Coronary Artery Bypass Surgery

What is coronary artery bypass surgery?

Coronary artery bypass surgery is an operation to improve the flow of blood to the heart muscle when your coronary arteries are severely narrowed or blocked by plaque. Coronary arteries are the blood vessels that carry oxygen and nutrients to the heart. Plaque is a buildup of fats, cholesterol, and other substances on the inside walls of the arteries.

The operation involves taking a blood vessel from another part of your body and attaching it to a coronary artery to go around a blockage. The blood is then able to flow around, or bypass, the blockage. If more than 1 artery is blocked, you may need more than 1 bypass.

Coronary artery blockages are found before surgery with a procedure called heart catheterization, or coronary angiogram.

When is it used?

This surgery may be recommended if you keep having symptoms, such as chest pain, despite treatment with heart medicine. An alternative procedure may be percutaneous coronary intervention (angioplasty). Your healthcare provider will make a recommendation based on where you have coronary artery disease, how severe it is, and other medical problems you may have, such as heart failure.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Allow for time to rest, and try to find people to help you with your day-to-day duties.

Talk to your healthcare provider and to other people who have had the surgery. Knowing what to expect can help lessen anxiety about the operation.

You may want to talk to your healthcare provider about the possibility of setting aside some of your own blood before the surgery. Then, if you need a transfusion during your operation, your own blood may be used.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before surgery. Be sure to tell your provider what medicines you are taking, including nonprescription drugs and herbal remedies.

Talk with your provider about what medicines you should take before the procedure. Your provider may prescribe medicine to prevent blood clots.

Follow any instructions provided by your healthcare provider. Take a shower and wash your hair the night before the procedure. Eat a light meal, such as soup or salad, the night before the procedure. Don’t eat or drink anything after midnight and the morning before the procedure. Don’t even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. The anesthetic will put you to sleep and keep you from feeling pain during the operation.

A team of surgeons will do the operation. In most cases your surgeon will make a cut in your chest and breastbone. In some cases the surgeon may be able to do the bypass through a small cut in the upper chest without cutting the breastbone, but this is not feasible for most people.

You will be connected to a heart-lung machine that will take over the work of your heart and lungs during the operation.

Veins may be cut out from the legs or arms, or arteries from the chest, to be used for the bypass. If a vein is used, one end of it will be sewn into the aorta. (The aorta is the main artery from the heart to the body.) The other end will be sewn into the area below the blockage in the coronary artery. If an artery from the chest is used, the lower end of the artery will be cut and attached to the coronary artery below the blockage. The blood will then use this new path as a detour to bypass the blockage.

When the bypass is done, your healthcare provider will restart your heart. He or she will take you off the heart-lung machine and close the cut in your chest by wiring together your sternum (breastbone). The cut in your skin will be closed with stitches. Your healthcare provider may leave some tubes in the cut to drain any blood or fluid.

The operation takes 2 to 6 hours, depending on how many blood vessels need to be bypassed.

What happens after the procedure?

After surgery, you will go to the intensive care unit (ICU). You will stay in the ICU overnight or as long as you need for observation. A constant electrocardiogram (ECG) will record the rhythm of your heart.

You will have respiratory therapy to prevent any lung problems, such as a collapsed lung, infection, or pneumonia. A nurse or therapist will give you a breathing treatment every few hours. Ask for pain medicine if you need it. You will have physical therapy, which includes walking around the hospital and other strengthening activities. You will learn how to move your upper arms without hurting your breastbone.

Your healthcare provider will prescribe a cardiac rehab program to help you get back to your normal activities slowly and safely.

What are the benefits of this procedure?

If you are having chest pain or shortness of breath, you may feel better after the surgery. Improving blood flow to the heart may help reduce or prevent heart failure.

What are the risks of this procedure?

There is risk with every treatment or procedure. Some of the risks are listed here. Talk to your healthcare provider about how the risks apply to you.

• There are some risks any time you have general anesthesia. Discuss these risks with your healthcare provider.
• Infection, particularly of the lungs, may be a problem.
• Bleeding after the operation sometimes means more surgery is needed to stop the bleeding.
• The bypasses could get blocked.
• There is a risk of stroke during and after the operation.
• You may have abnormal heart rhythms, which can be treated.

How can I take care of myself?

Follow the full treatment and take all medicines as prescribed by your provider. In addition:

• Follow your healthcare provider's advice about activity after surgery.
• Have someone help you with your bath or shower if you feel dizzy. You may want to use a shower stool or seat for safety.
• Avoid very hot water in your shower, bath, or hot tub because it can affect blood flow and make you lightheaded.
• When you first go home, avoid lifting anything heavier than 5 to 10 pounds.
• Get enough rest. Plan to have at least 2 rest periods during the day.
• Enjoy the support and visits of family and friends, but keep visits short and allow yourself time to rest.
• Do not drive, mow the lawn, mop floors, vacuum, or do any other activities that strain your upper arms and chest until your healthcare provider says it’s OK.
• Avoid sexual intercourse until your healthcare provider tells you it's OK.
• If you feel constipated, ask your provider about a stool softener or a fiber-based laxative. Constipation is a common problem after a lot of bed rest.
• Your provider may suggest wearing support hose to prevent swelling and blood flow problems in your legs. Putting powder on your legs can help you pull hose on more easily. Smooth out any wrinkles to avoid pressure spots.
• Don’t drink alcohol without your healthcare provider's approval.
• Learn deep breathing and relaxation techniques.
• Lose weight slowly if you are overweight.
• Follow a healthy, well-balanced diet that is low in salt, saturated fats, and cholesterol.
• Follow the exercise program prescribed by your provider.
• Weigh yourself every morning. Tell your healthcare provider if you have a sudden weight gain of more than 3 pounds.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 101.5° F (38.6° C).
• You become short of breath.
• You have worsening chest pain.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.