coronary artery bypass, the diseased sections of your coronary arteries are
bypassed with healthy artery or vein grafts to increase blood flow to the heart
muscle tissue. This procedure is also called coronary artery bypass grafting (CABG). Bypass typically requires open-chest surgery.
several newer, less invasive techniques for bypass surgery that can be used
instead of open-chest surgery in some cases. In some procedures, the heart is
slowed with medicine but is still beating during the procedure. For these types
of surgery, a heart-lung bypass machine is not needed. (For open-chest surgery,
a heart-lung machine is needed to circulate the blood and to add oxygen to it.)
Other techniques use keyhole procedures or
minimally invasive procedures instead of open-chest
surgery. Keyhole procedures use several smaller openings in the chest and may
or may not require a heart-lung machine. These techniques are still being
studied and may not be available in all medical centers.
Potassium is a simple mineral with a crucial job: helping your heart beat. A hundred thousand times a day, potassium helps trigger your heart's squeeze of blood through your body.
If you have high blood pressure, heart failure, or heart rhythm problems, getting enough potassium is especially important. Although potassium and cholesterol aren't directly related, eating a potassium-rich diet just might lower your cholesterol, too.
material in this section will focus on traditional open-chest bypass surgery.
View the slideshow on CABG surgery to see what happens during a
anesthesia before the surgery that will make you
sleep. In most cases, bypass surgery is open-chest surgery. During the surgery,
your chest will be open and your heart exposed. The surgeon makes a large cut,
or incision, in the middle or side of your chest. He or she may cut through your breastbone and
spread apart your rib cage.
The surgeon removes a healthy blood
vessel-often from the leg-and attaches (grafts) it to the blocked artery. The
new blood vessel bypasses the blocked artery to increase blood flow to the
heart. You may need just one bypass graft, or you may need more. Some people
have as many as two, three, or even four (double, triple, or quadruple bypass
surgery). How many grafts you need depends on how many arteries are blocked and
When the surgery is complete, the doctor may use wire to
put your rib cage back together and stitches to close the incision. The surgery
can take 3 to 6 hours. You will stay in the hospital at least 3 to 8 days after
the surgery. It can take 4 to 6 weeks to recover at home. Most people are able
to return to work within 1 to 2 months after surgery.
After surgery, there will be a short
stay (1 to 2 days if there are no complications) in the intensive care unit
(ICU). In the ICU, the person will likely have:
Continuous monitoring of his or her heart
A tube to temporarily help with breathing.
stomach tube, to remove stomach secretions until the person starts eating
A tube (catheter) to drain the bladder and measure urine
Tubes connected to veins in the arms (intravenous, or IV,
lines) through which fluids, nutrition, and medicine can be
An arterial line to measure blood
Chest tubes, to drain the chest cavity of fluid and blood
(which is temporary and normal) after surgery.
You will typically stay in the hospital from 3 to 8 days
after open-chest bypass surgery. The amount of time you stay varies and will
depend on your health before bypass surgery and whether complications develop
After discharge, recovery at home takes 4 to 6
weeks. Recovery includes physical therapy, respiratory therapy, occupational
therapy, and diet counseling. Exercise and driving may be resumed after about 2
to 3 weeks. People who are able to return to work can usually do so within 1 to
2 months, depending on the type of work they do. Some people find that they
experience heightened emotions (such as a greater tendency to cry or otherwise
show emotion in ways that are unusual compared with before the procedure) for
up to a year following surgery.
everyone with coronary artery disease needs bypass surgery. Some people can be
angioplasty with stents. Others use medical therapy,
which involves making lifestyle changes and taking medicines. Some people use
both of those treatments. Your doctor is likely to recommend bypass surgery
only if you will benefit from it and if those benefits are greater than the
Your doctor may advise bypass surgery if:
Your left main heart artery is very
All three arteries of the heart are blocked or the amount
of blood flowing through them is very low.
