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During the procedure
Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. On average, surgeons repair two to four coronary arteries. The number of bypasses required depends on the location and severity of blockages in your heart.
Most coronary bypass surgeries are done through a large incision in the chest while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery).
The surgeon cuts down the center of the chest, along the breastbone. The surgeon then spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped 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 (the internal mammary artery) or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.
There are other newer surgical techniques your surgeon may use if you're having coronary bypass surgery:
- Off-pump or beating-heart surgery. This procedure allows surgery to be done on the still-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. Because of this, it's not an option for everyone.
- Minimally invasive surgery. In this procedure, a surgeon performs coronary bypass through a smaller incision 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 may be called port-access or keyhole surgery.
Once you're put to sleep (anesthetized), a breathing tube is inserted through your mouth. This tube attaches to a ventilator, which breathes for you during and immediately after the surgery.
After the procedure
Coronary bypass surgery is a major operation. Expect to spend a day or two in the intensive care unit after coronary bypass surgery. Here, your heart, blood pressure, breathing and other vital signs will be continuously monitored. Your breathing tube will remain in your throat for a few hours or overnight after surgery, so you won't be able to speak. You can communicate with hand gestures and notes. The breathing tube will be removed as soon as you are awake and able to breathe on your own.
Barring any complications, you'll likely be discharged from the hospital within a week, although even after you've been released, you may find it difficult to perform everyday tasks, or even walk a short distance. If, after returning home, you experience any of the following signs or symptoms, call your doctor. They could be warning signs that your chest wound is infected:
- A fever higher than 100.4 F (38 C)
- 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. In most cases, you can return to work, begin exercising and resume sexual activity after six weeks, but make sure you have your doctor's OK before doing so.
- Eagle KA, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article — A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2004;110:1168.
- Bypass surgery, coronary artery. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4484. Accessed May 11, 2010.
- Shapira OM, et al. Coronary artery bypass graft surgery after acute ST elevation myocardial infraction. http://www.uptodate.com/index. Accessed May 11, 2010.
- Aranki S, et al. Early cardiac complications after coronary artery bypass surgery. http://www.uptodate.com/home/index.html. Accessed May 11, 2010.
- Aranki S, et al. Early noncardiac complications after coronary artery bypass surgery. http://www.uptodate.com/home/index.html. Accessed May 11, 2010.
- Holzhey DM, et al. Seven-year follow-up after minimally invasive direct coronary artery bypass: Experience with more than 1300 patients. The Annals of Thoracic Surgery. 2007;83:104.
- Suaya JA, et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116:1653.
- Puskas JD, et al. Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. The Annals of Thoracic Surgery. 2008;86:1139.
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