left ventricle, the heart’s primary pump.
Your doctor may recommend heart bypass surgery if your coronary arteries become so narrowed or blocked that you run a high risk of a heart attack.
This condition is called coronary artery disease, or atherosclerosis. Your doctor will recommend bypass surgery when the blockage is too severe to manage with medication or other treatments.
A team of doctors, including a cardiologist, identify whether you can undergo open-heart surgery. Some medical conditions can complicate surgery or eliminate it as a possibility.
Conditions that can cause complications include:
Discuss these issues with your doctor before scheduling your surgery. You will also want to talk about your family medical history and any prescription and over-the-counter (OTC) medications you’re taking. Planned surgery outcomes are usually better than emergency surgery.
As with any open-heart surgery, heart bypass surgery carries risks. Recent technological advancements have improved the procedure, increasing the chances of a successful surgery.
There is still a risk for some complications after surgery. These complications could include:
In the past decade, more alternatives to heart bypass surgery have become available. These include:
Balloon angioplasty is the most common doctor-recommended alternative to heart bypass surgery. During this treatment, a tube is threaded through your blocked artery. Then, a small balloon is inflated to widen the artery.
The doctor then removes the tube and the balloon. A small metal scaffold called a stent will be left in place. A stent keeps the artery from contracting back to its original size.
Balloon angioplasty isn’t as effective as heart bypass surgery, but it's less risky.
Enhanced external counterpulsation (EECP)
EECP is an outpatient procedure. It’s been shown to be an effective alternative to heart bypass surgery. In 2003, it was approved by the U. S. Food and Drug Administration (FDA) for use in people with congestive heart failure.
EECP involves compressing blood vessels in the lower limbs. This increases blood flow to the heart. The 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, becoming a sort of “natural bypass.”
EECP is administered daily for a period of one to two hours each day over the course of seven weeks.
There are some medications you may consider before resorting to heart bypass surgery or any other methods. Beta-blockers can relieve stable angina. Cholesterol-reducing drugs can slow plaque buildup in your arteries.
Also, most doctors agree that a daily dose of baby aspirin (low-dose aspirin) can help prevent heart attacks in high-risk individuals.
Diet and lifestyle changes
The best preventative measure is a “heart-healthy” lifestyle, as prescribed by the American Heart Association (AHA). Eating a diet high in omega-3 fatty acids and avoiding saturated and trans fats help your heart stay healthy.
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 is not an emergency procedure, you’ll most likely have several preoperative appointments where you’ll be asked about your health and family medical history.
You’ll also undergo several tests to help your doctor get an accurate picture of your health. These test may include:
Before the surgery
Before surgery, you’ll change into a hospital gown and receive medication, fluids, and anesthesia through an IV. 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 rib cage is then spread apart to expose your heart. Or your surgeon may opt for minimally invasive surgery. This involves smaller cuts and special miniaturized instruments.
You will be hooked up to a cardiopulmonary bypass machine. Also known as the heart-lung machine, it circulates oxygenated blood through your body while your surgeon operates on your heart.
Blood will be pumped out of your heart by the machine to remove carbon dioxide, and the machine will then be filled with oxygen. The oxygenated blood is pumped back into your body without going through the heart and lungs. This keeps oxygenated blood pumping throughout your body. Some procedures are performed “off-pump,” meaning that connecting you to the heart-lung machine isn’t necessary.
Your surgeon will also use cooling techniques, sometimes called “extreme cooling,” to bring your body temperature down to around 64.4°F (18°C). This technique suspends your body’s processes and makes long heart surgeries possible. Your heart needs less oxygen when your body temperature is lowered. Your doctor will cool down your heart with the help of the heart-lung machine or by dousing your heart in cold, salty water.
Cooling techniques allow your doctor to operate on your heart tissue for a few hours at a time. These techniques decrease the risk of heart damage or brain damage from a lack of oxygen.
Your surgeon will then remove a healthy blood vessel from inside your chest wall or leg to replace the blocked or damaged artery. When your surgeon is done, the heart-lung machine is removed, and the function of the bypass is checked. Once the bypass is working you’ll be stitched up, bandaged, and taken to the intensive care unit (ICU) for monitoring.
Throughout the surgery, several types of specialists will ensure the procedure is performed properly. A perfusion technologist (sometimes called a blood flow specialist) works with the heart-lung machine.
A cardiologist (or several) will supervise the procedure. A heart surgeon will perform the procedure, and cardiac anesthesiologists will ensure anesthesia is delivered to your body properly to keep you unconscious during the procedure.
Imaging specialists will also be present to take X-rays or help ensure that the team can view the site of the surgery and the tissues around it.
When you wake up from heart bypass surgery, you’ll have 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’ll likely be in the ICU for one to two days so your vital signs can be monitored. Once you’re 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 instructions on how to care for yourself, including:
- caring for the incision wound(s)
- getting plenty of rest
- refraining from physical activity
Even without complications, recovery from heart bypass surgery can take six to 12 weeks. That’s the least amount of time it takes for your breastbone to heal. During this time, you should avoid heavy exertion. Limit physical activity as much as possible, and don’t lift objects over 10 pounds. Also, you shouldn’t drive until you get approval from your doctor.
Your doctor will likely recommend cardiac rehabilitation. This will involve a regimen of carefully monitored physical activity and occasional stress tests to see how your heart is healing.
Tell your doctor about any lasting pain or discomfort during your follow-up appointments. You should also call your doctor if you experience:
- fever over 100.4°F (38°C)
- increasing pain in your chest
- rapid heart rate
- redness or discharge around the incision
Your doctor will give you medications to help manage your pain, such as ibuprofen (Advil) or acetaminophen (Tylenol). You may also receive Percocet, which contains both acetaminophen and oxycodone. Your doctor will also give you medications to help you throughout your recovery process. These will include antiplatelet drugs and angiotensin converting enzyme (ACE) inhibitors.
Talk to your doctor about what medication plans are best for you. This is especially important if you have existing conditions like diabetes or conditions affecting the stomach or liver.
|Type of drug||Function||Possible side effects|
|antiplatelet drugs, such as aspirin||help prevent the formation of blood clots||• stroke caused by bleeding rather than clotting
• stomach ulcers
• serious allergy-related issues if you’re allergic to aspirin
|beta-blockers||block your body’s production of adrenaline and lower your blood pressure||• abnormal weight gain
• shallow breathing
|nitrates||help reduce chest pain by opening up your arteries to let blood flow through more easily||• headaches
• abnormal heart rhythms
|ACE inhibitors||prevent your body’s production of angiotensin II, a hormone that can make your blood pressure rise and cause your blood vessels to narrow||• headaches
• loss of taste
|lipid-lowering medicines, such as statins||can help lower LDL (“bad”) cholesterol and help prevent strokes or heart attacks||• memory loss
• liver damage
• myopathy (muscle pain or weakness that doesn’t have a specific cause)
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 make healthy lifestyle changes. Talk to your doctor about dietary and other lifestyle changes to make after surgery.