Your doctor thinks that
bypass surgery will be more successful than angioplasty with stents.
Your choice may depend on the number of arteries that are blocked or which arteries are blocked. Talk with your doctor
about the best treatment for you. The best treatment for you may also depend on your age, your health, and
how much your chest pain is affecting your quality of life.
Bypass surgery reduces angina and other
symptoms of coronary artery disease. About 95 out of 100 people who have the
surgery get relief from chest pain right away, and 5 out of 100 do
More than 80 people out of 100 are
still free of chest pain 5 years after surgery.4
People who have bypass surgery tend to have longer relief from repeat heart
problems compared to people who have other treatments.
Bypass surgery can increase
your chances of living a longer life. More than 90 people out of 100 who have a
bypass are still alive 5 years after surgery.4
How long a bypass lasts depends on how long the blood vessel
grafts stay open. The risk of needing another operation gets higher each year after your surgery. After 5 years, about 2 out of 100 people need another surgery. After 10 years, 7 out of 100 people need another surgery.1
Lifestyle changes and medicines
The success of bypass surgery also depends on you.
If you smoke and don't quit, you won't get the most benefit from bypass
surgery. You may need to make some other big changes, like eating right and
getting regular exercise. These changes will help your bypass grafts last and
stay open longer. They will also give you the best chance of living a longer,
If you are taking medicines for angina, to lower
cholesterol, or to control blood pressure, be sure to take these
every day. Along with lifestyle changes, these medicines can help you get the
most benefit from bypass surgery.
Bypass surgery is not a cure
for heart disease. That's why all of these things-eating right, not smoking,
getting exercise, and taking medicines-are so important. Without them, you
raise your risk of getting new blockages and needing another surgery.
surgery has been done for more than 40 years. In the United States, it is done
more often than any other major surgery. But it has some serious risks.
The risks of bypass surgery include:
Death. Out of 100
people who have bypass surgery, 2 of them will have a serious complication that
leads to death, while 98 of them will not.1
Heart attack. Out of 100 people who have
bypass surgery, about 1 will have a heart attack soon after the surgery while 99 will not.3
Stroke. Out of 100 people
who have the surgery, 3 will have a stroke, and 97 of them will
Too much bleeding. This can lead to the need for a transfusion. This happens in
3 to 5 out of 100 people who have the surgery. This means
that 95 to 97 out of 100 people don't have bleeding problems.2
Other risks include return of angina, problems from
anesthesia, and infections at the site of the chest incision. Some people also
have memory loss and trouble thinking clearly. These problems are most common
in older people and tend to improve several months after surgery.
The chances of having a serious problem with bypass surgery are higher if
you are older than 70. Your risk is also higher if you have other problems such
as diabetes, kidney disease, lung disease, or
peripheral arterial disease. Talk
with your doctor to find out how your health affects your risk.
What To Think About
When bypass surgery is clearly
needed, surgery improves symptoms and in some cases prolongs life. But in
many situations, the reasons for doing bypass surgery instead of other
treatments are less clear.
In each case, the cardiac surgeon or cardiologist should
be able to clearly explain why bypass surgery is preferred over medicine or
angioplasty. Sometimes, a second opinion can be helpful when it is not clear
that surgery needs to be done.
Sabik JF, Lyle BW (2008). Coronary bypass surgery. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1504-1518. New York: McGraw-Hill Medical
Morris DC, et al. (2008). Management of the patient after cardiac surgery. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1519-1528. New York: McGraw-Hill Medical.
Gray RJ, Sethna DH (2008). Medical management of the patient undergoing cardiac surgery. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., vol. 2, pp. 1993-2012. Philadelphia: Saunders Elsevier.
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.
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
John A. McPherson, MD, FACC, FSCAI - Cardiology
May 10, 2010
WebMD Medical Reference from Healthwise
May 10, 2010
This information is not intended to replace the advice of a doctor.
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