What is bypass surgery?
Bypass surgery is used to improve the supply of blood and oxygen to your heart. The cardiac surgeon redirects the flow of blood around one or more arteries that are partly or completely blocked. The result is an improved blood flow to the heart that can relieve chest pain (angina) and decrease your risk for heart attack and sudden cardiac death.
Why do I need bypass surgery?
Bypass surgery may be necessary when blood flow in one or more of your coronary arteries is restricted or completely stopped because of the gradual accumulation of cholesterol and fibrous tissue to form a plaque inside the arteries. The thickening of the inside walls of your arteries, called atherosclerosis, can lead to chest pain and a heart attack. Some people with normal coronary arteries experience symptoms such as chest pressure, shortness of breath and fatigue. Other people may not have symptoms, but still have significant amounts of plaque in their arteries. Depending on the results of your coronary angioplasty (a procedure to open your veins and arteries) and your overall health, your physician may suggest bypass surgery.
How is bypass surgery performed?
Cardiac bypass surgery requires general anesthesia - you are unconscious. During the operation, the heart usually needs to be stopped temporarily, and a special machine (heart-lung machine) is used to take over the function of the heart and lungs. Or your surgeon may perform an "off pump bypass." In this procedure, your heart is kept beating while the bypass graft is sewn into place; just the portion of your heart with the affected artery is held still.
On the morning of surgery, you will have several intravenous lines placed. Once in the operating room, you are connected to a variety of machines that continually monitor your heart rhythm, blood pressure and oxygen levels.
The surgeon makes an incision down the middle of the chest and through the breastbone. A piece of the long vein in the leg (called the saphenous vein) is removed and used for the bypass. Sometimes, the surgeon will use arteries from the chest or arm instead of a leg vein. A bypass graft is attached to the aorta, the main artery in the body, and to a point below the blocked section of the coronary artery. A bypass can be done on each blocked artery.
What are the risks and complications?
Heart failure, stroke or heart attack could occur during or shortly after the surgery. Pneumonia, kidney failure, excessive blood loss and irregular heartbeat are other potentially serious complications. Bypass surgery is usually recommended for severe angina or when the person's risk for heart attack and sudden death outweighs the risk of complications. Your doctor can help you decide if this procedure is right for you.
What can I expect after surgery?
Your recovery begins in the intensive care unit, where you will be closely monitored as you wake up from the surgery. You'll likely be walking in one or two days, and discharged from the hospital in four to six days. When you return home, you'll have to care for your incision, take medication, get plenty of rest and follow your doctor's restrictions on physical activity. Weeks after surgery, you may have chest pain, shortness of breath or other symptoms that require immediate medical attention.
During your recovery, your doctor will likely want you to start a low-fat diet, to exercise regularly and to stop smoking. Lowering your weight and cholesterol and giving up cigarettes can reduce your risk of developing more heart problems. Your doctor will also talk with you about any other medications/treatments you should utilize to keep your blood pressure down, for instance.
What are the alternatives to bypass surgery?
Medication or non-surgical procedures, such as angioplasty to widen your blocked artery, are other options. Bypass surgery is usually recommended instead of these other treatments if you have many blockages, or obstructions at critical points in your arteries. The American College of Cardiology and the American Heart Association have prepared guidelines to assist your physicians when they weigh the risks and benefits of coronary artery bypass surgery vs. alternative treatments.
This article was reviewed and updated June 2007.
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