During a 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.
There are 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.
You'll receive 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 narrowed or blocked artery. The new blood vessel bypasses the diseased 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 narrowed or blocked and where.
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.
What To Expect 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, you will likely have:
- Continuous monitoring of his or her heart activity.
- A tube to temporarily help with breathing.
- A stomach tube, to remove stomach secretions until the person starts eating again.
- A tube (catheter) to drain the bladder and measure urine output.
- Tubes connected to veins in the arms (intravenous, or IV, lines) through which fluids, nutrition, and medicine can be given.
- An arterial line to measure blood pressure.
- 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 from surgery.
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.
After your surgery, your doctor may suggest that you attend a cardiac rehabilitation program. In cardiac rehab, a team of health professionals provides education and support to help you recover.
- How will I recover from bypass surgery?
- What will my first 24 hours of recovery be like?
- What will my recovery be like after the first 24 hours?
- What can I expect when I go home after surgery?
- What happens in a cardiac rehabilitation program?
- What can I do to help my recovery from bypass surgery?
- How can I help a loved one who has had bypass surgery?
Why It Is Done
Not everyone with coronary artery disease needs bypass surgery. Some people can be helped by 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 risks.
Your doctor may advise bypass surgery if:
- Your left main heart artery is very narrow.
- 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.
- You also need surgery to repair or replace a heart valve damaged by heart valve disease.
- You have diabetes and two or more narrowed or blocked arteries.
- Your heart is having trouble pumping. This is called a decreased ejection fraction.
Your choice may depend on the number of arteries that are affected or which arteries are affected. 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 angina is affecting your quality of life.
How Well It Works
- Bypass surgery reduces angina symptoms. About 95 out of 100 people who have the surgery get relief from angina right away, while 5 out of 100 do not.1
- More than 80 people out of 100 are still free of angina 5 years after surgery.1
- Bypass surgery might 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.1
- 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.2
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, healthier life.
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 having new places in your arteries that are narrowed. Then you might need another surgery.
Bypass surgery has been done for more than 40 years. In the United States, it is one of the most common major surgeries. But it has some serious risks.
The risks of bypass surgery include:
- Death. Out of 100 people who have bypass surgery, 1 to 4 of them will have a serious complication that leads to death, and 96 to 99 of them will not.2
- Heart attack. Out of 100 people who have bypass surgery, about 1 will have a heart attack soon after the surgery, and 99 will not.3
- Stroke. Out of 100 people who have the surgery, 1 to 3 will have a stroke, and 97 to 99 of them will not.4, 5
- 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.4
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.
Your 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. 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.
Transmyocardial laser revascularization (TMR) is sometimes used along with bypass surgery. TMR uses a laser beam to improve blood flow to the heart and relieve angina. It is not common but may be done to reach areas of the heart where bypass grafting does not work as well. And it is not the right treatment for everyone.
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.
Gray RJ, Sethna DH (2012). Medical management of the patient undergoing cardiac surgery. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1793-1810. Philadelphia: Saunders.
Tarakji KG, et al. (2011). Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA, 305(4): 381-390.
Other Works Consulted
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.
Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652-e735.
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical ReviewerJohn A. McPherson, MD, FACC, FSCAI - Cardiology
Robert A. Kloner, MD, PhD - Cardiology
Current as ofFebruary 20, 2015