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Coronary Artery Bypass Surgery

Table of Contents

Surgery Overview

Coronary artery bypass is surgery to treat coronary artery disease. It helps blood make a detour, or bypass, around one or more narrowed or blocked coronary arteries. These arteries are the blood vessels that bring blood to the heart muscle. This is also called coronary artery bypass graft (CABG) or bypass surgery.

Your doctor will make the bypass with a healthy piece of blood vessel from another part of your body. Then the doctor will attach, or graft, the healthy blood vessel to the narrowed or blocked artery. The new blood vessel bypasses the diseased artery to increase blood flow to the heart muscle.

The doctor typically makes a cut in the skin over your breastbone (sternum). This cut is called an incision. Then the doctor will cut through your sternum to reach your heart and coronary arteries. The doctor may connect you to a heart-lung bypass machine. It adds oxygen to the blood and moves the blood through the body. The machine will allow the doctor to stop your heartbeat while working on your arteries. The doctor will use blood vessels from your chest, arm, or leg to bypass the narrowed or blocked parts of your arteries. When the blood vessels are in place, the doctor will restart your heart. In some cases, the doctor may be able to do the surgery without using a heart-lung machine. This is called "off-pump" surgery.

The doctor may use wire to put your sternum back together. Stitches or staples will be used to close the incisions in the skin over your sternum and where your healthy blood vessel was taken. The wire will stay in your chest. The incisions will leave scars. They may fade with time.

You will stay in the hospital for a few days after surgery. You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks you will avoid lifting heavy objects and doing things that strain your chest or upper arm muscles. At first you may notice that you get tired quickly. You may need to rest often. It may take 1 to 2 months before your energy is back to normal.

How It Is Done

Figure 1

A coronary artery is narrowed or blocked
Heart, with detail of coronary artery narrowed by plaque

Coronary artery bypass grafting (CABG) surgery reroutes blood around narrowed or blocked arteries, increasing blood flow to the heart muscle tissue.

Figure 2

Incision in the middle of the chest for open-heart surgery
Location of incision in chest

Bypass surgery is most often done as an open-heart surgery. The surgeon makes a vertical incision in the skin and muscle in the middle of the chest and then cuts through the breastbone (sternum).

Figure 3

The heart is exposed
Retractor exposing the heart in the chest

The surgeon spreads the rib cage with a retractor to expose the heart and then cuts through the lining that protects the heart (pericardium).

Figure 4

Blood flow is rerouted
Location of saphenous vein in leg, and heart showing saphenous vein and an internal mammary artery used to bypass the diseased coronary artery

To reroute blood flow around the diseased blood vessel, surgeons use a blood vessel taken from another part of your body. For example, the saphenous vein from the leg or an internal mammary artery from the chest may be used.

Figure 5

Oxygen-rich blood flows to heart muscle
Decreased blood flow caused by narrowed or blocked artery before surgery and improved blood flow after surgery

Regardless of which type of blood vessel is used, oxygen-rich blood from the aorta is rerouted around the narrowed or blocked section of the coronary artery to improve blood flow to the heart muscle.

What To Expect

Right after surgery

You will go to the intensive care unit (ICU) after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room. In the ICU, you will likely have:

Recovery

You will stay in the hospital for at least a few days after the surgery. You will feel tired and sore for the first few weeks. Your chest, shoulders, and upper back may ache. These symptoms usually get better in 4 to 6 weeks. It may take 1 to 2 months before your energy level is back to normal. You may have some swelling or pain in the area where the healthy blood vessel was taken.

You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you'll avoid lifting heavy objects and doing activities that strain your chest or upper arm muscles.

After surgery, have a heart-healthy lifestyle. This lifestyle can help lower your risk of a heart attack or stroke. It also can help the bypass last as long as possible. To have a heart-healthy lifestyle:

Smoking can make it harder for you to recover. It will raise the chances of your arteries getting narrowed or blocked again. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

You may start a cardiac rehabilitation (rehab) program in the hospital. This program will continue after you go home. It will help you recover. And it can prevent future problems with your heart. Talk to your doctor about whether rehab is right for you.

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Why It Is Done

Bypass surgery is done to treat a heart attack and coronary artery disease. Surgery might be an option if:1, 2

Whether surgery is an option for you also depends on your age, your health, and how much your angina is affecting your quality of life. Your doctor is likely to recommend bypass surgery only if you will benefit from it and if those benefits are greater than the risks. You and your doctor can work together to decide if you want to have surgery.

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How Well It Works

Bypass surgery:

Risks

The risks during or soon after bypass surgery include:

The chances of having a serious problem with bypass surgery increase with age. Your risk is also higher if you have other problems such as diabetes, kidney disease, lung disease, or peripheral arterial disease. Your doctor can help you understand what your risk for problems is.

References

Citations

  1. Fihn SD, et al. (2014). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. DOI: 10.1161/CIR.0000000000000095. Accessed October 13, 2014.
  2. Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354–e471.
  3. Bravata DM, et al. (2007). Systematic review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Annals of Internal Medicine, 147(10): 703–716.

Credits for Coronary Artery Bypass Surgery

Current as of: December 2, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Martin J. Gabica MD - Family Medicine
Adam Husney MD - Family Medicine
David C. Stuesse MD - Cardiac and Thoracic Surgery


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