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Coronary bypass surgery

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Overview
Coronary bypass surgery
redirects blood around a section
of a blocked or partially blocked
artery in your heart. The
procedure involves taking a
healthy blood vessel from your
leg, arm or chest and connecting
it below and above the blocked
arteries in your heart. With a new
pathway, blood flow to the heart
muscle improves. Coronary
bypass surgery
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Coronary bypass surgery doesn't cure the heart

disease that caused the blockages, such as
atherosclerosis or coronary artery disease. However, it
can ease symptoms, such as chest pain and shortness
of breath. For some people, this procedure can
improve heart function and reduce the risk of dying of
heart disease.

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Why it's done

Coronary bypass surgery is one treatment option if you
have a blocked artery to your heart.

You and your doctor might consider it if:

You have severe chest pain caused by narrowing

of several arteries that supply your heart muscle,
leaving the muscle short of blood during even
light exercise or at rest.

You have more than one diseased coronary

artery, and the heart's main pumping chamber —
the left ventricle — isn't functioning well.

Your left main coronary artery is severely

narrowed or blocked. This artery supplies most of
the blood to the left ventricle.

You have an artery blockage that can't be treated

with a procedure that involves temporarily
inserting and inflating a tiny balloon to widen the
artery (angioplasty).

You've had a previous angioplasty or placement

of a small wire mesh tube (stent) to hold the
artery open that hasn't been successful. Or
you've had a stent placement, but the artery has
narrowed again.

Coronary bypass surgery might also be performed in

emergency situations, such as a heart attack, if you're
not responding to other treatments.

Even with coronary bypass surgery, you'll need to

make lifestyle changes after surgery. Medications are
prescribed routinely after coronary bypass surgery to
lower your blood cholesterol, reduce the risk of
developing a blood clot and help your heart work as
well as possible.

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Risks
Because coronary bypass surgery is an open-heart
surgery, you might have complications during or after
your procedure. Possible complications include:

Bleeding

An irregular heart rhythm

Infections of the chest wound

Memory loss or trouble thinking clearly, which

often improves within six to 12 months

Kidney problems

Stroke

Heart attack, if a blood clot breaks loose soon

after surgery

Your risk of developing complications is generally low,

but it depends on your health before surgery. Your risk
of complications is higher if the surgery is done as an
emergency procedure or if you have other medical
conditions, such as emphysema, kidney disease,
diabetes or blocked arteries in your legs.

How you prepare

Your doctor will give you specific instructions about
activity restrictions and changes in your diet or
medications that you should make before surgery.

Make arrangements for assistance after your surgery.

It will take about four to six weeks for you to recover to
the point where you can resume driving, return to work
and perform daily chores.

What you can expect

Before the procedure
If your coronary bypass surgery isn't performed as
emergency surgery, you'll likely be admitted to the
hospital the morning of the surgery.

During the procedure

Coronary bypass surgery generally takes between
three and six hours and requires general anesthesia.
The number of bypasses you need depends on where
in your heart and how severe your blockages are.

For general anesthesia, a breathing tube is inserted

through your mouth. This tube attaches to a ventilator,
which breathes for you during and immediately after
the surgery.

Most coronary bypass surgeries are done through a

long incision in the chest while a heart-lung machine
keeps blood and oxygen flowing through your body.
This is called on-pump coronary bypass surgery.

The surgeon cuts down the center of the chest along

the breastbone and spreads open the rib cage to
expose the heart. After the chest is opened, the heart
is temporarily stopped with medication and a heart-
lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel,

often from inside the chest wall or from the lower leg,
and attaches the ends above and below the blocked
artery so that blood flow is redirected around the
narrowed part of the diseased artery.

Other surgical techniques your surgeon might use

include:

Off-pump or beating-heart surgery. This

procedure involves doing surgery on the beating
heart using special equipment to stabilize the
area of the heart the surgeon is working on. This
type of surgery is challenging because the heart
is still moving. It's not an option for everyone.

Minimally invasive surgery. A surgeon performs

coronary bypass through small incisions in the
chest, often with the use of robotics and video
imaging that help the surgeon operate in a small
area. Variations of minimally invasive surgery
might be called port-access or keyhole surgery.

After completing the graft, the surgeon will restore your

heartbeat, disconnect you from the heart-lung machine
and use wire to close your chest bone. The wire will
remain in your body after the bone heals.

After the procedure

Expect to spend a day or two in the intensive care unit.
The breathing tube will remain in your throat until you
are awake and able to breathe on your own.

Cardiac rehabilitation often begins while you're still in

the hospital. You'll be given an exercise and education
program designed to help you recover. You'll continue
with monitored programs in an outpatient setting until
you can safely follow a home-based maintenance
program.

Barring complications, you'll likely be discharged from

the hospital within a week. You still might have
difficulty doing everyday tasks or walking a short
distance. If, after returning home, you have any of the
following signs or symptoms, call your doctor:

Fever

Rapid heart rate

New or worsened pain around your chest wound

Reddening around your chest wound or bleeding

or other discharge from your chest wound

Expect a recovery period of about six to 12 weeks. If

you have your doctor's OK, you can return to work,
begin exercising and resume sexual activity after four
to six weeks.

Results
After surgery, most people feel better and might
remain symptom-free for as long as 10 to 15 years.
Over time, however, it's possible that other arteries or
even the new graft used in the bypass will become
clogged, requiring another bypass or angioplasty.

Your results and long-term outcome will depend in part

on taking your medications to prevent blood clots,
lower blood pressure, lower cholesterol and help
control diabetes. It's also important to follow healthy-
lifestyle recommendations, including these:

Stop smoking.

Follow a healthy-eating plan, such as the DASH

diet.

Achieve and maintain a healthy weight.

Exercise regularly.

Manage stress.

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Coronary bypass surgery care at Mayo Clinic

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Doctors & Departments

Nov. 03, 2020

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nation for 2022-2023 by U.S. News & World
Report.

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