Coronary Bypass Surgery
Your heart is a muscle and like all muscles, it needs a good supply of
blood in order to work properly. It receives blood, as well as oxygen,
from the coronary arteries, which run on the surface of the heart. Sometimes
these arteries narrow due to a build-up of a fatty substance in the artery
walls. A partial blockage can result in symptoms of:
- chest pain (angina)
- shortness of breath
- abnormal heart rhythms
If you have these symptoms, you may be a candidate for surgery to reestablish
normal blood supply to your heart.
Coronary Artery Bypass Surgery is a procedure in which the arteries are
bypassed using the internal mammary artery from your chest wall, the radial
artery from your arm, or the saphenous vein from your leg. The grafts
are sewn on to the heart and then to the aorta for inflow.
What happens during coronary artery bypass surgery?
You will have general anesthesia for the surgery.
The first step in the surgery is for the surgeon to prepare the arteries
or remove the veins that will be used as bypass grafts.
Next, the surgeon makes an incision down the center of your chest, through
your sternum (breast bone), so your heart and coronary arteries can be
seen. Your heart will likely be stopped for a short time so the surgeon
can perform the bypass procedure on a “still” heart. During
this time, the heart-lung bypass machine takes over for the heart and
lungs, so blood keeps moving throughout the rest of the body. This is
called “on-pump” surgery. The pump is turned off after the
grafts are in place. Your heart beat and blood flow return to normal.
The surgery can sometimes be done without using the heart-lung machine,
while your heart is still beating. This is called “off-pump”
or “beating heart” surgery.
The bypass grafts are put in place by sewing one section of the artery
or vein around a tiny opening just below the blockage in the diseased
coronary artery and attaching the other end to a tiny opening made in
the aorta. This redirects the blood flow around the blockage. If an internal
thoracic (mammary) artery is used, one end is connected to the coronary
artery while the other stays attached to the aorta.
During the surgery, your surgeon will place temporary pacing wires and
a chest tube before your sternum is closed with special wires. Your chest
incision will be closed with internal stitches or traditional external
stitches. The chest tube is needed to drain fluid. The pacing wires are
placed in case you have an abnormal heart rhythm after surgery. This is
common, and if it happens, the wires are attached to a temporary pacemaker
until your heart rhythm returns to normal. The surgery generally lasts
3 to 5 hours, depending on the number of arteries that are being bypassed.
After Coronary Artery Bypass Surgery
You will start your recovery in an intensive care unit (ICU). You will
stay in the ICU for 1-2 days so your healthcare team can closely keep
track of your condition and vital signs. You will continue your recovery
in a step-down unit. Most patients stay in the step-down unit for 3-5 days.
How will I feel after surgery?
It will take about two months to recover from surgery. In the beginning,
you may feel worse than you did before surgery. This is normal and is
usually related to the trauma of surgery, not how well your heart is working.
The way you feel after surgery depends on your overall health, the outcome
of the surgery, how well you take care of yourself after surgery, and
how well you felt before surgery. Most patients feel better after they
recover. Call your doctor if you are concerned about your symptoms or
speed of your recovery.
Risks of coronary artery bypass surgery
As with any surgery, there are risks involved. Your surgical risks are
related to your age, other medical conditions you have, and the number
of procedures you have during a single operation. Your surgeon will talk
with you about these risks before surgery; please ask questions to make
sure you understand why the procedure is recommended and what all of the
potential risks are.
Activity during Recovery from Bypass Surgery
Your doctor will give you specific guidelines for your recovery and return
to work, including information about activity and your general health.
Most patients are able to drive in about 3 to 8 weeks after surgery.
It is very important to enroll in a
Cardiac Rehabilitation program. You will begin working with a cardiac rehabilitation specialist
while you are in the hospital, and you should continue your rehab after
you go home. Cardiac rehab includes exercise, education about your risk
factors and lifestyle, and peer support. The program will help you recover
safely, enjoyably and provide long-term benefits, like reducing your risk
of future heart problems.