What is heart bypass surgery?
Heart bypass surgery, or coronary artery bypass graft (CABG) surgery, is used to improve blood flow to your heart. A surgeon uses blood vessels taken from another area of your body to bypass the damaged arteries.
Doctors perform approximately 200,000 such surgeries in the United States each year.
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 called plaque builds up on your arterial walls, less blood flows to the heart muscle. This type of coronary artery disease (CAD) is known as atherosclerosis.
The heart is more likely to become exhausted and fail if it’s not receiving enough blood. Atherosclerosis can affect any arteries in the body.
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.
Your doctor will also 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’ll 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’s still a risk for some complications after surgery. These complications could include:
- blood clots
- chest pain
- kidney failure
- heart attack or stroke
In the past decade, more alternatives to heart bypass surgery have become available. These include:
Balloon angioplasty is the alternative that’s most likely to be recommended by doctors. During this treatment, a tube is threaded through your blocked artery. Afterward, a small balloon is inflated to widen the artery.
The doctor then removes the tube and the balloon. A small metal scaffold, also known as a stent, will be left in place. A stent keeps the artery from contracting back to its original size.
Balloon angioplasty may not be as effective as heart bypass surgery, but it’s less risky.
Enhanced external counterpulsation (EECP)
Enhanced external counterpulsation (EECP) is an outpatient procedure. It can be performed as
EECP involves compressing blood vessels in the lower limbs. This increases blood flow to the heart. The extra blood 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 over the course of seven weeks.
There are some medications you can consider before resorting to methods such as heart bypass surgery. Beta-blockers can relieve stable angina. You can use cholesterol-reducing drugs to slow plaque buildup in your arteries.
Your doctor may also recommend a daily dose of low-dose aspirin (baby aspirin) to help prevent heart attacks. Aspirin therapy is very effective in people with a prior history of atherosclerotic cardiovascular disease (such as heart attack or stroke).
Those without a prior history should only use aspirin as a preventive drug if they:
- are at high risk of heart attack and other atherosclerotic cardiovascular diseases
- also have a low risk for bleeding
Diet and lifestyle changes
The best preventive measure is a “heart-healthy” lifestyle, as prescribed by the
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 isn’t 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 may include:
Heart surgery tips
- Seek your doctor’s advice about any medication that affects how your blood clots. Many pain relievers and heart medications affect clotting, so you may have to stop taking them.
- Quit smoking. It’s bad for your heart and increases healing time.
- Tell your doctor if you have symptoms of a cold or flu. In particular, the flu can put further strain on the heart and can increase your chances of a heart attack or worsen heart failure. It can also cause myocarditis, pericarditis, or both. These are potentially serious heart infections.
- Prepare your home and make arrangements to stay in the hospital for several days.
- To reduce the risk of infection, wash your body with a special soap, like Hibiclens, the night before surgery. It’s made of chlorhexidine, which will help keep your body germ-free until surgery.
- Fast, which includes not drinking water, beginning at midnight before your surgery.
- Take all of the medications your doctor gives to you.
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.
The first step
Your surgeon starts by making an incision in the middle of your chest.
Your rib cage is then spread apart to expose your heart. Your surgeon may also opt for minimally invasive surgery, which involves smaller cuts and special miniaturized instruments and robotic procedures.
Connecting to the cardiopulmonary bypass machine
You may be hooked up to a cardiopulmonary bypass machine that circulates oxygenated blood through your body while your surgeon operates on your heart.
Some procedures are performed “off-pump,” meaning that connecting you to a cardiopulmonary bypass machine isn’t necessary.
Your surgeon then removes a healthy blood vessel from the leg to bypass the blocked or damaged portion of your artery. One end of the graft is attached above the blockage and the other end below.
The final steps
When your surgeon is done, 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 ensure the procedure is performed properly. A perfusion technologist works with the cardiopulmonary bypass machine.
A cardiovascular surgeon performs the procedure and an anesthesiologist ensures anesthesia is delivered to your body properly to keep you unconscious during the procedure.
Imaging specialists may 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:
- pain at the incision site
- pain with deep breaths
- pain with coughing
You’ll likely be in the ICU for one to two days so your vital signs can be monitored. Once you’re stable, you’ll be moved to another room. Be prepared to stay in the hospital for several days.
Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:
- caring for your incision wounds
- getting plenty of rest
- refraining from heavy lifting
Even without complications, recovery from heart bypass surgery can take 6 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. Follow your doctor’s orders regarding physical activity. 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 a narcotic for extreme pain.
Your doctor will also give you medications to help you throughout your recovery process. These will include antiplatelet drugs and other drugs prescribed by your doctor.
Talk to your doctor about what medication plans are best for you. This is especially important if you have existing conditions such as 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||• drowsiness|
|nitrates||help reduce chest pain by opening up your arteries to let blood flow through more easily||• headaches|
|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|
• dry cough
|lipid-lowering medicines, such as statins||can help lower LDL (bad) cholesterol and help prevent strokes or heart attacks||• headache|
• liver damage
• myopathy (muscle pain or weakness that doesn’t have a specific cause)
After a successful heart bypass surgery, symptoms such as shortness of breath, chest tightness, and high blood pressure will likely improve.
A bypass can increase blood flow to the heart, but you may need to change some habits to prevent future heart disease.
The best surgery outcomes are observed in people who make healthy lifestyle changes. Talk to your doctor about dietary and other lifestyle changes to make after surgery.